If you are in your 20s or early 30s and in reasonably good health, medical aid probably feels like a grudge purchase. It makes sense. You are healthy, hardly see a doctor, and are more worried about your debit orders clearing than what health plan you are on.

But here is the problem: that mindset could cost you far more in the long run.

Devan Moodley, Regional Manager - Healthcare Consulting at advisory firm, NMG Benefits says in South Africa, the healthcare landscape is crowded with terms like medical aid, medical insurance, gap cover, prescribed minimum benefits, and waiting periods. It is confusing, and most people, especially younger adults, simply buy based on price. We have seen this play out time and again. And unfortunately, it often ends in panic when someone realises their insurance policy does not actually cover what they thought it would.

Moodley unpacks some of the most common myths and what you should really know before choosing a plan.

Myth 1: “Medical insurance is the same as medical aid”

It is not. They are governed by different laws and provide very different levels of cover.

Medical aid must include hospitalisation and prescribed minimum benefits (PMBs), like chronic medication or emergency treatment. Medical insurance, on the other hand, usually only covers day-to-day GP visits, basic medication, and maybe emergency stabilisation. No planned surgeries, private hospital stays, or specialist visits unless network-approved. Even then, these are limited.

Medical insurance is not bad. In fact, it can be a great first step if you cannot yet afford full medical aid. But it is not a substitute. And if you do not know the difference, you might only find out when it is too late, like when you are scheduled for a major operation and suddenly realise you are not covered.

Myth 2: “I do not need cover because I am never sick”

major healthcare. But life happens. Accidents, sports injuries, pregnancy, sudden illness, all of these can turn your financial world upside down without proper cover.

Worse still, if you drop off a medical aid and try to rejoin later, you might face penalties like waiting periods or late joiner fees. Medical schemes reward consistency. Breaking your coverage too early can make it much harder (and more expensive) to come back later.

Myth 3: “Advice is for rich people”

This one could not be further from the truth. Many people think getting help from a broker will cost extra. But what they do not realise is that the advice fee is already embedded into most products. You are paying for it whether you use it or not. So why not take advantage of it?

A proper adviser (like NMG’s consultants) will look at your life stage, income, goals, and health needs, and then match you with a plan that fits your needs and reality. We can even help you supplement your cover by adding gap cover to plug holes. It is not just about choosing a brand. It is about choosing a future you can count on.

Bottom line: Ask the right questions

The South African healthcare system is complex. And with so much noise online, from comparison tools to chatbot advice, it is tempting to go it alone. But that is risky. Algorithms cannot explain waiting periods, PMBs, or underwriting rules. Your friends on TikTok might not know the difference between a GP network and a designated service provider.

That is where we come in.

At NMG, we spend our time explaining what others do not. We speak your language. We answer your questions. We do not push products but guide decisions. Whether you are just entering the workforce or managing a young family, we are here to help you understand what you are buying, what it means, and why it matters.

Because when it comes to your health, you do not just need a plan. You need a plan that works for you today and tomorrow.

As we mark International Stress Awareness Week (November 3–7, 2025), the spotlight is on how workplace stress and mental health challenges continue to quietly undermine productivity. One of the most telling yet often ignored signs of employee burnout is “clockwatching”: when staff mentally disengage and count down the hours instead of performing at their best.

According to Karin Mitchelmore, Executive Head of Healthcare Consulting at advisory firm NMG Benefits, this behaviour is more than a sign of boredom, it’s a red flag for deeper wellbeing issues that can cost businesses millions through absenteeism, presenteeism, and reduced performance.

“When employees feel unsupported, they mentally check out long before the end of the day,” says Mitchelmore. “Effective Employee Assistance Programmes (EAPs) provide access to counselling, wellness resources, and stress management tools helping employees feel valued and reconnected. Supporting mental health isn’t just the right thing to do; it’s key to building resilient, high-performing teams.”

We’d like to offer Karin Mitchelmore for an interview to unpack:

• How stress and burnout manifest as disengagement and clockwatching.
• The financial and cultural impact of presenteeism on South African workplaces.
• Why tailored Employee Assistance Programmes (EAPs) are critical for productivity and retention.
• Practical ways employers can support mental wellbeing during International Stress Awareness Week and beyond.

If this is of interest to you or your audience, please let me know and I will arrange the necessary logistics.

For many South Africans, a large part of ‘Janu-worry’ lies in how they will fit the annual medical scheme increase into their monthly budgets. For 2026, members can expect an average increase from anything between 7.2% and 9.9% which is still higher than both the current inflation rate and a typical annual salary increase. However, understanding why these increases happen and how to make informed choices about medical cover can make a real difference.

