Mom with two children

Make a Plan

Getting the Most From Medical Aid

With the rising cost of living, families are finding it harder to make ends meet each month. This means that getting value from all your insurance providers, including medical finance, 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 don’t have medical finance, 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 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 provide, 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 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:

● 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.

● Find out about the medical aid’s chosen network of service providers like hospitals, clinics, GPs, specialists and pharmacies. The schemes typically negotiate a rate with these networks, which could save you money, depending on the type of cover you take.

● Visit your GP before consulting a specialist

● Pay cash and claim back from the medical scheme to save you money. Some doctors and pharmacies put a premium on the transaction and a handling fee, which 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 doesn’t 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, age, and 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.

● Know your health risks – all medical plans have specified exclusions; it’s important to know what these are. That way, you won’t find out during a crisis that they don’t cover a condition you need medical aid assistance for

● Find out about the plan, 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.

● Study the fine print – this information is typically less noticeable and written in a small-sized font. It consists of terms and conditions that have an impact on the medical aid policy. You need to make sure you understand these before taking on the cover.

Find out about ‘gap’ cover

A gap cover is designed to pick up any shortfall in your medical cover. It could be worth exploring if you’d like the 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 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 aid schemes. 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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