Lee Callakoppen, Principal Officer of Bonitas Medical Fund, guides us on how to choose a medical aid plan.
At the top of most people’s wish list is being healthy and living a good quality life. To achieve this, it’s important to have the right people supporting you every step of the way – physically, emotionally, mentally and even financially. Which is why making an informed decision about private healthcare is critical, especially considering the many options, monthly contribution premiums and the varying benefits.
Lee Callakoppen, Principal Officer of Bonitas Medical Fund, says the medical aid landscape can be tricky to navigate. However, by evaluating your healthcare needs, understanding the different types of medical aid plans available and comparing the cost versus benefits, you can take care of your healthcare needs, within your budget.
The first step is to do a personal healthcare needs’ analysis to determine what cover you need. If you have dependents, factor in their healthcare needs too. Consider how often you and your family visit a doctor or specialist, what over-the-counter medication or chronic medication you require, specific conditions you may have, how much you tend to spend on dentistry or optometry and whether you have any surgeries or procedures planned.
This will guide you in terms of choosing a plan that meets your healthcare requirements.
Then factor things such as:
- Age and lifestyle. Medical needs change at different stages of your life. Younger, healthier individuals generally need less comprehensive cover, while older adults and those with chronic conditions, may need more extensive cover.
- Chronic conditions. If you have ongoing health issues, make sure your plan covers this as well as specific medication and treatment
- Family planning. Maternity and paediatric benefits are a priority if you’re planning to start a family
Plans differ
Most medical aids offer a variety of medical plan options and it’s important to understand the differences.
- Traditional Plans provide comprehensive medical cover to meet moderate to high healthcare needs, which includes hospitalisation and day-to-day costs on one plan
- Hospital Plans generally cover in-hospital expenses for planned and emergency hospital admissions. They are better priced but do not cover out-of-hospital expenses, such as doctor’s visits or prescriptions. However, some hospital plans also offer preventative and screening benefits
- Savings plans combine hospital cover with a medical savings account that pays for your day-to-day expenses. Once the savings are depleted, you’ll be responsible for these out-of-pocket costs
- Network plans require you to use specific healthcare providers within a network. They can be cost-effective, but you do need to check that the hospitals and doctors in the network are convenient for you. Make sure they have a good reputation for quality care
- Income-based plans offer specific medical cover at affordable premiums that are adjusted according to your salary
- Edge plans – exclusive to Bonitas – are driven by technology with access to day-to-day benefits, virtual care and more. These are aimed at a younger market.
Monthly contributions versus benefits
Medical schemes have all announced their premium increases and changes in benefits for 2025. But, before making your final decision, it’s important to weigh up the actual monthly monetary premium (not the percentage increase), against the benefits you will receive, to establish real value. Consider:
- Affordability. Your budget and what you can afford. Private medical aid is a monthly commitment and the rule of thumb is that your premiums should be around 10% of your monthly income
- Benefit limits. Look at the annual limits for various treatments and hospitalisation and ensure the plan provides adequate cover for chronic conditions and emergencies
- Co-payments. Some plans have co-payments which means you will be responsible for a portion of the cost. Check these carefully as this can impact your out-of-pocket expenses and budget
- Value for money. Don’t choose solely based on price. The cheapest plan might not be the best if it doesn’t cover your specific needs. Aim for a plan that offers a good balance between affordability and comprehensive cover
- Comparing options. On the Bonitas website (www.bonitas.co.za) you view the plans on offer and download the respective brochures. This can help you identify what the various plans offer in order to make a more informed choice regarding the cover you need
Check for added benefits
Look at what is offered in terms of preventative care, such as free vaccinations, screenings and annual check-ups. Does the plan you’re considering offer managed care programmes for health issues such as diabetes, cancer, HIV/AIDS along with optical, hearing and dental cover. All these added benefits will help you manage your health and save you money.
Waiting periods or exclusions
Often there are waiting periods before certain benefits can be accessed. Typically, these range from three months to a year, depending on the plan and the medical condition. This is particularly important for new members, so make sure you understand these terms and what they mean:
- A general waiting period usually applies to all new members, regardless of their health status
- Condition-specific waiting periods apply to individuals with pre-existing conditions, limiting or excluding benefits for those conditions for a certain period
- Exclusions – read the fine print for any procedures, treatments or conditions that the plan excludes entirely
Reputation and care
Ask your family, friends or doctor about which plan they are on or for recommendations, look online for comments or reviews on how the scheme treats its members and, importantly, the claiming process and access to a help line.
Research the solvency of the scheme, regulations stipulate that medical aid schemes must have a solvency ratio of at least 25% in order to cover claims. Also check the credit rating of the scheme and the average age of the membership. These all have a bearing on the sustainability of a medical aid fund.
Health and peace of mind
‘When finances are stretched, choosing the right medical plan requires careful consideration of your healthcare needs and budget. Always look at both the monthly cost and the range of the benefits. It’s about finding the right balance between affordability and healthcare cover. Your health and peace of mind are worth the investment.
‘If you’re feeling overwhelmed, consider using a broker,’ says Callakoppen. ‘Brokers are accredited with the Council for Medical Schemes and can provide expert guidance to help you choose the medical aid plan that is best suited to you and your family’s needs.’