Medical scheme contributions rise each year largely because of the cost of private healthcare. “There is a huge amount of pressure on the system,” explains Karin Mitchelmore, Executive Head of Healthcare Consulting at advisory firm, NMG Benefits. “Costs are soaring, and schemes have a responsibility to their members to remain sustainable. In some cases, this means adjusting the cost of comprehensive plans in line with the usage patterns of their members, who often choose these plans because their healthcare needs are higher. Members with fewer needs often choose plans with limited benefits and, while annual increases on these plans may be lower, careful budgeting is still key.”

Deciding whether to up- or down-grade your plan, or switch your scheme entirely, cannot be informed solely by cost. Mitchelmore points out that this decision requires a careful look at your personal circumstances: “It is vital to consider your family makeup and medical requirements, as well as your budget, before making any changes. For those with young families or chronic conditions, a comprehensive plan may remain essential. Others might find a lower-tier plan adequate for their everyday needs and emergency care.”

Time is also critical. Most schemes only allow plan upgrades once a year, effective 1 January. After that, you may have to wait until the following year unless you experience a qualifying life event. Downgrades are usually allowed at any time, but medical savings account usage and benefit allocations may affect how much is carried over and members may end up having to pay in a lump sum to compensate for limits that they reached before making the switch.

Gap cover is another piece of the puzzle. This is a separate insurance policy that covers the difference between what a medical scheme will pay for hospitalisation, certain procedures and what these services actually cost. While cover at 100% or 200% of the medical scheme rate may seem sufficient, the reality is that costs can far exceed this and it is the member’s responsibility to ensure that all these bills are paid in full. The good news is that gap cover is relatively inexpensive, and many providers are offering new options aimed at making the monthly premium even more affordable.

Medical schemes are also constantly innovating to help manage costs and provide more value for their members. Health-tracking programmes encourage members to monitor lifestyle factors like activity, nutrition, and sleep. Preventative care and screening benefits are growing in importance, encouraging members to get tested to help detect diseases before symptoms appear. Early detection could save your life and avoid you having to pay enormous bills for advanced disease treatment or hospitalisation later. Networks for virtual consultations with GPs and some specialists are expanding to increase access for members in remote areas, while provisions for mental health conditions are being widened. Some schemes are also acting on studies which show that certain patients recover better at home than in hospital and are ramping up benefits for at-home checkups and care accordingly.

The upshot of all these changes, says Mitchelmore, is that medical scheme benefits are getting increasingly complex to understand. “Consulting with a medical scheme advisory expert can help ensure that you have cover for your needs without paying for benefits that you are unlikely to use. NMG Benefits’ team of independent advisors guides members to analyse their needs and identify the most suitable plans and, because of the preferred provider pricing arrangements can secure prepared pricing for Gap Cover as well as Primary Care Insurance solutions. Act now and don’t leave these important decisions to the end of December which may be too late.”

Mental health challenges remain one of the biggest drivers of lost productivity in South African workplaces and one of the most visible symptoms is “clockwatching”. Employees struggling with stress, anxiety, or burnout often disengage, counting down the hours rather than performing at their best. This behaviour, while subtle, signals deeper wellbeing issues that cost businesses absenteeism, presenteeism, and reduced output.

According to Karin Mitchelmore, Executive Head of Healthcare Consulting at NMG Benefits, companies can no longer afford to ignore the link between mental health and productivity:

“When employees feel unsupported, they mentally check out long before the end of the workday. Effective Employee Assistance Programmes (EAPs) give staff access to the right counselling, wellness tools, and resources - creating a healthier, more engaged workforce. This isn’t just about care, it’s about business resilience. Companies that invest in structured mental health support see lower absenteeism, improved morale, and stronger performance.”

If the above is of interest to you and your audience, we’d like to propose an interview opportunity with Karin to further unpack:

• How poor mental health manifests as clockwatching and disengagement.
• The cost of presenteeism and absenteeism on South African businesses.
• Why tailored EAPs are critical to unlocking productivity and reducing long-term costs.
• Practical steps employers can take today to re-engage and support their people.

Looking forward to hearing back from you.

Mid-year fatigue is real, but support from employers and proactive steps from employees can help turn things around.

This is according to Karin Mitchelmore, Executive Head of Healthcare Consulting at financial advisory firm NMG Benefits. “We are halfway through the year, and, for many, the early-year energy has given way to fatigue. The end of the year feels far away, and it is taking a toll on employees and employers alike.”

