What is medical aid (medical insurance) in South Africa?

Medical Aid / Insurance in South Africa

In South Africa, we don’t really have medical insurance (which gives the impression that everything is covered) we have Medical Aid. This is comprehensive,
but limited in certain instances. This cover will be more than sufficient in the event of an accident etc.

This can be escalated to cover more and more
of your expenses, however this depends on the plan that you choose. It is recommended that a professional broker tell you more about medical aid as it
is a very complex topic.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

How does my medical history influence my premium?

A medical aid can not discriminate against you by charging you a higher/lower premium based on your medical history. The only influence your medical
history will have is that the medical scheme may give you waiting periods as a condition on your acceptance.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

What is the cost of medical cover in South Africa?

Cost of Medical Aid in South Africa

This varies greatly according to the level of cover you require, the size of your family and the ages of all members – as Late Joiner Penalties influences

the price greatly. Pricing also varies according to the brokers you use, if they include a broker fee etc.

To ensure that you receive the best advice for the most competitive premium, we would recommend contacting Incompass Insurance Services. They have

medical aid experts who will be able to help you find cover for your specific needs at affordable prices.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

How does my age influence my medical aid premium in South Africa?

If you are over the age of 35 and you have never had South African Insurance before – your age will affect your medical aid premium

Your age will determine if a Late Joiner Penalty (LJP) will be added to your premium and if so, to what degree you will be penalized. This only applies to

people immigrating to South Africa that are over the age of 35. The reason for this is that you have not contributed to the South African medical aid

pool.

If you would like more information on how this medical aid in South Africa works, you can contact our medical expert Cindy Alfino on risk@incompass.co.za .

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

Do I have to use the hospitals in my area of South Africa?

Does the area I live in determine the hospital I use in South Africa?

You can use any Hospital of your choice, however some medical aids in South Africa give you the option to use their pre-selected hospitals which will reduce
your monthly contribution. These hospitals are good private hospitals which have made an agreement with the medical aid, you will not be penalised by
selecting this option.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

Where can I obtain my chronic medication in South Africa?

Chronic medication in South Africa

Most Medical Aid companies allow you to get your chronic medication at any pharmacy. Some only allow you to get it from a specified provider and some
only allow you to get it from a state facility. This all depends on the option of Medical Aid you choose, this is often not disclosed by incompetent
brokers in the industry.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

Is there a waiting period on the acceptance of my Medical Insurance in South Africa?

Waiting period on acceptance of Medical Aid in South Africa

Once you apply to a Medical Aid company in South Africa there may be a three month general waiting period, depending on your risk factor. This can never
be determined by your Medical Aid advisor, as each individual medical aid company will look at each case on its own merits.

On the other hand if you have
a pre existing condition like High Blood pressure or Asthma you will have twelve month specific condition exclusion. This means that you cannot claim for
the condition, nor any other claims arising from/or related to this condition for 12 months. Thereafter it will be covered.

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

Is Chronic medication covered by South African Medical Aids?

Yes, chronic medication is covered unlimited according to the Chronic Disease List (CDL), which is included in the Prescribed Minimum Benefits (PMB’s).

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.

What are PMB’s (Prescribed Minimum Benefits) in South Africa?

Prescribed Minimum Benefits in South Africa

The prescribed minimum benefits are the minimum chronic conditions that South African Medical Aids include in their basic cover. The more comprehensive

(and more expensive plans) include up to 60 different chronic conditions. The Minimum Prescribed Benefits are:

Addison’s Disease

Asthma

Bronchiectasis

Cardiac Failure

Cardiomyopathy

Chronic Renal Failure

Coronary Artery Disease

Crohn’s Disease

Diabetes Insipidus

DiabetesMellitus type 1 or 2

ChronicObstructive Pulmonary Disease (e.g. emphysema)

Systemic Lupus Erthematosis

Dysrhythmia (heart arrhythmia

Epilepsy

Glaucoma

Haemophilia

Hyperlipidaemia (high cholesterol)

Hypertension (high blood pressure)

Hypothyroidism (underactive thyroid)

Multiple Sclerosis

Parkinson’s Disease

Rheumatoid Arthritis (not osteo-arthritis)

Schizophrenia

Ulcerative Colitis

Depression

HIVS/AIDS

This information has been provided by Cindy Alfino (Medical Insurance Authorised Representative – FSP 23418. For more information please use the contact form

or email risk@incompass.co.za.