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.

Changes that will come into effect from 1 March 2014

      • “It is proposed that the remaining aspects of the deduction system for medical expenses be replaced with the tax credit system in respect of all medical scheme contributions and qualifying medical expenses for all taxpayers. Under this system, a set level of credits will be allowed for medical aid contributions (with annual upward adjustments), with certain excess contributions and out-of-pocket expenses also eligible for tax credits (instead of deductions). “
      • “All credits will remain non-refundable. Like the current system for deductions, application of the tax credit system will fall into three categories: (i) taxpayers of age 65 and above, (ii) taxpayers with a disability factor under age 65 and (iii) all remaining taxpayers. “

“It is proposed that taxpayers of 65 years of age and above will become entitled to medical expenses tax credits in lieu of the current deduction system for all medical-related items. Other than the standard monthly medical scheme credits, the credits will generally be set at a 33.3 per cent level. More specifically, the medical credits will be calculated as follows:

      • The standard monthly medical scheme credits for the taxpayer, spouse and dependents;
      • 33.3 per cent credits for medical scheme fees that exceed three times the standard medical scheme credits; and
      • 33.3 per cent credits for all qualifying medical expenses (other than medical scheme contributions). “

Like current law, a separate calculation exists for taxpayers below 65 years of age if the taxpayer, his/her spouse and/or child is a person with a disability. Other than the standard monthly medical scheme credits, the credits will generally be set at a 33.3 per cent level. More specifically, the medical credits will be calculated as follows:

      • The standard monthly medical scheme credits for the taxpayer, spouse and dependents;
      • 33.3 per cent credits for medical scheme fees that exceed three times the standard medical scheme credits; and
      • 33.3 per cent credits for all qualifying medical expenses (other than medical scheme contributions).

Like current law, a separate calculation exists for taxpayers below 65 years of age in the residual category (if the taxpayer, spouse or children are not persons with a disability)

      • These credits will generally be set at a 25 per cent level. More specifically, these medical credits will be calculated as follows:
      • The standard monthly medical scheme credits for the taxpayer, spouse and dependents; and
      • 25 per cent credits of the value of the amount by which the aggregate of the medical scheme fees that exceed four times the standard medical scheme credits, and all qualifying medical expenses (other than medical scheme contributions), exceed 7.5 per cent of the taxpayer’s taxable income.

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)



Short Term Insurance

Your house or buildings, vehicle, personal and business items are all a vital part of your life. If anything happens to them you can have peace of mind, knowing that you are properly protected...

Medical Aid

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...

Tax & Accounting

When you retire and you are a member of a provident fund or provident preservation fund, your retirement interest is usually paid by way of a lump sum unless the...