There is no national medical insurance scheme in South Africa. Private medical schemes, regulated by the Medical Schemes Act, offer group membership or individual cover. Contributions to group schemes are usually split between the employer and employee. Medical aid costs are rapidly rising, partly because of the increase in the price of drugs, medical equipment and doctors' fees. The government wants to introduce a social insurance policy requiring all employees to have health insurance. Medical schemes, fearing that an influx of low-income earners into their schemes will place an enormous financial burden on them, are lobbying for a subsidised national health scheme instead.
Most medical schemes provide a variety of choices for the consumer - from a basic hospital plan to full medical cover. Belonging to a medical aid is becoming increasingly costly and members often have to pay additional expenses. Doctors bills and some private hospital costs often exceed the scale of benefits, or the amount that the medical aid is prepared pay. Medical aids also place ceilings on various categories of medical expenses - for example, R5,000 per year for dentistry for the family - and if these are exceeded, the member is liable for payment. Some medical aids, like Discovery Health, are encouraging their members to follow healthy lifestyles with a point system that rewards them with benefits for regular exercise, medical check-ups and other practices that reduce illness.
With 43 hospitals and 18 day clinics around the country, Netcare is the biggest private health provider in the country, and offers many specialist services. A total of 2,900 medical professionals are associated with the health care group. Netcare's web site provides a doctor search (of doctors in the group), as well as information about specific hospitals. Detailed information and photographs are supplied on each hospital, as well as lists of services offered, a doctor search, and hospital and doctor contact details. Another major private health company is the Medi-clinic group. which runs 35 hospitals around the country. A map on its website provides area-by-area details of each of the hospitals and the services they offer.
The Short-term Insurance Ombudsman Ombudsman for Short-term Insurance Association investigates complaints from the public against short-term insurers that are members of the Ombudsman for Short-term Insurance Association. You must first complain to the insurer or broker concerned. The ombudsman usually holds an open house on Wednesday mornings for quick advice sessions at Promat Centre, 5th Floor, 27 Stiemens Street, Braamfontein. Tel: (011) 726 8900 Fax: (011) 726 5501.
Short Term Insurance Ombudsman Links:
The Long-term Insurance Ombudsman investigates complaints from the public against life and long-term insurers that participate in the Ombudsman's Scheme. The consumer should try to resolve disputes with the insurer before consulting with the Ombudsman.Tel: (021) 674 0330 Fax: (021) 674 0951.
Long Term Insurance Ombudsman Links:
For a list of links to all medical schemes registered with the Board of Healthcare Funders (BHF), their representative organisation, go to BHF Global or tel: (011) 880 8900. The BHF will also deal with all complaints relating to medical aid malpractice. The Financial Services Board is an independent statutory body that oversees the non-banking financial services industry - including insurers, retirement funds, unit trust schemes, and financial markets - and handles complaints in the public interest. However, you should only contact the Board if you feel that the law has been transgressed or is inadequate.
Update 16/01/2013
Expatriate health insurance in South Africa
With so much to deal with before leaving your home country, (taxes, moving house, paperwork etc.) the careful planning of your expatriation to Johannesburg is an essential step. As far as healthcare is concerned, your local social security scheme won’t be accompanying you to your host country and, once abroad, you might be surprised by the care system you find in South Africa So, before leaving, make sure you have appropriate cover!
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