Should I upgrade my medical aid if NHI is coming?

Last updated on 19th November, 2024 at 09:38 am

It’s medical aid renewal season again, and if you’re wondering how the National Health Insurance should impact your decision, we’ve got you covered.

Reading time: 6 minutes

In this article you’ll learn:

• When to review medical aid coverage for next year
• The difference between medical aid and health insurance
• The impact of the NHI on medical coverage

Medical scheme members are weighing up their options for 2025, but with the National Health Insurance (NHI) dominating news headlines this year, you may be wondering whether to continue with your current coverage. We talked to Medscheme’s Fezeka Nompumza, Managing Executive: Clinical Risk and Advisory, and Stephanie van Niekerk, a Healthcare Actuary and Senior Manager: Integrated Product Development and Technical Marketing, to get their advice.

Crunch time for medical aid decisions

Medical schemes launch their benefits and contribution changes for the upcoming year in September and October. Since most schemes only allow you to change your option at year-end, usually in December, it’s essential for members to review their plans now. Typically, movement during the year is restricted.

Between now and the end of the year, members can review and make changes to their medical aid option. “It’s about making sure your coverage matches your health and life stage,” says Van Niekerk. Members can update beneficiaries, switch plans or adjust their level of coverage. “Affordability is often a key factor in these decisions, but the goal should be to ensure there’s a balance between cost and sufficient healthcare cover.”

However, Fedhealth Medical Scheme, the official Sanlam Healthcare partner, administered by Medscheme, offers the flexibility to upgrade during the year within 30 days of a life-changing event like pregnancy or a serious illness. It’s a unique benefit that provides extra security to members, says Van Niekerk.

What about the National Health Insurance (NHI)?

Many consumers are considering downgrading or otherwise changing their medical aid, especially with the NHI’s introduction. But Medscheme is clear that nothing is changing yet. “Your current medical scheme cover will continue unaffected for the foreseeable future. NHI isn’t immediately available, despite what you may hear in the media. You still need your medical scheme to ensure access to your benefits,” says Nompumza.

While the NHI is set to change the healthcare landscape in the long term, Medscheme reiterates that the implementation will be phased, and it’ll take many years for it to fully roll out. “We can expect government to work on regulations, which will give us more detail on what the NHI will cover in its different phases, but for now, it’s business as usual,” says Nompumza. Members should continue paying their medical scheme premiums to maintain access to their benefits.

While NHI may reduce the role of medical schemes in the future, this will only happen once the system is fully implemented. Until then, the status quo remains, she says. “Medical aid is still essential for ensuring access to comprehensive healthcare, and no changes to the current system are imminent.”

What about health insurance products?

Health insurance has become popular both among medical aid members and those without. Gap cover is only available to members with medical aid cover in place and helps with the shortfall between what medical schemes pay and what healthcare providers charge, while primary health insurance (PHI) covers day-to-day medical expenses like GP, dental and optometry visits.

However, Van Niekerk warns that these products aren’t a replacement for medical aid: “Health insurance products don’t cover Prescribed Minimum Benefits (PMBs), which are required by law for medical schemes.”

Find out more about how to get the most out of your medical aid: read 4 Medical aid benefits you probably didn’t know you have.

With Sanlam Health’s bundled healthcare solutions, combining medical scheme, gap and PHI cover, you can tailor solutions according to your specific needs while saving costs and increasing value. You can combine products from Fedhealth, the Sanlam approved medical scheme, Sanlam Gap and Sanlam Primary Health Insurance.

The bottom line? The NHI will eventually bring significant changes to the healthcare system, but this shouldn’t play a role in your decisions about medical aid for 2025. Rather, focus on determining the right cover for your needs.