The premium increases on 1 January 2020 did not help to balance the budget.  There is light at the end of the tunnel. Your employees do not need to be choked by their medical scheme premiums.

Most of us do not even consider changing to another medical scheme out of fear of the 3 months general waiting period that will apply.  Even, if it could result in saving a R1000 on the monthly premium?  Yes, it is possible to save that much and more on the monthly premium. What is even more insightful is the fact that you could end up having better benefits and pay a lower monthly premium, than on the medical scheme option that is more expensive.  Is it worth it to shop around and compare medical scheme benefits and options? Absolutely!

Mmmm….you are thinking I am talking through my neck here.  However, I do have a few tips that can save medical scheme members a lot of money.  Care to read my suggestions?

If you have not evaluated your health cover benefits in the past couple of years, chances are good

  • you could be over insured, in other words paying for a lot of medical scheme benefits you are not even using…
  • or you could be under insured, paying a lot of medical expenses out of your pocket and do not have a thorough understanding of your medical scheme benefits.

Many people are not aware of the fact that they can up or downgrade on their exiting medical scheme under certain circumstances, without being exposed to any waiting periods.

The popular money saving strategy is to use medical scheme cover for in-hospital procedures and serious life threatening conditions like cancer, as these can be very expensive and impossible to self-fund under normal circumstances.  However, with a doctor’s consultation at R500 and a normal flu prescription easily exceeding R700, the question arise if it is really beneficial to the personal household budget to self-fund these expenses?

A combination of a medical scheme hospital cover and health insurance to cover primary day to day expenses like doctor’s visits, prescribed medication, dentistry and optometry might just enable you to save for that family holiday or your child’s studies.

Speaking to your healthcare broker can save you money.

Karin Andrea

Chief Executive: Optivest Corporate Solutions

Optivest Health Services

Saving you money, supporting you for life

Start your savings journey today


  1. Change to a network option

Without compromising on your important benefits, you can change to a similar plan that have a list of approved private hospitals for planned procedures. This can create a saving on monthly premiums of 10 to 24% – Help me save money


  1. Optimise to a more affordable premium

Some medical schemes allow members to transfer to more affordable options during the year.  You will receive guidance and assistance from your Optivest consultant to ensure you do not compromise your health cover needs. Does my scheme allow this?


  1. Over insured? Why pay more?

We can assist you in evaluating your current medical scheme claims to determine if you are possible over insured.  In other words, you could be paying for more medical scheme benefits than you are actually using in a financial year.  Help me optimise my cover


  1. Ensure the best health cover for your children and save towards their studies

How can I save money valuing my children’s medical scheme premiums?

  • On some medical schemes you will pay for all your child dependants.
  • On others you will only pay for 2 children under the age of 18.



Medical schemes apply different rules to child dependant’s older than 21 yrs. Do you know what rule your scheme apply?  Below the different rules applied:

  • when a child turns 21 yrs, even if they are a full time student they will start to pay an adult dependant premium
  • when a child is a full time student they will pay an child rate until age 24
  • when a child is a full time student they will pay an child rate until age 26
  • when a child is a full time student they will pay an child rate until age 27
  • even if child is not studying but dependant on parents they will pay child rates until 26
  • some schemes offer student options that are very affordable


Making an informed decision re your children’s health cover, will help you save money on your monthly medical scheme premiums. Need assistance?


A specified in the Medical Schemes Act, all medical scheme options have to cover the 26 chronic conditions defined in the chronic disease list*.  The formulary can differ from option to option, but all scheme options have to cover these chronic conditions.

As specified in the Medical Schemes Act, all registered medical schemes options have to cover the Prescribed Minimum Benefits (PMB).  This means that all medical scheme options have to cover the costs related to the diagnosis, treatment and care of:

  • any emergency medical condition
  • a limited set of 270 medical conditions (Defined in diagnosis Treatment Pairs)
  • and 26 chronic conditions (defined in the Chronic Disease List)

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