# Medical Insurance



## 2fargone (Jun 14, 2011)

Hello!

I am trying to find the best medical insurance. I live in Cape Town, but I am an American. (Here on life partner visa) I still have my health insurance from the United States which covers me. But I have to pay upfront for everything, and then submit my paperwork.

This is what I need for health insurance:

1. I have chronic medications I need every month. I would like insurance that would cover it or a good part of it.

2. I have want full hospital coverage. 

3. And I want coverage that would cover CT Scans and MRI if I am not admitted in the hospital. 

4. I want coverage that would cover any surgery I might need.

I have looked at Discovery but it looks like it's going to be R2000+ a month :confused2:

FTX Im a 27 years old female. If anyone has any advice I would welcome anything!!


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## Johanna (Apr 13, 2009)

Poopsie23 said:


> Hello!
> 
> I am trying to find the best medical insurance. I live in Cape Town, but I am an American. (Here on life partner visa) I still have my health insurance from the United States which covers me. But I have to pay upfront for everything, and then submit my paperwork.
> 
> ...


 R2000 per month is not a lot, considering what you expect from a medical aid. 
I cannot vouch for it, but most medical aids may not cover pre-existing conditions. To my knowledge, most medical aids will cover most of what you expect if these tests (MRI and CT scans ) are done whilst you are hospitalised.
Discovery has many options, as do most medical aids, but as you may be aware, medical costs are extremely high all over the world.
Is your chronic medication very expensive..... if not, why not look at hospital plans?
You will receive full hospital coverage and all procedures done whilst in hospital.
Most medical aids require an authorisation number for many procedures, have a look at all the requirements.


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## concord (Jan 9, 2012)

Can you share your experience? I mean services of which company you use, which plan etc. (unless it's considered to be advertising).
Honestly I didnt explore it thouroghly yet but I wanted to know the opinion of people who live here for a long time. I went to the website of Discovery HealthCare and can say it is expensive unless you take a key plan which doesnt cover much (so if you're screwed you pay yourself). I might have understood it wrong since my English isnt perfect and they use professinal jargon in some cases. For example they say if you give a birth to a baby with Caesarian section they cover only 4 days/3 nights at a hospital. What if I have complications? My problems? Or they say you must let them know that I go to a hospital to give a birth 48 hours prior. Again what if I have complications and give a birth a month earlier?
I'm 27-year-old female with no chronic diseases.


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## Johanna (Apr 13, 2009)

concord said:


> Can you share your experience? I mean services of which company you use, which plan etc. (unless it's considered to be advertising).
> Honestly I didnt explore it thouroghly yet but I wanted to know the opinion of people who live here for a long time. I went to the website of Discovery HealthCare and can say it is expensive unless you take a key plan which doesnt cover much (so if you're screwed you pay yourself). I might have understood it wrong since my English isnt perfect and they use professinal jargon in some cases. For example they say if you give a birth to a baby with Caesarian section they cover only 4 days/3 nights at a hospital. What if I have complications? My problems? Or they say you must let them know that I go to a hospital to give a birth 48 hours prior. Again what if I have complications and give a birth a month earlier?
> I'm 27-year-old female with no chronic diseases.


 I am with Bestmed , option Pace 3

Discovery is a very good medical aid, take the best option you can afford. A C-section is not something to be too concerned about and if you do develop problems, it should be covered by the medical aid as it would be a totally different "treatment"

I always think one should look at different options and choose the best option you can afford. ( Our medical aid is subsidised, very few employees still do that )

Medical Aids South Africa | Compare online | Get medical aid quotes


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## concord (Jan 9, 2012)

Johanna, thank you for sharing your experience!


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## Saartjie (Mar 1, 2010)

I am on the Discovery Medical Aid (Comprehensive Option). It costs just over R3000 a month for me and my daughter. To date they have been very good so I can recommend them for sure.


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## Saartjie (Mar 1, 2010)

concord said:


> Can you share your experience? I mean services of which company you use, which plan etc. (unless it's considered to be advertising).
> Honestly I didnt explore it thouroghly yet but I wanted to know the opinion of people who live here for a long time. I went to the website of Discovery HealthCare and can say it is expensive unless you take a key plan which doesnt cover much (so if you're screwed you pay yourself). I might have understood it wrong since my English isnt perfect and they use professinal jargon in some cases. For example they say if you give a birth to a baby with Caesarian section they cover only 4 days/3 nights at a hospital. What if I have complications? My problems? Or they say you must let them know that I go to a hospital to give a birth 48 hours prior. Again what if I have complications and give a birth a month earlier?
> I'm 27-year-old female with no chronic diseases.


