While medical aid schemes’ call centres are generally good in providing you with information, some members seek the assistance of a broker to help them choose a medical scheme, or to understand some of the intricacies once they try and claim from their scheme, or encounter other problems.


The following tips may help you when choosing/dealing with a broker:

  1. How many schemes?– You have the right to ask your broker how many different schemes s/he is contracted to. The bigger the number, the greater the chances of you getting independent recommendations that really will suit your needs.

There are 23 open schemes in South Africa – it is unlikely that a broker will be contracted to all of them, but if there are only a handful on his/her list, get another broker.

  1. Choose a specialist– Bearing in mind the complexities of the medical aid industry, it is best to choose a broker who exclusively sells medical aids and not one with a wide range of other products as well, such as life insurance, income protection, short-term insurance and so forth.

You need a specialist who is up to date with developments in the field; not someone who may use the medical scheme to get you on board as a client and then try and sell you all sorts of other products.

  1. Changing health needs– As benefit options and benefit ranges change, so do your health requirements. An entry-level plan might have been fine for you when you were 25 and healthy, but as you grow older and/or you get a family, your healthcare needs may change.

A good broker will alert you to the options that are best suited to your needs.

  1. A sudden specific health issue – If you suddenly develop a particular, health problem (such as heart or dental problems or diabetes) a good broker will have the information available on which schemes and which options will give you the best benefits and maximum cover for your particular health problems.

It might require a change of scheme – a process which an efficient broker can handle seamlessly.Changing fortunes– Ask about more affordable options if your financial situation changes. It is a lot better for you to have a basic hospital plan than to cancel your medical scheme membership altogether.

  1. What can I claim? – A good broker will know what a scheme is obliged to pay for according to the Medical Schemes Act. He/she will have a thorough understanding of the provisions and legal requirements and the benefits on all the different options.

Sometimes members fail to claim for certain medical treatments, simply because they are unaware of the fact that they can.

  1. Fighting on your behalf – A broker is obliged to negotiate with the scheme on your behalf if there is a dispute about a specific claim. Few individual members have an overall in-depth understanding of benefit details – that is what your broker gets paid for.
  2. An early-warning system– If the scheme of which you are a member runs into financial trouble, you want to know about it early enough so that you can switch schemes and not be left without cover. By law, a scheme has to have 25% of its contributions in reserve.

When it drops much below this, alarm bells should be ringing. Letting you know this is the job of the broker.

  1. A safeguard– Many products, such as hospital cash-back plans, are not covered by the provisions of the Medical Schemes Act. Many people only realise this when they try and claim for medical costs unsuccessfully.

A knowledgeable broker should be able to counteract the beguiling advertising campaigns of many of these products.

  1. Regular contact– A good broker will contact you every year to find out if your needs have changed and to inform you of changes in the field of medical schemes which are relevant to you.

He or she should also keep you up to date of changes in benefit structures, changes in options within your scheme, or possible alternatives (possibly on other schemes) which might be better suited to your needs.