Read our five case studies to learn how to choose a medical aid option based on your health profile.

Married Male (Age 45)

Case study 1: Mr A, Managing Director of a software company

Age: 45

Income: R38 000 per month after all deductions

Employer contribution to medical aid: 50%

Family situation: Married with three children: 14 year old son, 12 year old daughter, 2 year old son. Wife does not work.

Financial responsibilities: Access bond on the house – last payment was made two years ago, but the bond remains active in the event of unforeseen expenses; car loan for two vehicles (R6 000 in total); school fees for two children (R3 000 per month, increasing to R3 800 per month from next year, when the youngest child goes to pre-school ); household expenses (R3 000 per month); spending allowances for Mr and Mrs A (R5 000); investment and savings (roughly R8 000 per month).

Health status of family members: Mr A is a healthy, with no chronic conditions. However, there is a family history of high blood pressure. He regularly visits the gym. Mrs A is also healthy, but last year underwent some tests for abnormal cell growth. The tests came back clear. She is a vegetarian, takes daily health supplements and prefers natural medicine. Their eldest child, John (14) plays soccer and cricket at school, and has no serious medical conditions. The middle child, Eliza (12) plays netball at school, is healthy, and also has no serious medical conditions. The youngest, Brian (2), is a healthy toddler who will begin pre-school in the New Year.

Medical aid requirements

The ideal medical aid plan for Mr A, based on his financial, health and family status, would be a comprehensive medical aid plan that offers both day-to-day and hospital benefits. Not only is Mr A able to afford this type of medical plan, but his employer will subsidise half the cost, making it a financially viable medical aid option for him.

Mr A and his elder children are fit and healthy, and are unlikely to require much day to day medical care. However, he has a family history of high blood pressure, and this may require management in future. Mrs A and their small son (who is likely to come into contact with more illnesses once he starts going to pre-school) may require increased levels of medical care or attention in the near future. A comprehensive plan offering a mix of hospital and daily cover is ideal for this family unit.

Medical aid plan recommendation: The Selfmed 80% medical aid plan.

Married Male (Age 34)

Case study 2: Mr vdM, a driver for a courier company

Age: 34

Income: approximately R2 700 per month after all deductions

Employer contribution to medical aid: 85%

Family situation: Mr vdM is married and his wife works part-time. Her income is R1 000 per month. They have an 8-month old son, and Mr vdM’s parents live with them and are financially dependent on him.

Financial responsibilities: Mr vdM rents a house (R1 050 per month), and has travel expenses of roughly R250 per month. Mrs vdM requires chronic medication for diabetes (R300 per month), and household expenses amount to R750 each month. Mr vdM spends his entire salary every month, and does not have any savings or investments.

Health status of family members: Mr vdM is healthy and has no chronic or serious illnesses. His wife suffers from diabetes. Their baby is generally healthy, though occasionally experiences colds, and has a recurring cough.

Medical aid requirements

Mr vdM needs to get his family onto a medical aid plan as soon as possible. Given his limited income, he can start with a hospital plan. Because his employer will contribute 85% towards his medical aid costs, Mr vdM would pay roughly R350 for himself, his wife and their baby to be covered by Selfmed’s hospital plan.

It is important for Mr vdM to be informed that his wife’s condition is a PMB (prescribed minimum benefit condition), which means that she can get medication and treatment from any state facility (based on the medical aid scheme rules and designated service providers). This will save the family R300 each month, which can be used towards medical aid costs.

It’s also recommended that Mr vdM considers saving some money each month, even if it is just a small amount. This will ensure that if their son requires medical attention that isn’t covered by the hospital plan that they will have the money to pay for doctors’ visits.

Medical aid plan recommendation: Selfmed’s MEDXII hospital plan.

Single Mother (Age 27)

Case study 3: Ms K, a personal assistant at an advertising company

Age: 27

Income: R7 800 per month after all deductions

Employer contribution to medical aid: None

Family situation: Ms K is a single mother to a 3-year-old daughter

Financial responsibilities: Car loan (R1 000 per month); medication for her daughter’s ADD (R950 per month). She has no other expenses, as she lives with her parents.

Health status of family members: Ms K has no chronic illnesses, but she suffers from bronchitis and tonsillitis every winter. There is a history of diabetes on her father’s side. Her daughter, Lira (3) was diagnosed with Attention Deficit Disorder last year, and is given Ritalin to manage the condition.

