The medical aid industry is known for confounding consumers with all sorts of complex terms. Among the most confusing of all are references to medical aid, or medical scheme, rates.
Schemes and plans are quoted as covering the costs of in-hospital procedures up to 100%, 200% or 300% of the scheme rate or tariff. You might reasonably think this means that medical aid will cover all healthcare expenses, up to 100% or more. However, this is far from the case.
In this article, we focus on medical aid rates, how they’re calculated and what impact the different tariff options have on medical aid members.
The truth about medical tariffs
Medical expenses in South Africa are not regulated. Doctors, specialists and hospitals can charge what they want, provided the fees are deemed to offer “fair value” to the consumer.
The Department of Health has, however, published a list of recommended tariffs pertaining to specific treatments and procedures conducted i