Medical Aid Benefit Comparison

Helfin can assist you in planning for a healthy future through the right medical aid package for you and your family.

Helfin does not charge a fee to administrate medical aid memberships as a commission is already included in the member’s monthly contribution to the scheme.  If this commission is not paid to an appointed broker the medical scheme keeps the amount for themselves.

Helfin can assist with difficult claims, hospital authorisations, general queries, upgrades and downgrades.  We can also review your current option at the end of each year, when, if needed, we can do a comparison should you wish to see if you are on the best possible scheme and option for your specific circumstances.

We have contracts with the following schemes:

Medical Scheme Brochures

Tax and Medical Aids

Medical Scheme Fees Tax Credit

A Medical Scheme Fees Tax Credit (also known as an “MTC”) is a rebate which, in itself, is non-refundable, but which is used to reduce the normal tax a person pays. Any portion that is not allowed in the current year (usually that amount which exceeds the normal tax payable) can’t be carried over to the next year of assessment. The MTC applies for years of assessment starting on or after 1 March 2012 (from the 2013 year of assessment). 

The MTC applies to fees paid by a taxpayer to a registered medical scheme (or similar fund outside South Africa) for that taxpayer and any “dependants” (as defined in section 6B(1) of the Income Tax Act, 1962).  
 
This MTC seeks to bring about greater fairness and help achieve greater equality in the treatment of medical expenses across all income groups.
 
The MTC is a fixed monthly amount which increases according to the number of dependants:
 
2018/2019 year of assessment
(1 March 2018 – 28 February 2019)
​ 2019/2020 year of assessment
(1 March 2019 – 29 February 2020)
​R310 per month for the taxpayer who paid the medical scheme contributions; or for a member or dependant of a medical scheme or fund where the taxpayer him- or herself is not a member of a medical scheme or fund.​R310 per month for the taxpayer who paid the medical scheme contributions or; for a member or dependant of a medical scheme or fund where the taxpayer him- or herself is not a member of a medical scheme or fund.
​R620 per month for the taxpayer and one dependant; or R620 in respect of two dependants where the taxpayer him- or herself is not a member of a medical scheme or fund.​​R620 per month for the taxpayer and one dependant; or R620 in respect of two dependants where the taxpayer him- or herself is not a member of a medical scheme or fund.
​R209 per month for each additional dependant(s)​​R209 per month for each additional dependant(s)
 See more tax rates here.
The MTC will effectively impact both the employer and the employee. This credit must be taken into account by the employer when calculating the amount of employees’ tax to be deducted or withheld from the employees’ remuneration.
 
Individuals who have not had their MTC taken into account by an employer (for example, an individual who is retired and receives a pension; or an individual who is self-employed) can claim the MTC on assessment by submission of an annual income tax return.
 
In addition to the MTC, an individual may also claim an Additional Medical Expenses Tax Credit for certain qualifying medical expenses, subject to limitation. See more information on claiming these medical expenses (Additional Medical Expenses Tax Credit). Also refer to the Guide on the Determination of Medical Tax Credits for further information.

Medical Tax Credit Rates

The Medical Scheme Fees Tax Credit Medical Scheme Fees Tax Credit (MTC) was introduced from 1 March 2012 (the 2013 tax year) but didn’t affect all categories of taxpayers at once. There are two different start dates depending on the age of the taxpayer:
  • Taxpayers younger than 65 – converted to the Medical Tax Credit from 1 March 2012
  • Taxpayers 65 and older  – converted to the Medical Tax Credit from 1 March 2014
​Per month (R)​20182017​​​2016​20152014​​​2013​
​For the taxpayer who paid the medical scheme contributions​R303​R286R270​R257​R242​R230
​For the first dependant​R303​R286​R270​R257​R242​R230
​For each additional dependant(s)​R204​R192​R181R​172​R162​R154
​Per month (R)​20202019
​For the taxpayer; or for a member or dependant of a medical scheme or fund where the taxpayer him- or herself is not a member of a medical scheme or fund​R310​R310
​​For  the taxpayer and one dependant; or in respect of two dependants where the taxpayer him- or herself is not a member of a medical scheme or fund​R620​R620
​​For each additional dependant(s)​R209​R209

Claiming Medical Expenses (Additional Medical Expenses Tax Credit)

An Additional Medical Expenses Tax Credit (also known as an “AMTC”) is a rebate which, in itself, is non-refundable, but which is used to reduce the normal tax a person pays. Any portion that is not allowed in the current year (usually that amount which exceeds the normal tax payable) can’t be carried over to the next year of assessment. It applies for years of assessment starting on or after 1 March 2014 (from the 2015 year of assessment) and is mostly calculated against qualifying medical expenses (for example, certain ‘out-of-pocket’ expenses) paid for you and any dependant. It is a rebate given in addition to the medical scheme fees tax credit (MTC), but is subject to limitation.  

