Medical aids too pricey, say members

2011-06-13 12:59

Johannesburg - The majority of medical aid members say their schemes are too expensive while a minority actually read their member guides, according to a survey released on Monday.

"Three-quarters of respondents felt that their medical schemes were too expensive," according to a statement on the findings of the 2010 OMAC Actuaries & Consultants Healthcare Monitor.

"It seems that members are adopting a 'rather safe than sorry' approach when selecting medical schemes and options, instead of trying to improve their understanding. This would exacerbate the feeling that medical schemes are expensive," said Margaret Hulme, head of healthcare consulting at OMAC.

However, only 44% of respondents had read their member guides thoroughly.

The survey of 1 002 medical aid members or beneficiaries found that nearly half did not use their broker, member guides or the internet to try and improve their understanding of their medical scheme.

"Call centres were the worst-rated area of service, which might contribute towards members' lack of understanding."

This led to ignorance of what their medical schemes offered.

"According to the survey, one-third of members said they did not know what they were covered for and that they only find out what they are covered for once they claim.

"A third of members complained that they found the benefit structure confusing."

The introduction of cost-saving initiatives may not get the desired response, such as in the introduction of designated service providers (DSP), where members get benefits if they use the services of only DSPs.

"Members do not like DSPs. This is not because of any problem with the concept itself, but rather owing to the perceived lack of freedom of choice - particularly when it comes to GPs."

She said 84% of members said their scheme offered good value for money, but they believed that more expensive options with more benefits and without DSPs provided the best value for money.

Hulme said in reality the options with lower benefits and using DSPs probably provided better value.

Members surveyed prefer higher monthly contributions and fewer co-payments to lower monthly contributions and more co-payments.

"This may explain part of the preference for more comprehensive and expensive options."

However, despite dissatisfaction few members change schemes.

"Of the members surveyed, 91% had not changed scheme or scheme options in the last three years - however, when comparing the price and their benefits of their old versus the new options, it emerged that members favour better value rather than lower cost," Hulme said. 

  • Lindetjie - 2011-06-13 13:14

    We pay a huge some to the medical scheme monthly, but then still get nailed with extra costs that are "not covered" - it's a rip off! Our medical aid won't even pay for our cholestrol medication which as far as I know is a PMB. So must we get heart disease, have a heart attack and then they pay for the hospital bills if we are lucky to survive? The list goes on - I still don't understand why medical aids won't pay for birth control either but will pay for the astronomical costs of pregancies, birth, etc.?

      jannie.debeer - 2011-06-13 13:41

      All medical schemes are legallu obligated to pay for PMB's. If not they fall foul of the Medical Scemes Act. There are criteria that need to be met though. Birth control is a touchy subject. Many of these medications are not used for the intended purpose. Should the scheme not pay for the confinement if you fall pregnant, when they are paying for this medication?

      Kathleen - 2011-06-13 14:08

      I totally agree with what you are saying. I pay almost R500 a month, on top of my R3 800 subscription to the medical aid, to cover cholesterol medication and anti-depressives. The medical aid sent a list of hypertension medicines for my husband to my doctor and he said they were all out-dated.

      Karools - 2011-06-13 14:18

      Lindetjie, it's because birth control pills are free at every clinic.

      DeonL - 2011-06-13 14:30

      High cholesterol is on the list of chronic meds that should be covered but most schemes have a formulary of meds covered and you need to qualify for the meds. Some doctors don't feel comfortable about meds on the list and describe something different or stronger, but they don't pay the meds. bill.

      devils_advo - 2011-06-14 09:47

      FYI. PMB or prescribed Minimum Benefits do cover cholestrol. What people faul to understand is that their are quite a few dozen medications for this condition. Only a handful are covered under the benefit. So if Medication A and B are covered and you insist on taking medication C, then what do you expect. Like the article says. people do not shoow an awareness of their cover and then bitxh and moan when ut isn't benefiting them.

