Make a Plan

Getting the Most From Medical Aid

The cost of living is going up and families are finding it harder to make ends meet each month. This means that getting value from all your insurance providers, including medical aid, is becoming increasingly important. Here are seven tips to make sure you’re getting the most from your medical plan.

Don’t cancel

Although you may be tempted to save on the monthly premiums, cancelling your medical aid isn’t necessarily the best option.

If you aren’t covered, a sudden illness or accident could ruin you financially or you may have to compromise on the care you receive because you can’t afford the best. Without a medical aid you may have to wait months or even years for surgery or other treatment.

Also consider the other benefits that your medical aid could be providing, such as reduced gym fees, rewards for living a healthy lifestyle and discounts on movies and holidays.

Another consideration is that if you’re a member of a medical aid you will continue to get cover after you retire, when you’re most likely to incur medical costs. If you aren’t already a member, you may have difficulty getting affordable coverage in your old age.

Providers can impose late joiner penalties for people who’ve either never had a medical aid or had one but cancelled it at some point. These fees vary and you may also have to wait up to 12 months to claim for certain conditions. 

Be smart

Even if you are a medical aid member there are ways to save money and get the most from the plan. These include:

  • Use generic medication which most plans will fully cover.
  • Make sure your doctors and specialists are part of the medical aid network and charge medical aid rates.
  • Visit your GP before consulting a specialist.
  • Paying cash and claiming back from the medical scheme can also save you money. Some doctors and pharmacies put a premium on the transaction and a handling fee and this comes out of your medical savings account. It’s best to check as the money in the medical savings account belongs to you, not the medical aid.
  • Make sure to register your chronic medication – if your GP does not complete chronic medication forms and send them to the medical aid provider, the costs of your medication will be deducted from your day-to-day expenses, rather than your major medical funds.
  • Stay healthy, have flu jabs, exercise, eat well – prevention is almost always better than cure and certainly cheaper. In addition many medical aids will reward you for living a healthy lifestyle.

Understand your plan

Find the best plan for you, based on your health, your age, your day-to-day needs, whether you have a family or are single. 

When applying, always be honest. Not disclosing pre-existing conditions can result in your medical aid refusing to cover related costs. 

Find out about the plan and what it covers and what it doesn’t. The better you understand this, the less likely you are to incur expenses that are not fully covered. Failing to get authorisation for an expensive procedure, for instance, can be a costly mistake.  

Find out about ‘gap’ cover

This is designed to pick up any shortfall in your medical cover.  It could be worth exploring if you’d like added peace of mind. 


Many people don’t know that you can negotiate rates with medical service providers, such as specialists and anaesthetists.  

Get a quote for an operation and, if your scheme won’t cover the full amount, ask your service provider whether there is any way they can reduce the cost.  

Keep track of costs

Keep track of your medical costs – you might find that you’re spending so much on out-of-hospital expenses that a simple hospital plan is no longer right for you and a more comprehensive plan would actually save you money, or vice-versa.

Remember, most schemes allow you to upgrade at any time during the year, but you can only downgrade at a certain time. Make sure you don’t miss the deadline.

Shop around

Review your cover annually and check the costs against other medical aids.

Ask friends and colleagues what they recommend, go online and do some research according to your needs. Once you have, DirectAxis can help source quotes quickly and easily.

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