Basic Information About Medical Schemes in South Africa

    November 7, 2017

    What do medical schemes in South Africa do?

    • They help you cope with medical expenses.
    • A medical scheme is a non-profit organization that pools member’s contributions together.
    • The strength of the fund depends on how well members pay and what claims they make.
    • They must register with the Registrar of Medical Schemes.
    • They can provide a range of products – from hospital plans to full cover.


    Medical aids or schemes assist you when it comes to medical expenses like surgery, doctor’s fees, etc. You pay a monthly premium and the company pays your medical expenses.

    Do I Have to Belong to a Medical Aid?

    Unless obligated to do so by your company, you don’t normally have to be a member. If you do try to join later in life, though, you are liable to have to pay an additional fee.

    The premiums are high. The cost of non-insurance is potentially higher. With medical costs soaring, Medical Schemesyou need to have a good source of funds to pay for private healthcare.

    With a medical scheme, you would be able to afford treatment as and when you need it.

    How Do Medical Schemes Work?

    Medical aids are non-profit organizations and must register with the Registrar of Medical Schemes. The Medical Schemes Act governs these non-profit schemes. Those belonging to the scheme receive benefits in return for the premiums paid. The scheme lays out the benefits it offers.

    Legally speaking, all schemes must offer prescribed minimum benefits. These cover a range of chronic conditions such as diabetes. The cover offered under the PMB is usually minimal and takes effect only when you have exhausted your full cover.

    A medical scheme is a non-profit organization and is registered with the Registrar of Medical Schemes. Members belonging to a scheme make contributions and in return receive medical cover according to the rules of the scheme. Each medical scheme must provide a minimum set of benefits to its members.

    There are only two sorts of medical aids – those that are open to everyone and those that are specific to a particular employer.

    How Do I Choose Between the Schemes?

    You need to check on the range of options available to you.  Your choice of plan must be based on how much you can afford and the cover you want. You need to look for a well-established scheme that will be able to pay out if you need it to.

    If you don’t know which option to choose, you can speak to a financial planner that is not affiliated with any one company.

    What Choices Do I Have?

    Each scheme offers a range of different options at different price points. If your budget is more limited, a hospital plan might be a better choice for you.

    If you need more help with day to day expenses, a comprehensive plan is usually the better way to go.

    Are There Alternatives to Medical Aids?

    There are a range of insurance products that can offer similar benefits to a medical aid. Some pay out a set cash amount based on how long you are in the hospital for. Others offer cover for day to day expenses but may limit access.

    These products are not strictly medical aids and fall under a different section of the legislation.


    All info was correct at time of publishing