These are amounts paid and not recoverable during the year of assessment in respect of you or any dependant, and include:
  • Services rendered and medicines supplied by any duly registered medical practitioner, dentist, optometrist, homeopath, naturopath, osteopath, herbalist, physiotherapist, chiropractor or orthopaedist;
  • Hospitalisation in a registered hospital or nursing home;
  • Home nursing by a registered nurse, midwife or nursing assistant, including services supplied by any nursing agency;
  • Medicines prescribed by any duly registered physician (as listed above) and acquired from any duly registered pharmacist;
  • Expenditure incurred outside South Africa in respect of services rendered or medicines supplied which are substantially similar to the services and medicines listed above;
  • Any expenses prescribed by the Commissioner and necessarily incurred as a result of any physical impairment or disability.
A dependant is:
  • A spouse;
  • A child and the child of a spouse (e.g. son, daughter, step son, step daughter, legally adopted child)
    • Who was alive during any portion of the year of assessment, and who on the last day of the year of assessment:
      • Was unmarried and was not or would not, had he or she lived, have been:
        • Older than 18 years
        • Older than 21 years and was entirely or partly dependent for maintenance on the person and has not become liable to pay normal tax for the year
        • Older than 26 years and was entirely or partly dependent for maintenance on the person and has not  become liable to pay normal tax for the year and was a full-time student at an educational institution of a public character; or
      • In the case of any other child, was incapacitated by a disability from maintaining himself or herself and was entirely or partly dependent for maintenance on the person and hasn’t become liable to pay normal tax for that year;
  • Any other member of a person’s family for whom he or she is liable for family care and support (e.g. mother, father, mother-in-law, father-in-law, brother, sister, grandparents, grandchildren); or
  • Any other person who is recognised as a dependant of that person in terms of the rules of a registered medical scheme or fund.
    A dependant is:
    • A spouse;
    • A child and the child of a spouse (e.g. son, daughter, step son, step daughter, legally adopted child)
      • Who was alive during any portion of the year of assessment, and who on the last day of the year of assessment:
        • Was unmarried and was not or would not, had he or she lived, have been:
          • Older than 18 years
          • Older than 21 years and was entirely or partly dependent for maintenance on the person and has not become liable to pay normal tax for the year
          • Older than 26 years and was entirely or partly dependent for maintenance on the person and has not  become liable to pay normal tax for the year and was a full-time student at an educational institution of a public character; or
        • In the case of any other child, was incapacitated by a disability from maintaining himself or herself and was entirely or partly dependent for maintenance on the person and hasn’t become liable to pay normal tax for that year;
    • Any other member of a person’s family for whom he or she is liable for family care and support (e.g. mother, father, mother-in-law, father-in-law, brother, sister, grandparents, grandchildren); or
    • Any other person who is recognised as a dependant of that person in terms of the rules of a registered medical scheme or fund.
The AMTC will depend on a person’s age and whether the person, his or her spouse or his or her child any has a disability as defined.
 
1. A person who is 65 years of age or older may claim the following AMTC:
  • 33,3% of the fees paid by the person to a registered medical scheme (or similar qualifying foreign fund) as exceeds three times the amount of the MTC to which that person is entitled; plus
  • 33,3% of the qualifying medical expenses paid by the person (for example out-of-pocket expenses).
2. A person who is, or whose spouse or child is a person with a disability, may claim the following AMTC:
  • 33,3% of the fees paid by the person to a registered medical scheme (or similar qualifying foreign fund) as exceeds three times the amount of the MTC to which that person is entitled; plus
  • 33,3% of the qualifying medical expenses paid by the person (for example, certain out-of-pocket expenses).

Note that this concession is only available where the person, or his or her spouse or child is a person with a disability. It is not available in respect of any other dependant with a disability (for example, the person’s mother).

3. All other persons who do not qualify in the two categories above, may claim the following AMTC:

  • 25% of the amount by which the sum of the amounts listed below exceeds 7,5% of the person’s taxable income (excluding retirement fund lump sum benefits, retirement fund lump sum withdrawal benefits, and severance benefits) before taking into account this AMTC:

(i) All fees paid by the person to a registered medical scheme (or similar qualifying foreign fund) as exceeds four times the amount of the MTC to which that person is entitled; and

(ii) The qualifying medical expenses paid by the person (for example, certain out-of-pocket expenses).

