Medical Scheme. Which one is preferable?

P

Peder

Hobbit
Joined
Oct 16, 2006
Messages
9,397
Reaction score
64
Location
Pretoria South Africa
Hi Guys

I was wondering my dad is currently in the army(on army medical) but may be moving over to the private sector and was wondering what medical aid would be best?

My parents are both on medication and we are resonably healthy although my mom had breast cancer.

Any ideas on a Good medical aid that won't charge a big packet?

Thanx
Peder
 
Hi Peder

I joined a medical aid (only hospital plan) for first time in July this year. Did quite a lot of research (the www.thinkmoney.co.za website pointed me in the general direction).

The bottom-line is that it's quite difficult to compare them, as with some you get 100% of NHRPL, some 150% and some even up to 300% of NHRPL. And you won't find one with 150% or 300% being cheaper than one with only 100% of NHRPL, of course. If it's cheaper, you get less.

One thing to watch out for is the total annual limit. There are some who cap your benefits at R100 or R100k and are therefore cheaper. Wouldn't wanna risk it, though. If you're in a major car crash and need all sorts of surgery, R150k is not gonna do the job.

I also phoned my GP to find out who has a bad reputation for late settlements: Discovery and Medi-help seem to be the main culprits in Cape Town (service does seem to vary according to the province for certain providers). Also, Medi-help won't pay for a friend's mom's rehab now after a stroke (R35,000 per month!). So, check all exclusions.

After short-listing 3, I checked their reputation on www.hellopeter.com. Again, Discovery seems quite unloved.

Oh yes, and you also need to check their solvency ratio. Anything above 35% is quite good.

In the end, I chose Prosano which covers up to 150% of NHPRL at R726 pm and seems quite geared towards maternity and pre-natal care (n/a to your dad, of course).
 
its possible and definately a possibility but mom doesn't like 1mil, and that place isn't really that lekker to goto, when last have you been to a army hospital?
 
Barefoot Billionaire said:
Hi Peder

I joined a medical aid (only hospital plan) for first time in July this year. Did quite a lot of research (the www.thinkmoney.co.za website pointed me in the general direction).

The bottom-line is that it's quite difficult to compare them, as with some you get 100% of NHRPL, some 150% and some even up to 300% of NHRPL. And you won't find one with 150% or 300% being cheaper than one with only 100% of NHRPL, of course. If it's cheaper, you get less.

One thing to watch out for is the total annual limit. There are some who cap your benefits at R100 or R100k and are therefore cheaper. Wouldn't wanna risk it, though. If you're in a major car crash and need all sorts of surgery, R150k is not gonna do the job.

I also phoned my GP to find out who has a bad reputation for late settlements: Discovery and Medi-help seem to be the main culprits in Cape Town (service does seem to vary according to the province for certain providers). Also, Medi-help won't pay for a friend's mom's rehab now after a stroke (R35,000 per month!). So, check all exclusions.

After short-listing 3, I checked their reputation on www.hellopeter.com. Again, Discovery seems quite unloved.

Oh yes, and you also need to check their solvency ratio. Anything above 35% is quite good.

In the end, I chose Prosano which covers up to 150% of NHPRL at R726 pm and seems quite geared towards maternity and pre-natal care (n/a to your dad, of course).
Click to expand...

I hope this does not come across as me targeting you after the ABSA bank thread but we seem to be interested in responding to the same threads! :)

This time I am partly in agreement with you. A few things that I would like to add.... it is not just about percentages of NHRPL and limits though. Some plans have no overall limit but then individual procedures or appliances will have heavy limits so you need to keep an eye out for this too.

Another way that they lower their costs, and therefore allow themselves to look better on the surface, is by applying co-payments to various procedures. How this works is pretty much like an excess on car insurance. If you go in for one of these procedures you need to pay a certain amount, sometimes up to 20% on one of the more popular medical aids, before the medical covers the rest. This co-payment can sometimes be a financial breaker.

Also be on the look out for things that you are more likely to benefit from. Some medical aids have a trauma benefit with no limit or a casualty benefit which allows you to get covered as an outpatient in the event of an injury like a broken leg for example. Other plans will not cover any of this, so again they may be cheaper on the surface. If you have a specific condition then make sure the limits for those are high enough to cover you for the full year.

As far as solvency is concerned, you are correct in pointing out that this is something to look at. The Medical Schemes Act requires all medical aids to have a solvency of at least 25%. This is the ability of a scheme to pay claims.
 
Last edited:
We had to co-pay about 20% on discovery hospital plan when I had pins removed from my legs..

They cover the hospital bill in total, but you co-pay on the anesthetist and on the surgeon..
 
Peder, don't know if you've made your decision yet, but I was just paging through the new Personal Finance magazine (4th quarter 2008) and there's an exhaustive 9-page article by Laura du Preez; 'How to choose a healthy medical scheme'.
 
I noticed this article this morning.
Medical schemes move to ditch Old Mutual
Solvency Rate is dropping.

Personally I am with Momentum Health. Haven't had need to use it, except my Savings portion which is always exhausted.

Surely at the moment affordability must be a big factor in your choice. And I think one members comment about phoning your Doctor's Surgery, perhaps several for that matter and ask them who is the best. This could even be an annual exercise.
 
the only thing i worry about is that my parents are on chronic medication and i don't think that is cheap so our medical is going to have to be quite strong, although maybe army medical is best, since we have the choice
 
Chronic Medication can also be State provided.
Probably entails having to wait in a queue once a month.
 
My parent are both on army medical, which is great (both have diabetes). Only have to pay a less than R100 continuation amount every month.
 
Hi BB, cheers fir the Personal Finance headsup. I am currently with Discovery, but it will be a worthwhile exercise to check whether I'm getting most bang for my buck.

air
 
Pleasure, air. But don't expect too much from the article, hey. It's more focused on the financial health of the schemes, and less on what you're getting for the premiums you're paying.
 
You must log in or register to reply here.
Back
Top
Sign up to the MyBroadband newsletter
X