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Why you should make KeyHealth your medical scheme of choice

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Choosing a medical scheme is almost always a complicated task. Medical jargon, a wide variety of schemes, and an even wider range of benefit options that make it extremely difficult to find the right one for you. KeyHealth Medical Scheme is one exception – true to its philosophy of being smart and keeping it simple, we believe that you should only ever require ONE good reason to do something. 


The truth is that many schemes are giving you many reasons to join them, but for the most part, these reasons are not even very compelling – they are generic and offered by the majority of schemes out there. That’s why the smart choice is first to understand why you need a medical scheme and then what is important to consider when evaluating the value proposition of different individual schemes. This will take a few minutes of your time, but it will definitely ensure that you make an informed, smart decision when choosing your medical scheme.

So, before we tell you why you should join KeyHealth, click on the links below to find out more...

Understanding the purchase decision

Belonging to a medical scheme is exactly like having life insurance. You hope that you never need it, but it sure comes in handy when you actually do!

The definition of insurance is: “An arrangement by which a company undertakes to provide a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a specified premium.”

That is exactly what a medical scheme does – it pays for your medical expenses should you have any, and in return you pay a monthly contribution.

Three reasons why you need to belong to a medical scheme

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Life happens – we are not invincible, even when we’re young! You owe it to yourself, and your family, to look after yourself, and them, to maintain your quality of life.

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To save you money. Perhaps that sounds contradictory, as medical schemes are expensive, but the cost of medical treatment is even more expensive. Imagine being in a car accident and having to pay hospital bills to the value of, say, R300 000 from your own pocket? Still think it is too expensive?

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The importance of access to private healthcare. When we are ill or hurt we are vulnerable – and want somebody to take proper care of us. Would you rather stand in a queue at an understaffed and overcrowded state facility or get attended to quickly by well-trained professionals in well-equipped hospitals?

Five things to remember when choosing a medical scheme

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Understand your healthcare needs. If you are young and healthy you will be OK with basic hospital cover as you will be able to pay normal expenses, like going to the GP on the odd occasion and buying medicine from the pharmacy, from your own pocket. However, if you are older, have chronic conditions, or a family to take care of, you might need to consider more comprehensive benefit options to cater for increased healthcare needs.

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How thick is your wallet? Choose a scheme, and a benefit option, that is affordable to you. Remember this is not a luxury expense – you might have to juggle the budget to make ends meet.

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Check out the financial soundness of the scheme. A good indicator of this is the scheme’s solvency (also referred to as ‘reserve’) level. All schemes are required by law to have at least 25% of members’ annual contributions in reserve to pay claims should anything go wrong. Schemes that don’t meet this requirement might not be sustainable in the long run and will probably have higher contribution rates in order to make up the shortfall.

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Start young - two reasons why:
- Underwriting – to join later in your life will mean that you might have to pay more for your cover and that certain conditions/procedures may not be covered.
- Prevention is better than cure. A number of schemes offer preventative care/screening benefits. This allows the member/s to become aware of problems that can possibly be prevented or treated immediately. Therefore having long-term physical and financial advantages.

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Make sure you understand the benefit structure of the scheme. The language used is filled with specific terminology, often vague, most of the time difficult to understand and might lead to nasty surprises later on. If unsure about a specific benefit, find out from the scheme exactly what it entails. Every medical scheme has exclusions, protocols and co-payments of some sort. Make sure you understand what these are upfront – again to limit the nasty surprises! At KeyHealth we do everything we can to ensure that our members are always well-informed. 

How does a medical scheme work ?

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All medical schemes are governed by a set of rules. These rules are approved annually by the Council for Medical Schemes and explain clearly the benefits available to members, the corporate governance of the scheme as well as the rights and responsibilities of both the scheme and the member. Make sure you are aware of the content of your scheme’s rules as it will be the determining factor in any dispute between yourself and the scheme.

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A medical scheme does not make a “profit”. Income is mainly generated by member contributions. Schemes may also have a smaller income as a result of investments. Expenses are made up of claims payments and admin costs.  If the income generated is more than the expenses incurred, the scheme will probably allocate the difference to their reserves (of which they need to have a 25% level) or pass this positive result on to the members by way of benefit improvements or lesser contribution increases for the following year.

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100% does not always mean 100%! Tariffs charged by service providers are no longer regulated in South Africa. Each medical scheme has therefore fixed its own rate at which it reimburses service providers. The majority refers to this rate as MST – Medical Scheme Tariff – and it can differ from the rate charged by a service provider. If the rate is less than the charged rate, the member will be liable for the shortfall. It is therefore advisable to check the rate payable with your scheme/service provider prior to obtaining treatment.

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Schemes usually have a range of benefit options available ranging from comprehensive cover to basic hospital cover. Price also differs. Choose the option that will suit your healthcare needs and wallet. Most schemes will only allow option changes at the end of each year. Therefore it is important to make sure your option choice makes provision for any foreseen healthcare needs during the course of the year.

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Understand PMBs – Prescribed Minimum Benefits. PMBs are a set of legislated, defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected on their scheme. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. More information on PMBs is available on the Council for Medical Schemes’ website (https://www.medicalschemes.com).

Why should I choose KeyHealth?

logo1So, now you are ready to find out why you should choose KeyHealth to be YOUR medical scheme:

In today’s world, it seems to be the norm for companies to hide behind smoke and mirrors – there’s always a “catch” and a “good deal” that is never quite as good as it seems. Essentially, things just need to be simplified, taken back to the basics and made transparent, so that truth can really shine through.

With transparency at its core, KeyHealth focuses on delivering products devoid of loyalty programmes, bonuses and frivolous add-ons – schemes stripped of misguided fringe benefits, so that what remains is pure Medical Aid.

What you see is what you get. Essentially, it is real value for money as opposed to perceived value for money. It’s Medical Aid without the extras and empty promises. It’s simple. It’s authentic. It’s smart.

Click here to find the right KeyHealth option for you.