  • Solo-JHB - 2011-06-13 13:16

    I am self employed and know exactly what my medical aids costs. Most of my friends are oblivious to what it actually costs because it's a salary deduction and company contribution on their payslip that they cant decipher.

  • Tolerant - 2011-06-13 13:25

    Some people are abusing the medical aid system. Do you have to visit a doctor for a common cold when only your nose is running?

      Albert - 2011-06-13 15:58

      He he, no, the problem is that some folk who don't read the details, think that when their nose in running, they need to run after it. Time that people didn't keep running to the Dr when they hurt their little finger. Wastes the doctors time and sends the membership fees up because of high claims.

      Flash - 2011-06-13 20:43

      Yeah true, but the doctors are also the problem. They are quick to prescribe antibiotics for viral infections, even though they don't work.

  • MuAfrica - 2011-06-13 13:36

    Medical aid companies sucks. They are thieves in boardrooms wearing suits and that's the only difference between them and the thief at the street corner.The motto is : squeeze as much money as you can from the poor hardworking people.

      DeonL - 2011-06-13 14:44

      No one forces you to join them. You probably can't wait for the "free" NHI system?

  • Judith - 2011-06-13 13:36

    Lost our medical aid in January as an accident made it impossible for me to continue the payments. Now owe them almost R2 000, which I am struggling to pay. They now want to blacklist me

  • Kevin - 2011-06-13 13:41

    expensive medical costs can only be tamed when it is treated as a global issue with governments regulating what companies can charge for medicine, lowering the hospital rates and regulating what doctors charge.As soon a hospital is private it is run as a business and costs start to soar. My 82 year old Dad had acid in his tummy 3 months ago and he was stuck into ICU for 4 days at a cost of R58000-00 when there was nothing wrong.The private clinic in Plett supposedly charged someone ICU rates when there is no ICU and there was no dedicated nurse or doctor. That bill was over R80000-00.Poor medical aids pass on the costs to us.

  • Ascendo Tuum - 2011-06-13 13:43

    Every year the contributions go up but the cover comes down. Medical aids that pander to their shareholders needs of higher dividends to the detriment of patients needs should seriously be looked at. I don't want cheap gym or movie tickets or God knows what other crap they offer. I want to know that when I need medical cover that I will get it. 'Sorry, we don't pay for this life saving procedure, but hey you have 3 months to live, so we would like to offer you this 50% off movie ticket to see the new HarryPotter movie before you snuff it'

      devils_advo - 2011-06-14 09:50

      Dude, do you know why they offer you an incentive off gym and other crap... So you can lead an active lifestyle. Active lifestyle means less likley to get sick. Less likely to get sick, less likely to claim... Less likley to claim, premiums come down. If you are referrring to Duscvery Vitality, this is not part of your medical aid premium. Its an extra add on. You choose to take it or not. Probably a bit too over your head though hey?

      robqb - 2012-11-19 10:32

      @devils_advo. I agree with you, partially. Please don't hold your breath waiting for premiums to drop. You will before they do. You will also find that the Med Aid "mother" company does the books, hence no profit!

  • Mitzie - 2011-06-13 13:51

    I find the comments quite interesting. Your broker should assist with claims not being paid as well as explain exactly how your medical aid works. Maybe some of the dr's codes were incorrect, therefore claims were not paid? Yes, it is expensive but the day that you become seriously ill or have a serious accident you'll be glad that you're on a medical aid. My medical aid has really helped me when we needed it.

      robqb - 2012-11-19 10:36

      @Mitzie. Agree. Med Aid is like a telephone, a necessary evil. Can't live with it, (price) can't live without it.

  • tut - 2011-06-13 13:55

    Health insurance with a good hospital plan is all that is necessary! No more out of hospital stop gap payment cr@p and re-packed Chinese generics distributed by well known psuedo Pharma Companies! However, I do believe there is cause for investigation by the competitions commission as well as by the public protector on the market "dominant" Medical aid service Provider. They dictate which private institution/s to use, what costs are to be charged at and then have the cheek to reimburse members only partial amounts! A Doctor's 3 am emergency call out fee will be reimbursed by them for less than R200! Go figure when a Plumber earns more than 3 times that amount on a 24 hour callout?? The entire industry is a sham!

