By Angelique Ruzicka, editor, Justmoney.co.za
If you think that you can’t afford medical cover in some shape or form from the major providers the research we’ve conducted below may yet change your mind. You can get basic hospital cover for under R550 a month from the major providers, such as Discovery, Fedhealth and Momentum.
If you think that you can’t afford medical cover in some shape or form from the major providers the research we’ve conducted below may yet change your mind. You can get basic hospital cover for under R550 a month from the major providers, such as Discovery, Fedhealth and Momentum.
The catch? Most, if not all, force you to consult their hospital or GP networks. And if you can’t or won’t do that then you will have to pay out of your own pocket. Generally these hospital plans or basic medical schemes will only cover 100% of the medical aid rate – just remember that some specialists you’d want to see out of their networks could charge as much as 400% of the medical aid rate.
To entice the low income earners into the market these budget schemes have, in some instances, incorporated extra benefits. “In terms of where the market is a lot of schemes have incorporated some more day to day benefits into their lower cost options and we’ve done the same with two entry products with the Maxima EntrySaver and the MaximaSaver,” points out Peter Jordan, principal officer of Fedhealth.
“We have an out of hospital expenses benefit and a savings portion, which together is called your ‘day to day’. The out of hospital expenses benefit is a risk benefit that pays for every day consults etc, out of the risk pool. What you generally find on those lower options that members do still want some day to day benefits such as a GP visit. That’s the kind of stuff that we’ve introduced for people who don’t want to pay a fortune. It’s more suitable for people that have just started out with a job.”
Pay slightly more and you could get a better deal. While most of the budget plans restrict you to hospital networks or state hospitals, Bestmed’s low cost option at R955 offers you the choice of going to any private hospital. “Market research shows that our product is the most affordable and less restrictive. Members have access to any private hospital of their choice and it is covered unlimited. Our co-payment and exclusion are also the least compared to similar products in the market, where some of our competitors can have up to 24 co-payments on their hospital plan,” says Elmarie Hendricks, head of distribution at Bestmed.
But are these cheaper basic options right for you? Jordan explains that you get what you pay for. “You can’t expect to drive a Mercedes and pay a reduced price. The freedom of choice increases as you pay more. You can see more service providers than just the ones in the network, and you pay for that at a premium as you go up the market. For a young person who is healthy and eating right you don’t need to be on these higher options. You are throwing your money away then.”
However, the no-frills cover is not ideal for families. “If you want to start a family you definitely need to move higher up. What happens is you have a pregnancy and then you find yourself restricted at the hospitals, making a co-payment or not being able to see the gynaecologist that you want to (without paying more). You only get a basic ward instead of a private ward,” points out Jordan.
1. Discovery Health Medical Scheme, from R490 a month
KeyCare Access: If you earn below R4,150 you pay R490 a month if you are a main member, R490 for any subsequent adults you add and R212 per child.
Pros: Unlimited cover in the KeyCare Access Hospital and KeyCare Hospital networks for emergency and trauma. You are also covered for childbirth and care for newborns at KeyCare Access Hospital Network.
Cons: No medical savings account. You will need to make use of the schemes network hospitals and in some cases would have to get treatment at government hospitals. Pays up to 100% of the Discovery Health Rate – some doctors charge more than 100%. Approved medicine must be bought from the Discovery’s network pharmacies or your chosen GP. Purchase medicines elsewhere and you will pay a 20% co-payment.
2. Bonitas – from R615 per month
Boncap: If you earn below R5,700 a month you only pay R615 if you are the principal member. Adult dependents will cost you a further R583, while child dependents will cost you R290.
Pros: Covers all major medical events.
Cons: You may only use contracted hospitals. There are sub limits applicable and in some cases the scheme will only cover you if it is a prescribed minimum benefit.
3. Fedhealth – from R504 per month
Blue Door: This is an entry level, salary-banded option that is only available to previously uncovered lower-income employees.
With the Blue Door option, if you earn below R5,000 a month you as the principal member will only pay R504 per month, adult dependents will be charged at R418 a month and child dependents R240 a month.
(If you don’t meet these criteria then you can apply for the Maxima EntryZone option at R962 per month as the main member).
Pros: Unlimited private hospitalisation at network hospitals. Unlimited GP visits at Blue Door contracted GPs. Unlimited prescribed medication. Basic cover for dentistry and optometry.
Cons: You have to make use of network hospitals and GPs.
4. KeyHealth Medical – R990 a month
Essence: The Essence range is KeyHealth Medical’s budget option. Principal members pay R990, R785 for adult dependents and R330 per child.
Pros: It contains a basic hospital plan with up to 100% coverage of the agreed tariffs according to the specifications of the package. Has a ‘Health Booster’ preventative care programme.
Cons: General hospital costs such as intensive care, theatre costs and emergency care are covered with set limitations in place.
Find more information here.
5. Liberty – R1143
Hospital Select (Gold Focus Select): Main member pays R1143, for adult dependents you pay an extra R963 and premiums per child are R434.
Pros: Preventative care benefits. The Hospital Benefit covers the cost of admissions to hospitals, including hospitalisation and associated costs, e.g., consultations, pathology and radiology. These benefits are subject to pre-authorisation.
Cons: No day to day benefits or savings. You can choose from contracted network hospitals only.
Find more information here.
6. Momentum – from R349 per month
Ingwe: If you earn below R500 you can pay R349 to get cover on Ingwe. For those earning between R501 and R5, 200, Ingwe charges R431 for the main member, R862 for a member and adult dependent and RR1094 for two adults and a child. A family of four (two adults and two children) is covered at R1326.
Pros: Cover for hospitalisation up to R1m for the family per year. Preventative care benefits are available.
Cons: You have to make use of Ingwe Network hospitals or State hospitals.
Find more information here.
Find more information here.
7. Bestmed – R955 per month
Beat 1: Cover the prime member for R955 a month, adult dependents for R742 and up to four children for R402.
Pros You can choose to go to any private hospital and cover is unlimited. Several preventative care benefits including flu vaccine, paediatric immunisations, female contraceptives, back rehabilitation programme, pneumonia programme and biometric screenings.
Cons: 100% scheme tariff. Most out of hospital expenses, such as GP and specialist visits are paid for in full by you.
Find out more here.
Not sure which scheme to go for? Don't sacrifice your health for the sake of cheap cover. Speak to a medical aid broker today or get a competitive quote through Justmoney.
All rates correct as at 27 May 2014.