Medical aid requirements

It is highly recommended that Ms K take out comprehensive medical aid cover with chronic benefits for herself and her daughter. Ms K frequently visits doctors, due to her recurring sicknesses in winter, and a comprehensive medical aid plan will cover the costs of doctors’ visits. Furthermore, ADD is not recognised as a PMB, which means it is not covered by hospital plans or basic comprehensive plans. However, it would be covered by medical aid plans that offer chronic medication benefits.

Although her employer does not contribute to her medical aid expenses, Ms K has sufficient disposable income to pay for a medical aid plan. Selfmed’s Med Elite medical aid plan, for example, offers comprehensive medical aid cover as well as chronic medication cover, and will cost her roughly R3 000 per month to cover both herself and her daughter. It will also cover the cost of her daughter’s medication, which means that she’ll essentially be paying only R2 050 extra per month (as she already spends R950 per month on her daughter’s medication).

Medical aid plan recommendation: Selfmed’s MED Elite medical aid plan with chronic benefits.

Divorced Mother (Age 52)

Case study 4: Mrs D, a sales manager at an IT company

Age: 52

Income: R20 000 per month after all deductions

Employer contribution to medical aid: 33%

Family situation: Mrs D is a divorced mother of two daughters. Her elder daughter is 22 years old, and her younger daughter is 16 years old. The divorce settlement states that the children’s medical aid expenses need to be covered by their father, up to an amount of R2 000 per month, with an annual increase of 10%.

Financial responsibilities: Monthly bond repayments (R5 000), monthly car repayments (R1 200); shared school and university fees (R900); savings and investments (R2 500).

Health status of family members: Mrs D was diagnosed with osteoporosis and is currently on hormone replacement therapy. Her elder daughter, Susan, is a university student and plays netball for the varsity team. She is healthy and has no serious illnesses or chronic diseases. Her younger daughter, Nicola, has suffered from asthma since early childhood. She has no other serious illnesses, and is currently undergoing orthodontic treatment.

Medical aid requirements

Given the fact that both Mrs D and her younger daughter suffer from chronic medical conditions, a comprehensive medical aid plan offering chronic medication benefits is essential for both of them. A comprehensive medical aid plan is likely to offer orthodontic benefits too. Because Nicola is only 16 years old, she will pay minor dependant rates, which are significantly lower than adult rates.
Susan, however, is healthy and is unlikely to require expensive medical care or treatment, except in the case of an emergency. Hence, a hospital plan would be sufficient for her, as it will provide unlimited hospital benefits in the event of an emergency, but will not offer any expensive benefits that she does not need.
Because both Mrs D’s employer and her ex-husband contribute to her medical aid costs, it will be affordable for Mrs D to take out medical aid cover for herself and for her daughters.

Medical aid plan recommendations: Selfmed’s MED Elite medical aid plan is recommended for Mrs D and her younger daughter, while Selfmed’s hospital plan, MEDXXI, will be ideal for her elder daughter.

Co-habiting (Single 27 year old)

Case study 5: Mr G, assistant manager of a sporting goods supplier

Age: 27

Income: R12 000 per month after all deductions

Employer contribution to medical aid: none

Family situation: Single; recently moved in with his long-term girlfriend

Financial responsibilities: Monthly rent (R3 000); car loan (R1 500 per month); household expenses (R1 500 per month); petrol (R1 000 per month); insurance and savings (R800 per month).

Health status: Mr G is fit, healthy and active, and has no history of family illnesses. He plays amateur rugby every week, and often participates in rugby matches.

Medical aid requirements

Because Mr G is young and healthy, he has few medical expenses and thus does not need to spend a lot of money on a comprehensive medical aid plan. However, every individual should have medical aid – especially one who is exposed to potential injury, such as a rugby accident. A hospital plan would be the ideal type of medical aid cover for Mr G, as it will provide unlimited hospital benefits in the event of injury or accident, but does not offer unnecessary day-to-day benefits. Hospital plans are affordable, and even though Mr G’s employer does not contribute to his medical aid costs, he will be able to afford on his budget.

Medical aid plan recommendation: Selfmed’s MEDXII hospital plan.