Medical Aid

RedViking said:
Good OR Cheap.

Can't have both.

Who You using for medical insurance?
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Insurance is with Affinity. Covers me for unlimited doctor visits and most of any medication (my doctor dispenses). They also pay a decent amount for hospitalisation, but nowhere near enough to cover something major.

Yeah, I know you can't have good and cheap. It's like with bicycles, you get cheap, light and strong, but you can only have two at once. I'm asking for the best compromise of good and cheap...
 
pinball wizard said:
Whilst we are on this topic, I have a medical insurance that covers 100% of my day to day needs. I've been with them for two years and am very happy so far. What I am looking for is a good and cheap hospital only cover?
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Discovery Core around R2k, or Coastal core R1700 but only if you live near the seaside.
 
I.am.Sam said:
Hello all,

Another medical aid thread

I am on the classic smart plan at discovery and was wondering how can i save further

Any other medical aids with just a basic good hospital plan

Currently paying 4642 for 2 adults and 2 kids. Need to save more money :)
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Not at the coast because that seems very pricey.

I'm paying R4,508 for Coastal Core also with 2 adults and 2 kids.

This because Coastal Saver's MSA fees are bullshit and actually ripping you off so now I just save them myself in my home loan and I'm a few grand better off for it.
 
newby_investor said:
Ideally this is what we should all be doing.
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Most people rely on medical savings which they quickly deplete as medical schemes love going for that money first before giving out their own - first hand experience and why we don't have a savings attached.

Then it's Mr Magic Plastic which easily gets used for other (non-essential) purchases and then you sit with a maxed out credit card.

What I've learnt the hard way with hospitals is to have immediate access to cash. Once had to pay R10K within an hour else they where going to kick me out of the hospital bed.
 
pinball wizard said:
So, who is decent at less money? Hospital only?
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You're looking at Bestmed Pace 1, Discovery KeyCare (Plus, Access, Smart), Momentum Ingwe, Bonitas BonCap for entry-level cover.
Here's the problem: There is no such thing as a "hospital plan" as we knew it many years ago that is a medical aid. Any medical scheme option, even Discovery's "Hospital Plan" Core-series, is forced by law to cover Prescribed Minimum Benefits in full. That is why it is so hellishly expensive. They may say in the brochure that there are no day-to-day-benefits, but the reality is much different.
Even on a "hospital plan", if you have high cholesterol or high blood pressure (both PMBs), they are forced to pay your chronic medications, an annual battery of blood tests, 4 GP consultations. Everything in full and without a co-payment. If you have major depression, your "hospital plan" is obliged to pay 15 consultations at a clinical psychologist. Same issue with diabetes, bipolar mood disorder, etc. People with a "hospital plan" end up with full medical cover. They go to the GP for another issue such as flu and just ask the doctor to give up their PMB ICD10-code. Magic! It gets paid in full..
Personally, I wouldn't touch medical insurance products. Just go for an entry-level medical scheme.
 
Sputnik100 said:
Personally, I wouldn't touch medical insurance products. Just go for an entry-level medical scheme.
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I'm under the impression that there's a difference between what we typically call medical aid and "medical insurance". Could someone explain the distinction? I've never been able to Google a good explanation in the South African context.
 
newby_investor said:
I'm under the impression that there's a difference between what we typically call medical aid and "medical insurance". Could someone explain the distinction? I've never been able to Google a good explanation in the South African context.
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Medical insurance products
) May never use the term "medical scheme" or "medical aid" in their name.
) Examples include "gap cover", hospital cashback plans, DomestiCare from Momentum, Affinity Health Insurance, "Guardian Angel" etc.
) Regulated by the Short-term Insurance Act. They are allowed to make money. They use underwriting like any other insurance: i.e. may decline to issue you a policy, decide on exclusions and endorsements, give loadings to high-risk policyholders.
) Will cover only what is stipulated. For e.g. R1000 per day in hospital. Or "unlimited GP visits at a CareCross facility" or the gap between what your medical scheme paid and the actual bill. They have strict limits.
) The government tries very hard to get rid of these products as they may be confusing. Many of these products are being phased out.

Medical Schemes
) Will always use the term "medical scheme" or "medical aid" in their name. There are +- 80.
) Examples are Discovery Health Medical Scheme, Bonitas Medical Scheme, Size Medical Scheme, etc.
) Regulated by the Medical Schemes Act and Council or Medical Scheme. They are required by law to be non-profit entities and they do community rating and risk-sharing. This means they may not refuse anyone membership, ever. They may not impose premium loadings to high risk members (apart from late joinder penalties). They may not exclude pre-existing conditions (except for strictly regulated waiting periods).
) They are all required to cover 270+ conditions on the list of Prescribed Miminum Benefits and is therefore open-ended. They may stipulate limits, but if it is a PMB, the limit falls away.
 
