Most South Africans want medical aid cover to afford private healthcare. Low income earners are no different. Unfortunately medical aid is expensive but schemes have introduced innovative options to ensure that medical aid for low income earners is accessible. Although these medical aid plans have restricted benefits, it still allows low income earners the luxury of private healthcare paid for by a medical aid.

Who is a low income earner?

The definition of a low income earner can vary among different industries. It usually refers to people who earning at the level of the national minimum wage and slightly above it. Most medical schemes consider people R5,000 per month or less as low income earners but this range may also be extended to people who earn less than R8,000 in 2017. These limits change yearly as a rise in wage and inflation can alter the definition of a low income earner.

Without medical aid, low income earners were forced to either attend public health facilities like government hospitals and clinics or self-fund their medical care. The latter is often unaffordable beyond primary healthcare needs for most people within limited financial resources. Therefore a low income medical aid, despite have restricted benefits, is a financial lifeline that allows many South Africans access to quality healthcare that they could otherwise not afford.

Cover on Low Income Medical Aids

It is important to understand how medical aid works. The benefits on a low income medical aid may not always be as extensive and unrestricted on higher medical aid plans. The cover usually limits the members to designated service providers. These are doctors and hospitals within a specific network that is determined by the medical scheme. In other words a low income member cannot visit any doctor or private hospital of their choosing.

A chronic benefit and hospital cover is available on all of these low income medical aid plans. Depending on the plan that a low income earner qualifies for, there may also be out of hospital benefits. This allows the member to see a doctor on an outpatient basis. Any out of hospital specialist treatment can only be authorised if the patient is referred by the designated general practitioner (GP).

Medication is often limited to generic drugs and there may be little to no benefit for auxilliary services like occupational therapists, physiotherapists or psychologists. However, this can vary among medical schemes and the different plan options available on medical aids for low income earners. Hospital cover may also be restricted as well as any diagnostic investigations such as blood tests or scans.

Who Can Join A Low Income Medical Aid?

There are a certain criteria that has to be met in order for a person to qualify for these low income medical aid plans. Simply stating that you are  a low income earner does not necessarily qualify you for the respective options offered by medical scheme. A person has to verify that their income or all sources of income which have to collectively fall within the low income threshold.

Apart from working adults, these low income medical aids are also popular among senior citizens who are retired. Since there is no specific medical aid for pensioners, these low income plans help seniors with a limited retirement income to afford private healthcare. However, low income medical aid plans are subject to same terms as other options. Waiting periods and late joiner penalties may therefore also be applicable apart from salary bracket.


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