Important: The amounts may vary depending on the number of months in the tax year that a taxpayer and dependants are members of a medical scheme or fund.

Information sourced from SARS website

Link 1Link 2  Link 3

Top Tip: Stay informed by visiting the website regularly, or even better, subscribe to SARS RSS feeds and you will be alerted when any changes are made to the pages you subscribe to.

What is "Medical Gap Cover?"

You should never assume that your medical scheme will cover the full cost for operations and procedures done in hospital. Medical schemes pay doctors and specialists at a rate of between 100% and 300%, but the reality is that many medical practitioners charge in excess of these rates which could result in a gap between the actual cost and the amount that the medical schemes pay. You will be held liable for this shortfall.

Furthermore, medical schemes may impose upfront co-payments for certain in- and out-of-hospital procedures, depending on your medical scheme option, these co-payments are either payable from your medical savings account or as an out-of-pocket expense.

With our chosen GAP cover policy, these unforeseen medical expenses could be taken care of through a variety of options, for an affordable premium per month.

When it comes to choosing the right option within a medical scheme, it is very important that you ask yourself the following questions first:

  • How much do you want to spend on your monthly premium?
  • Do you want an option which is income and network-based – meaning you must make use of specific service providers or do you want the freedom of choice?
  • Do you only want a Hospital Plan or an option that offers out of Hospital benefits too?
  • Does anyone make use of any chronic medication and is that condition covered on the option you consider joining?

Once these questions have been answered, you can start looking at the specific options that will suit your needs and pocket.

There are 5 specific groupings of options within most medical schemes and they are as follows:

  • Capitation (income-based) Network options
  • Hospital Plan options
  • New Generation options
  • Comprehensive options
  • Traditional options

When choosing a medical scheme, it is important to keep the following in mind:

  • The average age of the medical aid scheme.
  • Pensioner ratio of the scheme.
  • The solvency ratio of the scheme.
  • Claims processing.
  • The average annual increase for the past 5 years.

These options are income-based, meaning that the monthly premium is determined by the Gross salary of the main member OR the highest household income between the main member and spouse/partner.

These options offer in- and out-of-hospital benefits, but services must be obtained from specifically designated service providers (Hospitals. GP’s, Dentists, Optometrist etc.) and you don’t have freedom of choice. The benefits of these options are very limited and it is very important that the member takes note of the exclusions on these options.

These options also cover the 26 PMB Chronic conditions as listed in the Medical Scheme’s Act.

The Hospital Plan of registered South African medical aid schemes must not be compared to Hospital Insurance, because there are big differences. Medical Aid Schemes Schemes Hospital Plan’s cover you from day one, covers PMB procedures and there is no daily rand limit.

These plans are there to cover you for Hospital events. All out of Hospital benefits (GP & Specialist consultations, prescribed medication, dentistry etc.) is paid from the members own pocket. These options also cover the 27 PMB chronic conditions as listed in the Medical Scheme’s Act.

This is an option which offers in- and out-of-hospital benefits. The out of Hospital benefits (GP & Specialist consultations, prescribed medication etc.) is paid from your Medical Savings Account.

The Savings account is built into your total monthly contribution which is pro-rated and available upfront for the year.

Once this Savings account has been depleted, the member will have to pay for out of Hospital expenses up until the 31st December that year. The member will be allocated a full year’s Savings again on the 1st of January of the following year.

Should your Savings not be depleted by the 31st December, it will accumulate and carried over to the following year.

These options also cover the 26 PMB Chronic conditions as listed in the Medical Scheme’s Act.

Comprehensive options offer Hospital benefits, out of Hospital benefits (subject to available Savings) and they also cover more chronic conditions i.e. (between 50 and 60 conditions).

The Savings component works exactly the same as the New Generation options listed above.

The difference, however, is that comprehensive options have a Self-Payment Gap as well as a Threshold benefit, which offers the member more out of Hospital benefits, should it be reached.

These options are for members who claim a lot and have high chronic medication use.

Traditional options are also comprehensive as explained above, but they do not have a Savings component.

Instead, they offer you Rand limits per “out of Hospital event” or a limited amount of consultations. This means that you can, for example, have R5 000 per year for GP consultations or 15 consultations.

These limits/benefits will be applicable to GP’s, Specialists, Dentistry, Optometry, Prescribed Medication etc.

