Image of a woman undergoing an eye test for an article on the moneysmart community comparing medical aid schemes in South Africa

Compare Medical Aids: The Extras Not Covered by Medical Schemes

12/02/2013 • • by
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In this article we'll compare medical aid providers in South Africa with regards to procedures and treatments that generally aren’t covered by most medical schemes (comprehensive or hospital plans). The following treatments and procedures are not generally covered by medical schemes: 
  1. Basic dentistry
  2. Advanced dentistry
  3. Optometry
  4. Pre-natal care
  5. Take-home medicine
  Before we look at which schemes (if any) do in fact cover these benefits, a short summary under each will make it easier to understand what we're talking about: 1. Basic dentistry This benefit includes for example your normal 6 monthly check-ups, extractions and fillings. 2. Advanced dentistry Also known as Specialised Dentistry. This benefit includes for example root canal treatment and orthodontic treatment.  3. Optometry This benefit will include your bi-annual eye check-up, frames and lenses. 4. Pre-natal care Also known as the maternity programme. This benefit includes gynaecologist check-ups, pregnancy scans etc.  5. Take-home Medicine This benefit covers the medicines prescribed to you upon discharge from the hospital. Medical Schemes Compared Below is a short comparison of 4 of the top medical schemes in South Africa. 
    Bonitas   Discovery   Fedhealth   Medihelp
Basic Dentistry   UNLIMITED   Subject to protocols   FROM SAVINGS*   Separate benefit on KeycarePlus FROM SAVINGS*   Separate benefit on BlueDoor UNLIMITED subject to protocols   Prime 2 from Savings
Advanced Dentistry UNLIMITED subject to protocols   BonSave from Savings FROM SAVINGS* FROM SAVINGS*   UNLIMITED subject to protocols   Prime 2 from Savings
Pre-natal Care MATERNITY PROGRAMME   Number of gynae visits depends on option FROM SAVINGS*   Separate benefit on KeycarePlus   FROM SAVINGS*   Separate benefit on BlueDoor MATERNITY PROGRAMME   2 visits 2 x 2D scans 2 pediatric visit in baby's first year
Optometry 24 MONTHLY BENEFIT   BonSave from Savings FROM SAVINGS*   Separate benefit on KeycarePlus FROM SAVINGS*   Separate benefit on BlueDoor 24 MONTHLY BENEFIT  
Take- Home Medicines R275 average   R250-R400, depending on option FROM SAVINGS* 7 DAYS' SUPPLY R260 PER ADMISSION
PLEASE NOTE: The above comparison is VERY BRIEF for further detail contact moneysmart or Nelda Celliers. Furthermore, NOT ALL options on a specific scheme provide the above listed benefits. Before assuming a benefit is covered under an option,  confirm with your scheme or medical aid advisor. *From Savings means that there's a rand limit to it, depending on the amount of savings under your plan. How to we go about planning for these "extras"? There are only two tips which I'd like to share with you: 1 Be informed of what your scheme covers Make sure you read and fully understand your medical scheme's brochures and newsletters. 2 Review your medical aid annually It's very important to understand when you can move between medical scheme options OR between medical schemes. Within medical schemes you're allowed to move between scheme options ONLY ONCE a year at the end of each year. Therefore it'd be the only time that you could change your option to include a benefit which is not covered on your existing option.  HOWEVER, should you be moving BETWEEN SCHEMES you can do so at ANY TIME of the year. Lastly, should you wish to join a medical scheme for the first time, you can do so at any time of the year. The Annual Review What has changed during the past year that could affect the cover you require? Did you get married and are possibly be starting with a family soon? Did you just found out that your child will be needing braces?  Knowing your current scheme option, you would already know if you have cover for any of the above-mentioned events. If you aren't covered, you would need to investigate further. The easiest way would be to contact a medical aid advisor who would be able to guide you towards the best option which would cover these benefits. For medical aid advice contact nelda@medicalbenefits.co.za or tel. (021) 975-8324.

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