Medical Aid

South Africa does not have a fully implemented public health system. National Health Insurance is going to take approximately another 14 years to be in place. In the meantime this means that either a consumer has to deal with the public facilities available or seek medical attention from the Private Sector.

There are many factors to consider when looking for a medical aid scheme to suit your needs, a few points to consider are:

  1. In hospital cover which is classified as the “Risk portion” of any medical aid plan.
  2. Chronic conditions that require chronic medications. There is a list of chronic conditions that are classified as Prescribed Minimum Benefits (PMB’s) by the council for Medical Schemes ( ). Most scheme’s cover extra chronic conditions on higher plans so this is always something to keep in mind.
  3. Day-to-day needs. When we talk about day-to-day needs or expenses we are referring to costs for things such as GP visits, dentistry, optometry, medication from the pharmacy and so forth. These expenses will need to be paid out of pocket (covered by yourself and not the medical scheme) unless you have a savings portion to your medical aid plan. Day-to-day expenses will come from the savings portion until it is exhausted and then will revert back to being paid out of pocket by the member. A savings portion of any medical aid plan is given as an upfront (in advance) amount to the member for 12 months (1 Year) to use. This savings portion is merely a savings vehicle which some members choose not to use and rather fund themselves.

Any Individual will qualify to join a medical scheme however the scheme may impose waiting periods as prescribed by the Council for Medical Schemes. Potential waiting periods are as follows:

  • A 3-month waiting period before any general request for aid can be made
  • A 12-month waiting period for specific conditions
  • A Late Joiners Penalty (LJP) is applied to anyone over 35 years or was never enrolled as a dependent or member prior to 2001. An additional rate which added to a member’s premium based on the number of years over the age of 35 without creditable coverage. Please note that a medical insurance is not considered creditable coverage.

It is vitally important that a member agrees to do an annual review of their needs with their broker in order to ascertain if they are indeed on the correct plan. Life changing events such as pregnancy or illness can drastically change a person’s requirements.

Chic Solutions is currently contracted to Discovery Health, Momentum, Fedhealth, Compcare & Bonitas with the ability to contract to more should the need arise.

GAP Cover

It is important to understand that should you be admitted to hospital for any reason there could be a difference in what the medical scheme pays and what the hospital & doctors have charged which leaves yourself as the member liable for the difference. GAP cover is a product that was specifically designed to bridge the gap and cover the shortfalls.

There is currently a demarcation issue around GAP cover however nothing has yet been finalized. We will keep you updated on our facebook page with any news relating to the issue. In the interim GAP cover providers are taking on new clients and paying claims without hesitation.

For more information on the GAP products please contact us

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