The big difference between this and a Savings component is that if the benefits are not depleted by the 31st December, it will fall away and not get carried over to the following year, where your savings will.

Health Services Medical Cover Needs Analysis and Medical History Declaration

Section 1: Personal details


Section 2: Financial information


Please find an explanation of Cover options on the first two pages of this document


Section 3: Dependants and medical details


Do you or your dependants suffer from any of the following Chronic Diseases (please tick where applicable)



Medical Aid Benefit Comparison

Helfin can assist you in planning for a healthy future through the right medical aid package for you and your family.

Helfin does not charge a fee to administrate medical aid memberships as a commission is already included in the member’s monthly contribution to the scheme.  If this commission is not paid to an appointed broker the medical scheme keeps the amount for themselves.

Helfin can assist with difficult claims, hospital authorisations, general queries, upgrades and downgrades.  We can also review your current option at the end of each year, when, if needed, we can do a comparison should you wish to see if you are on the best possible scheme and option for your specific circumstances.

We have contracts with the following schemes:

When it comes to choosing the right option within a medical scheme, it is very important that you ask yourself the following questions first:

  • How much do you want to spend on your monthly premium?
  • Do you want an option which is income and network-based – meaning you must make use of specific service providers or do you want the freedom of choice?
  • Do you only want a Hospital Plan or an option that offers out of Hospital benefits too?
  • Does anyone make use of any chronic medication and is that condition covered on the option you consider joining?

Once these questions have been answered, you can start looking at the specific options that will suit your needs and pocket.

There are 5 specific groupings of options within most medical schemes and they are as follows:
• Capitation (income-based) Network options
• Hospital Plan options
• New Generation options
• Comprehensive options
• Traditional options

When choosing a medical scheme, it is important to keep the following in mind:
• The average age of the medical aid scheme.
• Pensioner ratio of the scheme.
• The solvency ratio of the scheme.
• Claims processing.
• The average annual increase for the past 5 years.

These options are income-based, meaning that the monthly premium is determined by the Gross salary of the main member OR the highest household income between the main member and spouse/partner.

These options offer in- and out-of-hospital benefits, but services must be obtained from specifically designated service providers (Hospitals. GP’s, Dentists, Optometrist etc.) and you don’t have freedom of choice. The benefits of these options are very limited and it is very important that the member takes note of the exclusions on these options.

These options also cover the 26 PMB Chronic conditions as listed in the Medical Scheme’s Act.

The Hospital Plan of registered South African medical aid schemes must not be compared to Hospital Insurance, because there are big differences. Medical Aid Schemes Schemes Hospital Plan’s cover you from day one, covers PMB procedures and there is no daily rand limit.

These plans are there to cover you for Hospital events. All out of Hospital benefits (GP & Specialist consultations, prescribed medication, dentistry etc.) is paid from the members own pocket. These options also cover the 27 PMB chronic conditions as listed in the Medical Scheme’s Act.

This is an option which offers in- and out-of-hospital benefits. The out of Hospital benefits (GP & Specialist consultations, prescribed medication etc.) is paid from your Medical Savings Account.

The Savings account is built into your total monthly contribution which is pro-rated and available upfront for the year.

Once this Savings account has been depleted, the member will have to pay for out of Hospital expenses up until the 31st December that year. The member will be allocated a full year’s Savings again on the 1st of January of the following year.

Should your Savings not be depleted by the 31st December, it will accumulate and carried over to the following year.

These options also cover the 26 PMB Chronic conditions as listed in the Medical Scheme’s Act.

Comprehensive options offer Hospital benefits, out of Hospital benefits (subject to available Savings) and they also cover more chronic conditions i.e. (between 50 and 60 conditions).

The Savings component works exactly the same as the New Generation options listed above.

The difference, however, is that comprehensive options have a Self-Payment Gap as well as a Threshold benefit, which offers the member more out of Hospital benefits, should it be reached.

These options are for members who claim a lot and have high chronic medication use.

Traditional options are also comprehensive as explained above, but they do not have a Savings component.

Instead, they offer you Rand limits per “out of Hospital event” or a limited amount of consultations. This means that you can, for example, have R5 000 per year for GP consultations or 15 consultations.

These limits/benefits will be applicable to GP’s, Specialists, Dentistry, Optometry, Prescribed Medication etc.

The big difference between this and a Savings component is that if the benefits are not depleted by the 31st December, it will fall away and not get carried over to the following year, where your savings will.

WHAT IS “MEDICAL GAP COVER”?

