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How is my medical Aid Scheme Benefits set up?

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All medical aid schemes offer a set amount of benefits per scheme that you sign up for, but how exactly do they determine what benefits to put to what?

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All medical aid schemes and funds work on the same general principle when determining your benefits and options. Of course, each package will differ from medical aid scheme to medical aid scheme, but the general idea is all based on the following charts:

The chart is divided into two main sections, In-Hospital and Out of Hospital:

Medical Aid Schemes are divided into two sections

Wether you look at a traditional medical aid scheme option, or new generation, you will always have your benefits divided into those two sides.

Traditional Medical Aid Schemes

The traditional medical aid scheme benefits setup is a pretty straightforward affair. You either get benefits, or you don't. Or you get up to a point. End.

As said above, all benefits are divided into the two sides, in hospital and out of hospital benefits. Traditional medical aid schemes are divided into three main categories of benefits:

Medical Aid Scheme Benefits: full, none, network

These are the basic layouts of the benefits you will be signing up for:

  • Full Medical Aid Scheme Benefits (100%)
  • Full Medical Aid Scheme Benefits minus self-cover (80%)
  • Limited Full Medical Aid Scheme Benefits (100%)
  • Networked Medical Aid Scheme Option
  • Hospital Plan
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New Generation Medical Aid Scheme

The new generation medical aid schemes have taken a more complex approach to your benefits package. Once again it is divided into the in-hospital and out of hospital groups, but the out of hospital options are a lot more complicated than before, with the introduction of the medical aid scheme savings plan:

medical aid scheme benefits: full cover, no cover, savings plan

The basic medical aid scheme benefits options you can expect are as follows:

  • Incentive Savings Plan
  • Comprehensive Incentive Savings Plan

New generation medical aid schemes are especially popular with schemes such as Discovery, topmed and GEMS.

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