Medical Aid for Young Adults

medical aid for young adults

Young South Africans should start exploring their medical aid options sooner rather than later. Accidents happen when least expected and young people are increasingly susceptible to chronic conditions and dread diseases. These range from infectious diseases like HIV and TB to conditions like hypertension and diabetes, associated with sedentary lifestyles.

Don’t drag your heels 

If you're without cover, medical costs associated with hospitalisation, surgery, therapy, consultations and medication can catapult you into debt.

Also, the longer you are without medical aid, the more costly it becomes. Any South African, aged 35 years or above, who has never belonged to a medical aid scheme automatically attracts a late joiner fee. The same penalty applies to anyone who has been without cover for 90 days or more.

What are your medical aid options?

To provide benefits suitable for young South Africans with varying budgets and health care requirements, the top medical aid schemes offer a portfolio of products. Popular youth-centric medical aid options include affordable income-based plans and hospital plans.

Low Cost Income-Based Plans

Entry-level income-based medical aid plans charge a premium based on your monthly salary. They're ideal for low- to mid-income earners seeking basic  cover, provided you're willing to use designated service providers only.

As well as being affordable, income-based plans typically offer unlimited benefits in hospital, usually at 100% of the scheme rate. Because tariffs are pre-negotiated, co-payments do not apply in most options, provided you use network providers.

In addition, income-based plans typically provide limited cover for clearly defined out-of-hospital expenses, such as consultations with network GPs, prescribed medicines, and general radiology and pathology. They may also provide limited maternity cover, making them suitable for young South Africans who are planning families.

These income based plans can also consist of a Hospital plan with chronic medication for certain illnesses and no out of hospital day-to-day cover.

Hospital plans

Hospital plans cover the costs of procedures, consultations and medication provided in hospital when a client is admitted. They also usually provide benefits for radiology and pathology, oncology, dialysis and internal prostheses, such as pace makers.

Cover is provided at 100%, 200% or 300% of the scheme rate and is commensurate with the value of your monthly contribution – the more you pay, the more cover you'll have while hospitalised.

Some options, such as BonEssential by Bonitas, offer limited maternity benefits out of hospital.

More expensive hospital plans provide benefits at any private hospital or clinic, while budget options usually cover costs only at state hospitals or specific, designated private facilities.

In addition, there are hospital plans with savings. These hybrid medical aid products set aside a percentage of your total annual contributions in a savings account to be used to cover day-to-day expenses. Once you've exhausted your annual savings, you have to pay for GP and specialists visits, as well as medication, out of your own pocket. Some plans like: Fedhealth’s Saver options do however, cover GP visits at a Network of GP’s after the savings is used up.

Easy medical aid upgrades

Notwithstanding the type of medical aid plan you choose, you can choose to upgrade to a more comprehensive product, as and when your circumstances change.

For instance, if you're diagnosed with a dread disease that requires sustained medical intervention out of hospital or you're ready to start a family, you can level up to a product that offers the higher level of benefits that suits your particular situation.

In most cases, you may be allowed to upgrade only at certain times of the year, and a pre-existing condition may be temporarily excluded from cover. Be sure you read and understand the terms and conditions of the scheme, or approach an expert for a detailed explanation of the fine print.

Get professional independent advice

As a young South African, you’re advised to chat to specialists in the field. Medical aid brokers are trained to assess your risk and then recommend an appropriate medical aid product, based on your monthly budget and individual requirements. They also have the inside track on each scheme’s financial indices and beneficiary demographics.