Medical Aid Comparison & Selection Wizard

TiredPlatypus said:
Medical aids are funded by the concept that on average when you were younger you were paying more then receiving and then the reverses. If people only join when they were older monthly contributions will have to go up substantially for everyone. One of the pressures on schemes pushing up premiums is less young people joining.

In your parents case they did not pay premiums for 10 years and entry level package of essential core is 3356pm over 10 years of missed premiums, and 35 years of growth on top of that at a 5% above inflation growth that equates to just under 2.
8 million in today's money.

Sure you would have to subtract their claims from that but in average those are low for young people.

I think it fair to have a penalty for that instead of expecting that gap in premiums to be absorbed by other members.
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Lol this is nonsense. Young people are not joining because they can see its a money-making racket. The penalty does nothing but make them money. They had medical insurance, provided by a state that makes South Africa's hospitals look like childs play, but they do not count that because its an easy loophole to make more money. Their explanation had nothing to do with the above, they were viewed as "high risk" due to not having medical aid for that period and this penalty story is made-up to supposedly balance it out. Its nothing more, the rest is just fancy wording to try to justify robbing people. And I fully agree with young people not joining, its an old, archaic, money-making scheme that leaves billion-rand companies and profit, and many people with declined claims, penalties based on air, and a large chunk of their salary going towards what is basically a bank account and a loan.

Also, the above is meaninless if they belongs to multiple medical aids, which no doubt someone at that age would. Discovery is not benefitting from someone paying Profmed 35 years ago. Neither is Bonitas benefiting from the person on Discovery for 20 years who decides to switch - but has a gap because they lived out of the country.
 
neoprema said:
Lol this is nonsense. Young people are not joining because they can see its a money-making racket. The penalty does nothing but make them money. They had medical insurance, provided by a state that makes South Africa's hospitals look like childs play, but they do not count that because its an easy loophole to make more money. Their explanation had nothing to do with the above, they were viewed as "high risk" due to not having medical aid for that period and this penalty story is made-up to supposedly balance it out. Its nothing more, the rest is just fancy wording to try to justify robbing people. And I fully agree with young people not joining, its an old, archaic, money-making scheme that leaves billion-rand companies and profit, and many people with declined claims, penalties based on air, and a large chunk of their salary going towards what is basically a bank account and a loan.
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I never said why young people are not joining. Just that people only joining when they are old will push up premiums. Not sure if you are debating the maths behind that? Or you just saying the penalty is high enough to counter that 2.8million in savings. Or is your argument that the maths works but it is just not fair?

Also keep in mind besides waiting periods they are not allowed to penalize people who join with preexisting conditions if you were allowed to wait until you are sick and join without any penalty the other members will be funding this.

Remember medical aids only get a small portion of that late joined fee (or any of their premiums) the majority of it is going to the members which the medical aid shareholders cannot touch.

Not sure the relevance of them being in another country with better state hospitals to our private ones is.

neoprema said:
Also, the above is meaninless if they belongs to multiple medical aids, which no doubt someone at that age would. Discovery is not benefitting from someone paying Profmed 35 years ago. Neither is Bonitas benefiting from the person on Discovery for 20 years who decides to switch - but has a gap because they lived out of the country.
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Sure, but the late penalty fee is set by the government and they are more interested in what happens in South Africa and for obvious reasons are less concerned of your contributions to other countries. If they applied it to South Africa as well they would effectively be locking you into a medical aid for life and removing competition.
 
Kosmik said:
It seems all on moving but it can be waived by the scheme if they choose.
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Thanks. Will have to contact them then. Pointless if switching exposes you to the very thing you're paying to cover. Murphy's Law is too strong a force these days.
 
When Resolution Health collapsed we were subjected to a waiting period from Discovery.

The circumstances and the fact that we had never been without a medical aid meant nothing, they wouldn't budge.
 
I didn’t see Sanlam on here but this tool is really great medical aids are confusing by design so it’s nice to have a tool to simplify it
 
Another thing to add on is while some planners are cheaper there is some high cost co payment fees such as when you get admitted to a hospital which would be nice to see upfront
 
saor said:
Would be nice if at the end you could enter the plan you're currently on and compare to the suggestions.
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New section at the bottom of the results (after the side-by-side, before the ranked list): "Already on a medical aid? See how it stacks up" with two cascading dropdowns (scheme → plan).
 
airborne said:
What we actually also need is something that can tell you the cheapest plans for all risks cover.
Because some of the entry level plans have exclusions or very low limits for implants/back surgery/cancer etc which in my mind makes them pointless. I don't mind using network hospitals or similar but I do want full coverage for all medical procedures.
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Good news: this is built and live now.
Every plan in the tool now has a "Major procedure cover" breakdown showing how it handles cancer treatment, implants and internal prostheses, joint replacements, back and spinal surgery, and dialysis and transplants. Where there's a rand cap you'll see the actual amount, and where cover is PMB-only or excluded it says so in plain language.
There's also a new tick box under Health needs: "Must have strong cover for major procedures". Tick it and any plan with PMB-only cover or exclusions in those five categories falls away, then you can sort what's left by price. To answer your question directly: 29 of the 61 plans survive that filter, and the cheapest ones come in around the R2,300 to R2,400 mark for a main member.
You were right to be suspicious of the entry-level plans by the way. A few of them have no cover at all for joint replacements or back surgery beyond the legal PMB minimum, and one has no cancer benefit above PMB level either.
 
hellfire said:
the problem is that 3 month no-cover gap that medical aids impose when moving
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That isn't all medial aids, as far as I'm aware if you move to Discovery as long as you previously had a medical aid they will cover you for anything immediately barring pre-existing conditions which does have a 6 month waiting period if I recall correctly.
 
airborne said:
That isn't all medial aids, as far as I'm aware if you move to Discovery as long as you previously had a medical aid they will cover you for anything immediately barring pre-existing conditions which does have a 6 month waiting period if I recall correctly.
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12 month exclusions on existing. If they can't find any existing they throw the 3 months general exclusion at you.
 
hellfire said:
12 month exclusions on existing. If they can't find any existing they throw the 3 months general exclusion at you.
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For three months you'll have zero coverage whatsoever?
I find that hard to believe.

Edit - it seems you are correct, ok that is quite eye opening, I wonder why I haven't ever known about this, that makes changing schemes quite a risky undertaking.

Understanding Waiting Periods​

When switching to a new medical aid, you may be subjected to waiting periods.

These include:

  • General waiting period: A three-month waiting period where you may not claim for non-emergency treatments.
  • Condition-specific waiting periods: If you have a pre-existing condition, the scheme may impose a 12-month waiting period before covering treatment related to that condition.
 
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airborne said:
For three months you'll have zero coverage whatsoever?
I find that hard to believe.

Edit - it seems you are correct, ok that is quite eye opening, I wonder why I haven't ever known about this, that makes changing schemes quite a risky undertaking.

Understanding Waiting Periods​

When switching to a new medical aid, you may be subjected to waiting periods.

These include:

  • General waiting period: A three-month waiting period where you may not claim for non-emergency treatments.
  • Condition-specific waiting periods: If you have a pre-existing condition, the scheme may impose a 12-month waiting period before covering treatment related to that condition.
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It's proper scary.
I think they have to cover certain emergencies. But I shudder at the thought of having to have this fight with emergency department admin staff at night when the medical aid offices are closed.
There are some specific exceptions to the waiting periods - things like changing employers and being obligated to join a group employee scheme, getting married and joining your spouse's medical aid and so forth.
 
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