You should never assume that your medical scheme will cover the full cost for operations and procedures done in hospital. Medical schemes pay doctors and specialists at a rate of between 100% and 300%, but the reality is that many medical practitioners charge in excess of these rates which could result in a gap between the actual cost and the amount that the medical schemes pay. You will be held liable for this shortfall.

Furthermore, medical schemes may impose upfront co-payments for certain in- and out-of-hospital procedures, depending on your medical scheme option, these co-payments are either payable from your medical savings account or as an out-of-pocket expense.

With our chosen GAP cover policy, these unforeseen medical expenses could be taken care of through a variety of options, for an affordable premium per month.

Tax and Medical Aids

With ever-increasing medical aid contributions, doctors and dentists’ bills, as well as the escalating cost of medication, it is important to know what tax relief is available to taxpayers in the form of medical deductions.

Only amounts actually paid by tax payers in respect of themselves, their spouses and qualifying children and stepchildren are deductible. Apart from the normal medical expenses, other qualifying medical expenses will include payments to homeopaths, osteopaths, physiotherapists, herbalist’s orthoptists and nursing homes. The claim is limited to the extent that it exceeds 7,5% of the taxpayer’s taxable income (before this deduction), unless the taxpayer has reached the age of 65 years or qualifies for the concession available to taxpayers who are disabled or who have a spouse or child with a disability.

Taxpayers do not have to submit proof of the medical expenses claimed, but must retain the information in case the South African Revenue Service requests this.

Where medical expenses that are substantially the same as medical expenses that would have been deductible if incurred in South Africa, were incurred outside the Republic, such expenses will also be deductible unless the taxpayer was reimbursed for the expenses.

From the 1st of March 2014 a medical Scheme fees tax credit will be introduced. A rebate, to be known as the medical scheme fees tax credit must be deducted from the normal tax payable by a taxpayer who is a natural person.

From 1 March 2014 taxpayers will be subject to a new system which allows only tax credits. Therefore it will no longer be allowed for any deductions against Income Earned, but only tax credits that reduce Tax Payable.

TAXPAYERS UNDER 65:

Fixed credit per month of R 257 (2015 tax year) per dependent for dependents 1 and 2, and R 172 (2015 tax year) for dependents 3, 4, 5 etc. Plus – if their medical aid contribution is greater than 4 x the above credit, then (that difference + out of pocket medical expenses) less an amount equal to 7.5% of your taxable income multiplied by 25% is allowed as a further credit to reduce tax payable.

TAXPAYERS OVER 65 OR WITH DISABLED DEPENDENTS:

Fixed credit per month of R 257 (2015 tax year) per dependent for dependents 1 and 2, and R 172 (2015 tax year) for dependents 3, 4, 5 etc. (same as above) plus – if their medical aid contribution is greater than 3 x the above credit, then (that difference + out of pocket medical expenses) multiplied by 33.3% is allowed as a further credit to reduce tax payable.

 

A taxpayer who makes his or her own contributions to a medical aid independently of an employer may claim the full contributions to the medical aid as well as all medical expenses not covered by the medical aid. The total claim will be limited to an amount as set out above, unless the taxpayer qualifies for the disability concession. Taxpayers who do not belong to a medical aid will be able to claim all medical expenses, subject to the above-mentioned limits.

A taxpayer who makes his or her own contributions to a medical aid independently of an employer may claim the full contributions to the medical aid as well as all medical expenses not covered by the medical aid. The total claim will be limited to an amount as set out above, unless the taxpayer qualifies for the disability concession. Taxpayers who do not belong to a medical aid will be able to claim all medical expenses, subject to the above-mentioned limits.

The person who pays the expenses may claim the deduction. For tax purposes, spouses or persons who quality as spouses in terms of the definition of a spouse in the Income Tax Act should therefore rather have one spouse pay all the medical expenses and not split them. The spouse with the lowest income will have a smaller disallowed portion than the spouse with a higher income. A taxpayer who qualities as a “handicapped person” may claim the excess of the sum of all qualifying outlays over R500. Even if no expenditure has actually been incurred in respect of the handicapped person, all medical expenses paid by the taxpayer will still remain deductible. Deductible expenses are not limited to medical expenses and any expenditure necessarily incurred as a result of a disability is allowed as a deduction.

Medical Cover Needs Analysis and Medical History Declaration

Section 1: Personal details


Section 2: Financial information


Please find an explanation of Cover options on the first two pages of this document


Section 3: Dependants and medical details


Do you or your dependants suffer from any of the following Chronic Diseases (please tick where applicable)



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