Medical aid is one of the biggest costs in a household budget. Premiums have grown enormously, and we all know why. Yet despite the cost, many people simply sign on the dotted line without asking the right questions. Buyer beware. Caveat emptor.
If you’re going to spend thousands every month, you need to think clearly and prepare yourself. That means asking two sets of questions:
1. Questions to ask yourself before you contact anyone.
2. Questions to ask the advisor when you sit down (or go online) with them.
Remember: unless you’re dealing with a truly independent advisor, you’re likely to get a biased pitch. Advisors are salespeople selling a product. Treat it like any other product — test it, question it, demand the details in writing.
Part 1: Questions to Ask Yourself
This self-audit helps you know what you really need — and stops you from being talked into the wrong plan.
Personal & Family Health Profile
• Who needs cover? (Just me? Family? Elderly dependants?)
• Do we have chronic conditions such as hypertension, diabetes, or asthma?
• Are there upcoming medical needs (surgery, pregnancy, specialist care)?
• Do lifestyle risks apply (sports injuries, frequent travel)?
Financial Considerations
• What is my realistic monthly budget?
• How much could I cover out of pocket in an emergency?
• Do I want comprehensive cover or just hospital/catastrophic cover?
Practical Preferences
• Do I want my own doctors/hospitals, or am I willing to use a network?
• What’s most important: day-to-day benefits, hospital cover, or savings?
• Am I comfortable with designated service providers (DSPs)?
Existing Cover
• Am I already on a plan? What do I like or dislike about it?
• Do I have waiting periods to carry over if I switch?
Part 2: Questions to Ask the Advisor
Use your answers from Part 1 to guide this conversation. Be direct. Push for clarity.
Plan Structure & Core Cover
• Is this a regulated medical aid (with Prescribed Minimum Benefits) or health insurance (a short-term product with limited payouts)?
• How are PMBs covered?
• What are the main buckets of cover: day-to-day, hospital, chronic conditions?
• Are there annual limits or sub-limits for big procedures (knee surgery, dentistry, oncology)?
Costs & Payments
• What is the total monthly premium for my family structure?
• Aside from premiums, what extra payments will I face?
• Deductibles/excesses?
• Co-payments for scans, specialists, or surgery?
• How do claims work — do I pay upfront and claim back, or do you pay directly?
• What happens if I miss a payment?
Network & Access
• Must I use specific hospitals, doctors, or pharmacies?
• How do I see a specialist — direct access or referral only?
• What’s the emergency process, and which hospitals are covered?
• What if I go outside the network?
Rules & Fine Print
• Are there waiting periods or exclusions (especially for pre-existing conditions)?
• How do I add or remove dependants?
• What’s the cancellation policy?
• How do I appeal if a claim is rejected?
Advisor Transparency
• Are you licensed to give this advice?
• Do you earn commission, and is it higher for certain plans?
• Based on my needs, which two or three plans fit best, and why?
• Will you send me a written summary of benefits and brochures?
Final Word
Don’t rely on promises. Always get the details in writing. Medical aid is a long-term financial commitment, and the stakes are high. By asking the right questions, you stop being a passive buyer and start being an informed consumer.