  • Mitzie - 2011-06-13 13:55

    I am sure if you start asking your broker these questions he/she will assist you with the claims that have not been paid or just to understand the benefits of the options you have selected? Yes, medical aids are expensive but when the day comes that you are seriously ill you will make full use of the medical aid and when you start adding the hospital costs etc it may by far exceed contributions you have paid to a medical aid. I have lately been grateful that I had a medical aid.

      robqb - 2012-11-19 10:44

      Wish I could find my broker. He came to the company where I was working, signed me up and left. Next time I saw him was, per chance, at a hospital where my wife was recuperating from a mild heart attack. I spoke to him about my pending cataract op and was told by him to get all the particulars, forward it to him and he would see what he could do. "I" must do the running around? If I had my way with brokers, they'd stay broke!

  • Tjopper - 2011-06-13 13:56

    If you want a detailed comparative quote between various medical scheme options, go to

  • mike881 - 2011-06-13 13:58

    Hate my medical aid - Spectramed. The problem is the medical aid companies know that they "own" us as the average person is to afraid to use the government hospitals and services. My one worker went to go and have her tooth removed. They removed the wrong tooth. This is just one of countless horror stories I can recount. Never mind the days spent waiting in queues.

      robqb - 2012-11-19 10:54

      @mike881. A Saturday night/ Sunday morning a few months back I went to a state hospital with chest pains. If I was younger(I'm 70), I would more than likely have ignored it. Well I was released on Monday afternoon. I went back a while later and was given a cardiograph and numerous other tests as well as blood tests. About a month later they discharged me saying I had an irregular heart beat. I then went to a private Doctor, not medical aid! She had a look at all my test results and told me that I was a heart attack looking for a place to happen. Needless to say I went to the Med Aid Cardiologist and 3 days later I was on the table having stent insertions. State hospital? Never again, if I can help it.

  • Grazy - 2011-06-13 14:00

    The cost of medical scemes are high yes, but it is the rediculous cost of medicals in general that get me down. I'm self employed and whent for a less comprehensive scheme, and found out that I end up paying more for the same service I had by trying to save some. I had a broker come see me and he helped a lot to make lights come on. We cannot be experts on all fields to know what is best, or time to waste finding out. I believe those on medical schemes are subsidising those to lazy to work, and those who cannot afford a scheme. It cost an arm and a leg to pay for good medicals, but to go for government hospitals may cost your life.

  • David - 2011-06-13 14:01

    Been with Spectramed for 6 years loyally paying every month, they just change the account type this year cause they can, get flu have No medical savings cause they changed it! have to buy my own meds now, asked to cancel with them, they wont reply! Well irritated that after over paying R72K i cant get a bottle of cough mixture!

  • Johan - 2011-06-13 14:01

    I paid medical contibutions for 18 years and left for the USA for 10 years. On returning and wanting to continue with a medical aid, the contribution is so loaded that it is impossible to become a member because of the cost. So we will become just a another state dependant.

      robqb - 2012-11-19 11:00

      @Jahan. I know what you're saying. When I signed up for my present scheme, my wife was on 75% and I on 50% penalties. Well I've managed to get myself down to 0% and the wife onto 25%. The reason that we had that gap of not being on Med Aid was because of being "between jobs" or working for companies that did not have a Med Aid. So, Yeh.

  • Plain Jane - 2011-06-13 14:06

    I've got the best medical aid! Unfortunately it is only for people working for Anglo platinum... Monthly cost is about R700 - but there isn't any limit on GP visits - also no co-payments when referred to specialist or stay in Hospital. Unfortuanetly people abuse this privalege - they just go to the doctors for anything! Viva Platinum Health!

  • sabc10 - 2011-06-13 14:08

    An unsustainable corporate scam in South Africa. Medical aids are now even selling insurance to boost income. "Profits before service" is their motto They use marketing and misleading information to sell their products.