I used to be on Discovery Key Care Plus, it was not very good but all I could afford at the time. They only covered C-Section if it was deemed that you must have it (i.e. that a doctors says you cannot give natural birth). They do not cover if you elect to have a C-Section yourself. Therefore I have now changed my plan.


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## Crawford (Jan 23, 2011)

Poopsie23 said:


> Hello!
> 
> I am trying to find the best medical insurance. I live in Cape Town, but I am an American. (Here on life partner visa) I still have my health insurance from the United States which covers me. But I have to pay upfront for everything, and then submit my paperwork.
> 
> ...


Just interested to know what US Health Insurance Plan you have which covers you in SA? 

Does it also cover you in any other parts of the world?


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## concord (Jan 9, 2012)

Saartjie said:


> I used to be on Discovery Key Care Plus, it was not very good but all I could afford at the time.


 I guess I'm in the same situation  - Key Care plan is what we can afford for now. It's not like I'm too concerned about C-section specifically... But you never know what might happen in the future. Just when I was reading Discovery Maternity section it drew my attention somehow. Maybe because they mentioned C-section together with 2- and 3-D scans in the description of every insurance plan.


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## Saartjie (Mar 1, 2010)

concord said:


> I guess I'm in the same situation  - Key Care plan is what we can afford for now. It's not like I'm too concerned about C-section specifically... But you never know what might happen in the future. Just when I was reading Discovery Maternity section it drew my attention somehow. Maybe because they mentioned C-section together with 2- and 3-D scans in the description of every insurance plan.


I had my baby here in SA and had a C-Section (but paid for it) because my daughter was in breech position so for the next one (if we decide to have another kid that is) I will also want a C-section as they say it is really hard to give natural birth after having had a C-section the first time. Hence as soon as I could afford it I changed my plan so I can now take the decision myself rather than have to rely on a doctors opinion. Still, Key Care served its purpose for us in many other ways so it's not a bad plan really.


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## 2fargone (Jun 14, 2011)

Crawford said:


> Just interested to know what US Health Insurance Plan you have which covers you in SA?
> 
> Does it also cover you in any other parts of the world?


Hi I have Blue Cross Blue Shield. But it's Cobra. 

Yes, it also covers me in other parts of the world. 

I also found out from the hospital I was at I can get a letter from my insurance saying they will pay for everything, and I don't have to pay upfront like I have been paying. But right now I have been paying and then claiming back with Blue Cross. I must say they have been very good at paying back. But I also know someone in insurance who helps me with my claims.


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## concord (Jan 9, 2012)

I have maybe a stupid question...
What happens to your medical insurance if you stop paying your monthly fees for let's say 3-4 months?

Situation: for example you pay R2 000 for your medical insurance every month for a couple of years. Then one day you lose your good well-paid job and can't pay it till you find another one. As I understand if something happens to you they won't help you. Is it true? I mean yes, you don't pay now but you already paid R48 000 (R2 000*12 months*2 years). So basically all that money vanish and you can't use it before you start paying insurance again?

Did any of you hear of a situation like this?


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## Saartjie (Mar 1, 2010)

concord said:


> I have maybe a stupid question...
> What happens to your medical insurance if you stop paying your monthly fees for let's say 3-4 months?
> 
> Situation: for example you pay R2 000 for your medical insurance every month for a couple of years. Then one day you lose your good well-paid job and can't pay it till you find another one. As I understand if something happens to you they won't help you. Is it true? I mean yes, you don't pay now but you already paid R48 000 (R2 000*12 months*2 years). So basically all that money vanish and you can't use it before you start paying insurance again?
> ...


I think it works like any insurance that is if you don't pay you're not covered. My monthly payments is not going towards a savings plan or anything, it's just a premium so if I stopped paying then I would no longer be covered. Saying that I think there are different types of medical aids, in that some of them are like saving plans and in that scenario I am not sure how it would work.


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## concord (Jan 9, 2012)

Medicine in Russia is free that's why I dont really know how all this system works... So basically if your insurance plan doesn't have any savings option you lose all the money you'd been paying for a long time. And that could be a big amount. So insurance company just decalcates your money. Not fair... Anyway we know life is not always fair.


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## Johanna (Apr 13, 2009)

concord said:


> Medicine in Russia is free that's why I dont really know how all this system works... So basically if your insurance plan doesn't have any savings option you lose all the money you'd been paying for a long time. And that could be a big amount. So insurance company just decalcates your money. Not fair... Anyway we know life is not always fair.


concord, Saartjie is correct, if you do not pay, you cannot claim.
Most medical aids have a "savings option" from which all acute medications are paid from.
Dentists, doctors,etc are also usually paid from the savings part of your medical aid 
( in saying that, no all medical aids are the same and it depends on the level of cover you have.)

