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Medical Aid Questions Answered

How do medical schemes work?

The definition of a medical aid scheme is: A non-profit organisation made up of a board of trustees, at least half of whom are elected by the scheme’s members. This board is responsible for managing the scheme so that its members benefit.

Members pay contributions to the scheme each month that are then pooled and used to pay out members when they need medical cover. Because schemes belong to the members, any extra funds stay in the scheme and are used for the benefit of scheme members. Every scheme is required to provide a minimum set of benefits to its members.

There are two types of medical schemes in South Africa: open and closed schemes. Open schemes are open to anyone, while closed schemes are designed for specific groups of people only, such as employees in a company.