Best Comprehensive Medical Aid in South Africa

comprehensive medical cover

Comprehensive medical aid offers extensive benefits for consultations, medications and procedures conducted in and out of hospital. It’s the “Rolls Royce” of paid healthcare in South Africa.

As with all financial products, consumers can select from a wide range of options, offered by multiple providers. In this article we highlight what to look for in comprehensive medical aid plans, and who they are best suited to.

We also provide a brief overview of some of the best comprehensive medical aid plans currently available from South Africa’s leading medical aid providers.

What to look for in comprehensive medical aid plans

Before you sign up for comprehensive medical aid cover, it’s important to assess the following:

  • Rate at which medical aids cover expenses: medical aids pay for consultations and procedures at a defined percentage of the agreed tariff or scheme rate. It can be 100%, 200% or even 300%. As specialists often charge four or five times the rate, it’s important to choose a plan that pays the highest percentage you can afford. Outstanding amounts are paid from your own pocket.

  • Annual sub-limits in-hospital: medical aid providers usually cover the costs of specialised medication, psychiatric treatment, hospice care, oncology and internal prostheses up to a certain limit per person per year. The elderly and frail, and people with a high cancer risk, should select a plan that offers the best sub-limits based on budget.
  • Co-payments: co-payments usually apply to in-hospital procedures such as scopes and MRI and CT scans. More affordable plans have higher co-payments, and vice versa.
  • Above-threshold benefits: new generation comprehensive options with medical savings accounts offer above-threshold benefits. These benefits kick-in once the annual medical savings have been depleted and you’ve funded the prescribed self-payment gap. People with high day-to-day medical costs should consider selecting a plan with generous above-threshold benefits.
  • Chronic cover: the level of chronic cover is directly linked to the monthly contribution in all comprehensive plans. South Africans in their golden years and people living with chronic conditions should opt for plans with the best possible chronic benefits they can afford.

Who should choose comprehensive medical aid plans?

Comprehensive medical aid plans are ideal for anyone who can afford them – but they’re especially beneficial for families with multiple children, senior citizens and people suffering from chronic diseases.

Individuals who have a genetic predisposition for developing cardio-vascular diseases or cancers are also commonly advised to consider comprehensive medical aid plans.

Some of the best comprehensive medical aid options in SA

It’s worth keeping an eye on the medical aid market, with leading providers periodically introducing new comprehensive medical aid plans or adding significant benefits to existing ones. Here we provide an overview of three of the top comprehensive plans to consider.

Resolution Health Supreme

Resolution Health Supreme is an affordable comprehensive plan designed in the traditional mould. It pays for treatments and procedures at 100% of the scheme rate at any hospital. Co-payments apply to multiple procedures.

Contracted specialists are paid at up to 220% of the contracted rate. Supplementary healthcare services are covered at 100% of the scheme rate.

The plan includes limited benefits for MRI and CT scans, hospice and step-down facilities and psychiatric disorders. Dialysis and oncology benefits are unlimited, subject to scheme protocols and rules.

Day-to-day benefits are limited and paid at up to 100% of the scheme rate. The chronic condition benefit covers 54 conditions at designated service providers (DSPs).

BonComprehensive by Bonitas

The BonComprehensive plan covers in-hospital expenses at 300% of the scheme rate. Contracted specialists are paid in full.

Specialised radiology and supplementary healthcare services are covered at 100% of the rate. Sub-limits apply to specific treatments and procedures conducted in-hospital. There are no co-payments.

Generous day-to-day benefits are paid from medical savings and an unlimited Above Threshold benefit. There’s chronic medication cover for 50 conditions and limited oncology, dentistry, optometry, maternity, and mental health benefits, among others.

Fedhealth Maxima Plus

Fedhealth covers contracted GPs and specialists in full at any hospital. Supplementary healthcare services are paid at 100% of the scheme rate. There are no co-payments.

Day-to-day benefits are covered by medical savings and above-threshold benefits. Contracted GPs are paid by the scheme. There’s unlimited cover for pathology, general radiology and MRI and CT scans out of hospital.

Oncology cover is unlimited in and out of hospital at DSPs. The chronic medication benefit covers CDL conditions only. There are limited dentistry, optometry, mental health and maternity benefits, among others.

At IFC, we offer informed, objective advice about South African medical aid schemes, and can assist you in identifying and joining the best comprehensive medical plan for your needs and budget. Contact us for more information or to discuss your needs.

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