MEDICAL AID COVER

Why do you need Medical aid cover?

The cost of private hospitalisation and Prescribed Minimum Chronic benefits (PMB’s) has escalated to the point that members cannot afford to pay for these charges out-of pocket. The current state and condition of Government hospitals and clinics where quality treatment and technology services is lacking or not available, necessitates clients to insure their health cover with a registered medical scheme. The extra cost of Late Joiners Penalties (LJP’s) according to Medical Scheme Legislation from age 35 years, will also result in members paying an extra life-long penalty of 5% – 75% to their risk premium. A medical scheme will cover private hospitalisation 100% unlimited and more of scheme tariff from day one unlimited, which offers members the peace of mind that they will have full cover for private hospitalisation. Medical Scheme Legislation regulate PMB’s and provide that members of medical schemes have full cover for the diagnosis, treatment and medication for the 26 PMB chronic conditions and 270 other identified Minimum Benefits, with certain conditions.

Medical schemes offer members a wide variety of affordable products e.g. Network options that are the most affordable in the market and that will determine your premium on your family size and monthly income. You will also have the option to register on a Hospital plan without a Medical Savings Account (MSA) and manage your day-to-day claims out-of-pocket or from your MSA. Available savings by 31 Dec are always carried over to the next year. If you need Comprehensive cover you will have a range of traditional options or hybrid options that will cater for your specific healtcare needs. Interchange between options are possible without underwriting once a year. Client will have to take note of the fact that registration to a open medical scheme will be subject to underwriting e.g. 3 months general waiting period, 12 months exclusion on pre-diagnosed conditions and LJP’s, that will be determined by evaluating each individual members health profile.

Medical Insurance (e.g Clientéle) do not cover your total healthcare need and you will not have peace of mind, since medical insurance will normally cover you only from day three and will also pay a specific pre-determined rand value for in-hospital procedures. Members will have an out-of-pocket expense when the available rand value is depleted. Medical insurance normally exclude pre-diagnosed conditions for whole of life, contrasting to a medical scheme that can only exclude a pre-existing condition for 12 months. Membership on a medical insurance product will not be accepted by a registered medical scheme, therefore potential members will be exposed to a Late Joiners Penalty if you are older than 35 years of age.

CMAC offers access to the following open medical schemes e.g.: Bonitas, Bestmed, Discovery, Fedhealth, Genesis, Hosmed, Keyhealth, La Health, Liberty, Momentum, Medihelp, Medshield, Profmed, Sizwe, Resolution Health, Spectramed, Selfmed, Topmed en Umvuzo (see product brochures in download folder)