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6.2 Medical Scheme Analysis

The aim of the analysis of a medical scheme is to select a portfolio of medical schemes and options that the broker feels are sustainable, as well as provide good benefits and value. The analysis furthermore will provide an understanding of the benefits and restrictions within every option of the various medical schemes. Every option […]

6.1 Introduction

In order for a broker to advise a client, a continuous process of evaluation of medical schemes needs to be undertaken. Medical schemes usually may adapt the rules and contributions for a new benefit year. This may impact on the suitability to the needs or affordability of the client. All these changes to the rules […]

5.7 Tax Treatment of Medical Savings Account

Withdrawals from the MSA for purposes other than relevant health service are taxable. Transfer of funds to the member from the MSA after cancellation of membership of the medical scheme is taxable. Transfer of the MSA to an MSA of another medical scheme when changing medical schemes option, is not taxable. Interest received on the […]

5.6 Tax Treatment of Medical Scheme Contributions and Medical Expenses

In 2012, the South African Reserve Bank (SARS) changed the way it treats medical expenses and introduced a medical scheme fee tax credit. The medical tax credit consists of the following two amounts: The medical scheme fees tax credit. The additional medical expenses tax credit. These tax credits are considered in the subsections following: A. […]

5.5 Exclusions

Medical schemes make provision in the rules for a list of exclusions. There will be no benefits available for the services listed under the Exclusion List. The exclusion list of scheme options (Annexure C of scheme rules) deals with limitation of entitlements. Exclusions usually include the following: Injuries sustained in professional and speed contests, unless […]

5.4 Wellness/Loyalty Programmes

Although the so-called loyalty programmes do not form part of a medical scheme, certain clients may want to choose an option that provides access to these programmes at an additional fee. Wellness programmes are not administered by medical schemes. Although loyalty programmes can encourage healthy living, being a member do not reduce monthly medical aid […]

5.3 Contribution Determination

Benefit categories are used to design a product option. Most important is that each option, however limited in benefits, will include the Prescribed Minimum Benefits (PMB). Member contribution of an option will be determined by the following factors: How rich the benefits within the option are, in other words, to what extent the financial limits […]

5.2 Most Common Options

Most medical schemes offer standard combinations of benefits in their options, but limits, exclusions, co-payments and reimbursement rates vary. The most common options are considered in the subsections following. A. Comprehensive plans Comprehensive plans usually provide unlimited hospital cover and comprehensive day-to-day benefits. The plans can also include a personal medical savings account. B. Essential plans […]

5.1 Introduction

Benefit categories are used to design a product option. Most important is that each option, however limited in benefits, will include the Prescribed Minimum Benefits (PMB). There are distinct categories of benefits used in benefit design. It is important to understand the different categories and the benefits typically covered. These categories are used to design […]

4.14 Waiting Period

A waiting period refers to a period during which the member pays a contribution towards the medical scheme joined but during which time the member and/or dependents are not entitled to benefits. There are two kinds of waiting periods: A general waiting period of up to three 3 months. A condition-specific waiting period of up […]