  • David - 2011-06-13 14:09

    Been with Spectramed for 6 years loyally paying every month, they just change the account type this year cause they can, get flu have No medical savings cause they changed it! have to buy my own meds now, asked to cancel with them, they wont reply! Well irritated that after paying over R72K i cant get a bottle of cough mixture!

      Wigwam - 2011-06-13 14:23

      Spectramed are useless. Was with them and they messed us around wholesale. Got pre-authorisation from them for a procedure for my mom, she had the procedure and then they refused to pay. But never bothered telling us that, we found out from the hospital when they sent us a bill! Spectramed even had it on their file that they authorised it but still refused to pay. I found another medical aid and gave notice to leave them immediately! Still had to give 3 months notice...

  • MasendeAkho - 2011-06-13 14:09

    I'm just having a look at what the head honchos at Discovery earn, jirreeeeee they are loaded

      Ploert - 2011-06-13 14:45

      It sure is a lot, but have a look at what the medicine companies are earning, the pharmaceutical companies, they are the fat cats and nobody says a word. They make the price(with nice profits), then the hospital/doctor adds his bit(with profits)and the medical aid has to pay, this increases our contributions to keep up.

  • Streetdreams - 2011-06-13 14:11

    There are ripping us offf, the Coimpetition commission needs to something............

  • Blue_Ray - 2011-06-13 14:22

    The truth is that people cannot chop and change, otherwise they lose the "company" portion of medical aid. Medical aid will take as an example R6.5k for 6 family members per month, but only have R5.5K available for Dr's, dentistry and self medication per year. R6.5k x12= R78 k - R5.5k =R72.5.....what happens to the rest??!! Any form of insurance is daylight robbery, services like these should be regulated so that people who do not abuse it, get their money back.....and guess what? the Insurances will still make profit becuase of the interest and investments they make with your hard earned money.

      Ploert - 2011-06-13 14:49

      It is the pharmaceutical companies that are bleeding us dry. They sell to the hospital(with prifit), the hospital "sell" to us(with profit)and the medical aid picks up the tab. They just increase our contributions.

  • AndV - 2011-06-13 14:27

    What is neededs a regulation similar to the engineering ECSA scales that can set charging criteria for doctors depending on the disease and severity of he treatment required. This will level the playig field and assist medical aid scemes to plan and budget better and members will be far less vulnerable and exposed than now. It will also benefit Dr's and medical facilities.

  • Jenny - 2011-06-13 14:30

    Medical Aid savings are a rip. Mine only cover our basic non chronic medication until end May. Then I have a self payment gap of over R4,000. My husband is diabetic and on 2 types of insulin, they will on pay for 1 type of insulin a month. So that is a extra R500 a month I have to find for insulin and dare I ask for strips or needles. We both ware glasses which at the end of the day we have to pay for them ourselves. Last year I was diagnosed with a 40% bilateral hear loss and require 2 hearing aids. The medical aid will pay but that has to come out of my medical savings. Bingo that means if I want to hear I need to find in the region of R15,000 which is not going to happen as my husband in unemployed. So it just goes on and on, we are all in a catch 22 situation and you have wiegh very carefully you medication and need to go to a doctor etc.

  • lounel - 2011-06-13 14:42

    discovery r to busy suporting sport and various other things, members come second. and wen u really need them then its exhusted. very depresing.

      Jenny - 2011-06-13 16:14

      Discovery is a financial institue not a medical aid.

      Mr. Spice - 2011-07-05 08:30

      Lounel, please go research info before you spill such nonsense on here... Medical Aids are a not for profit organization and by law, they cannot use your premiums for things like sport etc... you premium is broken down to provide Hospital cover, day to day, medication, managed care, broker commison and adminsitrators... more so, to pay your claims...

  • Jim - 2011-06-13 15:15

    The medical aid schemes are hugely expensive. To the avarage person they are complex to understand as well. Then you land up with top ups etc on basic medication. Dental is virtually non existent with most schemes. A rip off.

