When you only start looking around at medical aid options, the need to have someone else drill down into a comparison becomes clear.
It is worse than buying a car; consumers in South Africa are absolutely spoilt (read confused) by the plethora of medical aid plans on offer.
This does not even touch on gap cover and hospital insurance, which is another beast entirely. Enter Grant Thornton Consulting's Medical Aid Comparison of Costs and Benefits for 2016.
The survey used various scoring methodologies to give medical aid plans an overall 'likelihood of support', either low, medium or high. What was clear was that not all the best medical aids offered the best plans for certain situations and vice versa.
At the end of the day, it is down to your unique circumstances and needs.
GTC arrived at an overall rating which placed the following five medical aids as consistent top performers:
The table below takes into account both macro factors and micro factors (see an explanation below the table) to show the overall best performing plans.
- Genesis/Momentum (sharing 4th place)
Macro factors are those provided by the Council for Medical Schemes. These macro factors include the longevity of the plans taking into account average age, solvency ratios, change in member ages, among others.
The table also takes into account micro factors including member contributions (payments) per year, self-payment gaps, in-hospital cover, and cover for chronic conditions. For risk only (hospital plans) they have excluded savings elements, and for all plans, they have assumed that everyone has gap cover and, therefore, have not compared the percentage of medical aid rates.
This makes it easier to compare 'apples with apples'. Above you will also notice 'target market' versus 'student market'. Student market are those members earning less than a R1000 per month and target market are those (low earners) earning between R4000 and R7000 a month.
For further explanations, please see the glossary at the bottom of the article.
Plans with a high 'likelihood of support' in each category
However, with GTC's overall rating of enthusiasm per type of plan, they were able to recommend a few plans per family size. This gives consumers the ability to make the final decision on the best medical aid for their needs.
For entry level comprehensive network plans, the following plans did well for singles, couples and families:
- Discovery KeyCare Plus
- Bonitas BonCap
- Momentum Ingwe Network
- CompCare NetworX
For entry level comprehensive non-network plans (giving you a choice of doctors), the following plan did well for singles, couples and families:
For a hospital-only network plan, the following also did well for all family sizes:
For a hospital-only network plan, the following did well for all family sizes:
- Momentum Custom Associated State
- Bestmed Beat 1
For a saver plan with carry over funds in a network, for all family types, the following stood out:
- Bestmed Beat 1
- Genesis Private Choice
- Bonitas BonEssential
- Profmed ProActive - R5000
For a saver plan with a network with no carry over facilities, GTC recommended the following Bonitas plan:
- Bestmed Beat 2N
- Bonitas BonFit
- Medihelp Dimension Prime 1 (or Prime 2 for families of four)
For the above savings plan (with carry over) but not in a network, the top choices across the board were:
And then for the non-network savings plan without any carry over funds, the following led the pack:
- Topmed Active Saver
- Medihelp Dimension Prime 1
- Medihelp Unify
- Bestmed Beat2
- Discovery Essential Priority
For the top end comprehensive plans, GTC recommended the following plans, among others, for both network and non-network options:
- Compcare Mumed
- Medihelp Medisure Max or Standard
- Bonitas Primary
- Bestmed Pace 1
- Momentum Extender
- Fedhealth Maxima Standard Elect
- Discovery Essential Comprehensive[embed]https://www.youtube.com/watch?v=JPr156ZBQqc[/embed]
Essential terminology when deciding on medical aids
Gap cover: Most medical aids only cover 100 - 200% of medical aid rates. Private doctors can charge 300 - 400% as normal. Therefore, gap cover essentially covers this gap.
Network: Most medical aids use a network of doctors that charge their members set rates. If the consumer wants to use their own doctors they need to choose a non-network option.
Hospital plan: only covers you in hospital and not for day-to-day visits, e.g. visits to the GP or specialist out of hospital (over 60% of medical costs are for events in hospital)
Comprehensive cover: covers everything up to the limits set out in the policy wording booklet
Entry level plan: normally for those who do not have a lot of extra money to spend on medical aid
MSA: Medical savings account. Normally the member contributes a certain amount per month that is then available as annual savings to use at any time of the year.
PMBs:that all medical aids are required by the Council for Medical Schemes to pay for. These include common disorders such as Diabetes and Bipolar depression.
Risk cover: This is cover that is standard with the policy and not part of the member (your) savings. Essentially it is the medical aid's risk in providing the cover.
GTC stresses that this is by no means a definitive or final rating, as ‘soft’ factors such as existing servicing relationships, past experience, administration ability, service level agreements and turnaround times and / or call centre availability have not been taken into account, not to mention website ease of access.
No medical plan is going to suit all members equally, but at least an informed decision can be made based on these indicators, which will go a long way to easing member concerns about what is best for their needs according to GTC.
The full survey and explanation of the methodology used is downloadable in PDF format here.
Income protection covers medical aid payments if you lose your job or take time off work after an accident or illness.