Sputnik100 said:
Medical insurance products
) May never use the term "medical scheme" or "medical aid" in their name.
) Examples include "gap cover", hospital cashback plans, DomestiCare from Momentum, Affinity Health Insurance, "Guardian Angel" etc.
) Regulated by the Short-term Insurance Act. They are allowed to make money. They use underwriting like any other insurance: i.e. may decline to issue you a policy, decide on exclusions and endorsements, give loadings to high-risk policyholders.
) Will cover only what is stipulated. For e.g. R1000 per day in hospital. Or "unlimited GP visits at a CareCross facility" or the gap between what your medical scheme paid and the actual bill. They have strict limits.
) The government tries very hard to get rid of these products as they may be confusing. Many of these products are being phased out.

Medical Schemes
) Will always use the term "medical scheme" or "medical aid" in their name. There are +- 80.
) Examples are Discovery Health Medical Scheme, Bonitas Medical Scheme, Size Medical Scheme, etc.
) Regulated by the Medical Schemes Act and Council or Medical Scheme. They are required by law to be non-profit entities and they do community rating and risk-sharing. This means they may not refuse anyone membership, ever. They may not impose premium loadings to high risk members (apart from late joinder penalties). They may not exclude pre-existing conditions (except for strictly regulated waiting periods).
) They are all required to cover 270+ conditions on the list of Prescribed Miminum Benefits and is therefore open-ended. They may stipulate limits, but if it is a PMB, the limit falls away.
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Excellent explanation, thanks very much!
 
Sputnik100 said:
You're looking at Bestmed Pace 1, Discovery KeyCare (Plus, Access, Smart), Momentum Ingwe, Bonitas BonCap for entry-level cover.
Here's the problem: There is no such thing as a "hospital plan" as we knew it many years ago that is a medical aid. Any medical scheme option, even Discovery's "Hospital Plan" Core-series, is forced by law to cover Prescribed Minimum Benefits in full. That is why it is so hellishly expensive. They may say in the brochure that there are no day-to-day-benefits, but the reality is much different.
Even on a "hospital plan", if you have high cholesterol or high blood pressure (both PMBs), they are forced to pay your chronic medications, an annual battery of blood tests, 4 GP consultations. Everything in full and without a co-payment. If you have major depression, your "hospital plan" is obliged to pay 15 consultations at a clinical psychologist. Same issue with diabetes, bipolar mood disorder, etc. People with a "hospital plan" end up with full medical cover. They go to the GP for another issue such as flu and just ask the doctor to give up their PMB ICD10-code. Magic! It gets paid in full..
Personally, I wouldn't touch medical insurance products. Just go for an entry-level medical scheme.
Click to expand...
Thanks for the round up. I use my medical insurance as a gap cover more than anything else.
 
Been with Discovery for 10 years but currently have a complaint about stroke pmb rehab they stopped paying for without rhyme or reason given.
One year now at CMS.
Hearing more and more horror stories from doctors about them...
Any complaints about Bonitas Primary?
 
dunkyd said:
Been with Discovery for 10 years but currently have a complaint about stroke pmb rehab they stopped paying for without rhyme or reason given.
One year now at CMS.
Hearing more and more horror stories from doctors about them...
Any complaints about Bonitas Primary?
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Every medical scheme will have complaints because they're human beings. Sometimes they work well and other times they don't. The people who are satisfied mostly keep quiet, the ones who speak up will be the few who have battled.
 
newby_investor said:
Every medical scheme will have complaints because they're human beings. Sometimes they work well and other times they don't. The people who are satisfied mostly keep quiet, the ones who speak up will be the few who have battled.
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Another problem is loads of people think Hellopeter is a company that does things for you wrt your complaint.
 
carstensdj said:
So I've been looking at Hospital Schemes over the past week and the one that stands out to me is MediHelp. Seems to be a good offering for what you paying. Has anyone had any experience with them?

Plan that I'm looking at Prime 1 (Network option): https://www.medihelp.co.za/docs/default-source/plans/2019/medihelp-benefit-options.pdf
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Was with them at my previous employer. They're very good value for money and never had an issue with claims.

You may as well go for option 2 or 3 since you get more benefits, for almost the same price as other hospital plans...
 
Mike Hoxbig said:
Was with them at my previous employer. They're very good value for money and never had an issue with claims.

You may as well go for option 2 or 3 since you get more benefits, for almost the same price as other hospital plans...
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Thanks for the feedback. Glad to hear that you thought they are worth looking into. However, even option 1 is a big push (financially) for me, so options 2 & 3 are a definite no go at the moment. Thanks though.
 
Mike Hoxbig said:
Was with them at my previous employer. They're very good value for money and never had an issue with claims.

You may as well go for option 2 or 3 since you get more benefits, for almost the same price as other hospital plans...
Click to expand...

Have you claimed for any major procedures or hospitalization when you were with MediHelp?
 
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