  • john lugg - 2011-06-13 15:49

    DID YOU KNOW - the first R250 (if not more) of your MONTHLY contribution goes directly to the "administrator". Your medical scheme is a "not for profit" organisation, and as such, annual surplusses are saved to cover future years expenses etc. Your medical scheme doesnt have shareholders who benefit from the profit, however the "admisistrator" does. They can charge what ever admin fees they like and few people question it, or even know about it. And thats where the ripoff comes....

  • john lugg - 2011-06-13 16:04

    DID YOU KNOW that the first R250 (if not more) of your monthly contribution goes directly the the "administrator' Medical aids a "not for profit" organisations, and all surpluses are saved to benefit you the member. However, the administrators are all about making profit, and very few people challenege the annual fee increase. 9/10 times the medical aid's board has an insestuous relationship with the administrators anyway. Stop always blaming the medical aids, tackle the administrators! thats where the unbridled rip off happens!.

      Jim - 2011-06-13 19:09

      Medical aids were initially a not-for-profit plan for the members, but as you rightly say, the administrators may make a profit. My former medical aid reported a break-even situation for 2009, BUT the administrators made a profit of over R46 million!

      Solo-JHB - 2011-06-14 11:15

      Correct, it's as high as 17% of your contribution!

  • Thu - 2011-06-14 09:50

    I will always say most of the time is us the consumer as we take no time to complain about the increases in this institutions. We give them our money every month but we don’t even care how they spent our hard earned cash. We need to start being more responsible with our money. Then all this companies will change their pricing behavior.

  • devils_advo - 2011-06-14 09:53

    There are some really stupid mamparras on this forum today.... Do people think before they speak, I could honestly sit and run through each complaint below and walk away with each person having a better understanding of their situation.

  • Snowbuddy - 2011-06-14 12:14

    I was unemployed for almost 2 years. Now I want to join a Medical Aid again after finding a job and am hammered for the fact that I did not belong to a Medical Aid during that time, although my medical expenses cost (chronid medication) had to be paid out of pocket which I had to borrow from friends/family, and I still have to pay a penalty (which will be added to my monthly contribution from when I rejoin again). This is absolutely ridiculous. I did not have the benefit of Medical Cover in those 2 years and now I have to pay extra for the next (however many years I belong to the Medical Aid again), plus there is a waiting period of 1 year before enjoying any benefits for the conditions we currently suffer with. We already suffered enough without Med Aid and now still have to be punished by paying more every month (which means how much in total being added) + pay for our chronic meds -so all in all, we now have to pay a penalty, pay for whatever chronic medication we are currently on which costs around R1300 p.m. (during the 1 year waiting period) as well as the membership fee. This is ludicrous! Can this issue not be addressed??? Medical Aids are expensive as are doctors and hospitals, but the service we receive at hospitals are shocking. I feel there are major issues which need to be addressed and if we are paying such exhorbitant membership fees, surely there are more medical conditions that should be covered.

  • Std - 2011-06-17 05:40

    yes, medical aids are too expensive, many members on the STDdatings. com always discuss about this.. they share their personal treatment stories. some ways work for most of the sufferers.

  • alv1990 - 2011-09-18 13:44

    Medical aids are a rip off, they don't take individuals into consideration !! You are just a number contributing to their excessive bonuses, cars, cocktail parties, fancy offices etc....!! Mr Spice, wake up !! I pay in excess of R35,000 per year to my medical aid and I claim approx R6000 per month if I have to pay when I have reached MSA a further R3,000 until the gap they have gained in excess of R250,000 from me !! Why am I penalised for someone who abuses and constantly claims from Medical Aid?? To everyone out there who is considering joining a Medical Aid, DON'T JOIN DISCOVERY !! They mis inform their members and are quick to claw - back AND they are the most expensive Medical Aid out there at present !!

  • alv1990 - 2011-09-18 13:45


  • Wackyme - 2011-11-09 13:52

    How many employees are locked in by their employees. My employee wont allow me to change even though I am paid as a TCOE employee

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