For employers, this toll has a hard cost: In 2023, mental and emotional exhaustion resulting in depression and anxiety cost the global economy an estimated US$1 trillion annually in lost productivity, largely driven by absenteeism and presenteeism.

A relatively new concept, ‘presenteeism’ is when people show up at work but are too stressed, anxious or burned out to be productive. The syndrome is costing South Africa around R235 billion a year – roughly R96,500 per employee; nearly seven times the cost of absenteeism.

Mitchelmore says that employers can do a lot to support their people. “Employee assistance programmes (EAPs) are a practical and cost-effective tool that companies can use to address burnout throughout the year, but they work best when they are not just a tick-box initiative. If you want real impact, wellbeing cannot only be talked about during Corporate Wellness Week. It needs to be part of your culture all year round, with protective policies, accessible support systems, and leaders who model healthy behaviours.”

To start with, everyone should know what burnout looks like.

The signs often creep in slowly: fatigue, lack of motivation, constant feelings of stress, brain fog, irritability, working longer hours and getting less done. It is triggered by a combination of factors: juggling work, home, family, and personal needs; financial pressures; deadlines and workload; and the mental load of reflecting on the year so far and realising there is still a long road ahead.

Mitchelmore has some suggestions for those who are feeling the pressure:

Re-align what really matters: Burnout often happens when we are pulled in too many directions, and we lose sight of our ‘why’. Reflecting on your goals – and what gives your work and personal life meaning – can help you prioritise what really deserves your energy.

Rest and boundaries are not luxuries: They are essential for long-term performance. You do not have to solve everything overnight. Claiming small wins each day can help you rebuild your momentum.

Do not suffer in silence: While burnout can feel deeply personal, it is important to recognise that you are not alone – one in three South African employees are struggling alongside you. Burnout is also not a personal failing or weakness, and you do not have to feel guilty about asking for help. Talk honestly to your manager or HR contact about where you are at. The more these conversations are normalised, the more the stigma is removed.

Corporate Wellness Week is a timely reminder to start reflecting, resetting, and taking action. “Whether you are an employer wanting to better support your team, or an employee wanting to take better care of yourself, this is a good time to pause and figure out what you need to get through the year in a healthier, more sustainable way,” says Mitchelmore.

As many as 76% of South African employees run out of money before the end of the month, and 89%  worry about being able to pay their monthly bills. With the cost of living climbing and the cost of healthcare, increasing, gap cover is coming to the fore as an inexpensive added protection against having to pay towards certain costs that are not covered by medical schemes.

Gap cover is an insurance product that aims to cover the shortall between what a medical scheme pays and what a healthcare provider charges for medical services. This coverage becomes essential when doctors and hospitals charge more than the amount paid by the medical scheme. Even though most medical schemes cover up to 100% of the scheme rate, with top-tier plans covering 200% or 300%, the actual costs often surpass these limits. Gary Feldman, Executive Head of Healthcare Consulting at advisory firm NMG Benefits, explains that while gap cover is not a replacement for medical aid cover, it has become an essential add-on.

Consumers who have gap cover speak for themselves; employers can amplify the advantages by offering it to all their employees as part of a group scheme cover. “Gap cover is by no means new in the market, and many providers target individual consumers. However, group gap cover can mean preferential rates, reduced waiting periods, continuity of cover, and access to value-added services like trauma counselling, top-up cancer cover, and lump sum payouts for cancer diagnoses.

Employers can also play an important role in ensuring that employees’ gap cover policies do not lapse due to non-payment. Running the premiums via a payroll deduction will ensure that payments are always made on time and in full.

Offering group gap cover also offers many benefits to employers such as low absenteeism at work. It is estimated that absenteeism costs the South African economy between R12 and R16 billion annually, with businesses losing up to 17% of their payroll every year – possibly making absenteeism the most expensive challenge for local businesses.

“With worry-free access to the most appropriate medical care, employees can be treated, and recover, with the least-possible impact on their ability to be productive. Not only are they medically ‘fit’; they are also likely to take fewer sick days due to stress and anxiety relating to paying for medical treatments,” says Feldman.

Another significant advantage for employers offering group gap cover lies in how it enhances their ability to attract and retain top talent. A robust benefits package, including gap cover, makes an employer more attractive and improves overall job satisfaction.

However, when investigating group gap cover options, it is critical to look beyond just the cost; benefits should be compared on an ‘apples for apples’ basis to determine overall value. Feldman advises employers to work with specialists who can leverage expertise and a thorough understanding of the different products on the market.

“Navigating the gap cover market can be complex. However, working with an experienced employee wellness adviser, like NMG Benefits, will help to ensure that group gap cover solutions align with business needs.”