You are correct, you do lose what you have put into the medical aid if you stop paying into it. Like any other insurance --- medical aid = medical insurance. It pays when you need it.

Hope it clarifies the situation.


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## Karin408 (Aug 12, 2011)

Hi,
I'm in the same situation. I'm staying in SA for more then 3 years now and I always had a German Medical Aid that covered all my medical expenses. I always had to pay upfront and hand in the paperwork. But it just cost me R 500 a month and everything was covered. 
I compared different medical aids and options (Sanlam, Discovery, Bestmed, Momentum, Medshield,....) They were all R1500,00 and more. 
Now I applied for the German Medical Aid (DKV) again. 
I was really surprised when I received the first quotations for the SA Medical Aid, this explains why so many people can not afford to have a medical aid...


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## Uvongo (Apr 12, 2012)

Hi All,

I'd been searching for medical insurances for quite a while before I got an insurance with Momentum. I must say it was quite an exercise to compare them all!! Eventually we realized that you'll never know where you win and where you loose, so after few positive comments from friends we decided to try Custom Option with Momentum (they tailored the package according to our needs). 

We pay R1690 for both of us (my husband and I). In case somebody is interested, this is what we get for it:

1. Full unlimited hospital cover in Momentum Associated Private hospitals, including surgeries, emergencies, maternity and etc, plus international cover for emergencies (including dental, eyes, terrorism and etc) for 5.8 million rand. 

2. Unlimited MRI and CT scans, co-payment R1700 per scan. 

3. 53 specialized procedures, like gastroscopy, laparoscopy, angiogram, ECG and etc. that can be done in and out of hospital.

4. Oncology - R265 000 cover per year

5. Cover for 26 chronic conditions in a State hospital (we don't use any chronic medications, that's why we chose State hospital, otherwise one can chose Private and thus pay higher premium)

6. Health platform benefit - free yearly examinations, like mammogram, blood tests, pregnancy scans and tests and etc, and a bunch of other benefits.

For day-to-day things, like GPs, optometrists and stuff we pay out of our own pocket.

You can change your package once a year before the renewal date, according to your needs, i.e. switch from State to Private hospital and stuff like that.

Hope it helps!

Cheers!


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## 2fargone (Jun 14, 2011)

Uvongo said:


> Hi All,
> 
> I'd been searching for medical insurances for quite a while before I got an insurance with Momentum. I must say it was quite an exercise to compare them all!! Eventually we realized that you'll never know where you win and where you loose, so after few positive comments from friends we decided to try Custom Option with Momentum (they tailored the package according to our needs).
> 
> ...


Hello!!!

Wow!! Thank you very helpful!! Was there a website you went to that helps compare all the medical aids? Or was there a number you called? It seems when I call or to a Medical aid directly they try to sell me their highest package. Just didn't know if there was someone I could work with.

Thanks again for posting this!! Very helpful!!


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## Uvongo (Apr 12, 2012)

Poopsie23 said:


> Hello!!!
> 
> Wow!! Thank you very helpful!! Was there a website you went to that helps compare all the medical aids? Or was there a number you called? It seems when I call or to a Medical aid directly they try to sell me their highest package. Just didn't know if there was someone I could work with.
> 
> Thanks again for posting this!! Very helpful!!


Hi Poopsie23,
Not sure if you got my previous message as I don't see on the screen.

This website medicalaidcomparisons.co.za helped a lot.

Also, when I was no longer able to read through all those manuals, I just left my phone number on Momentum website (for no particular reason ) and they called me back. I had like half an hour consultation on the phone with a very knowledgeable guy, after which he sent me a quote, and everything looked fine, so we decided to give it a try. I can't say anything about their service when it comes to claims, as we didn't get a chance yet, knock on wood!!!! But from what I heard they are pretty good at delivering their promises! Good luck!


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## 2fargone (Jun 14, 2011)

Uvongo said:


> Hi Poopsie23,
> Not sure if you got my previous message as I don't see on the screen.
> 
> This website medicalaidcomparisons.co.za helped a lot.
> ...


Thanks Uvongo!

I did get your previous message. Thanks soo much for all this information it really helps a lot!!!!


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## concord (Jan 9, 2012)

That sounds cheap! My husband pays over R1 000 for Discovery med insurance for the same services... Maybe sometimes you pay more for additional perks (like cheaper cinema tickets - with a Discovery card you pay R12 instead of R40. Then I think you get additional Smart points with P'n'P Smart shopper program).


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## liako (Jul 8, 2013)

Can you pls try prime meridian insurance.


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## shantelW (Jul 31, 2013)

Discovery key care is not worth it. It really is a waste of money


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