Medical aid schemes are actually non-profit organisations, where resources are pooled by a large number contributing individuals who can then access this money when they need to pay for various medical expenses. In a medical aid scheme, members pay a monthly amount called a premium or contribution into a “collective pot” that is administered by the scheme. This money is then used to pay out medical claims made by members.

What can you claim for on your medical aid?

Depending on the medical aid plan you’re on, you can claim for in-hospital treatment, as well as other benefits like screenings for certain diseases, day-to-day expenses like medication or GP visits, and dental treatment. Medical aid schemes usually require that you use their own network of hospitals and healthcare providers to be fully covered: if you use providers outside of the network, you may be liable for extra charges.

Who regulates medical aid schemes?

The way medical aid schemes function is governed by South Africa’s Medical Schemes Act – this ensures that your rights as a member of a medical aid are protected, and that you get access to healthcare when you really need it.