The private health cover sector in South Africa is experiencing unprecedented growth. This is
partly because people are becoming more aware of the importance of such cover but also because the public health
system is increasingly coming under tremendous pressure.
There are many service providers that offer a bewildering variety of plans and it may
be difficult to decide just which plan will be most suitable. Many people, however, cannot afford
comprehensive medical cover and for such people health insurance may be a good
Just what is health insurance?
Many people are under the misconception that it is just another type of medical aid plan. This
is not the case whatsoever. This type of insurance is offered by both medical schemes and other insurance companies
and should be seen as similar to the type of insurance one purchase for covering a car. The insurance only pays
when there is damage to the car. In the case of medical insurance the insurer generally pays out if the member is
hospitalized. There are a few aspects to consider when thinking about getting medical
In many cases the cash pay-out from the insurer is made directly to
the beneficiary and not to the medical service provider. The insurer does not care what the money
is actually used for. It may be used to go on holiday or to pay other bills. The amounts paid out
will depend on the specific policy but they generally vary from three thousand rand a day to five
Many schemes will pay only the approved medical aid rates. The
reality is that doctors, hospitals and specialist often charge much higher than these rates; in
many cases up to four times as much. The medical scheme will pay the approved rate and the
difference is for the pocket of the member. Medical insurance is an excellent way for making
provision for this difference in price.
It is vital to carefully study the terms and conditions of a
medical insurance policy. In most cases the daily allowance is only paid from the third or fourth
day of hospitalization.
Some policies do not include travel insurance. This may be an
important consideration for those people that travel regularly and that may require
hospitalization in another country.
What is National Health Insurance all about?
Citizens of South Africa have access to either the private or the public health systems. The
public health system is often criticized but it actually compares very favourably with the public health systems of
developed countries such as Great Britain and the United States.
The problem is that the South African health system is completely overburdened. More than
eighty percent of the citizenry rely on the system for medical care. The fact is simply that the system cannot cope
with the demand. On top of this is the fact that it is under-funded and that too few medical professionals choose
to work in the public sector.
It is for these reasons that the Department of Health has embarked upon a campaign to establish
a National Health Insurance. By compelling all citizens to make a contribution to this insurance plan, new
facilities can be commissioned, existing facilities can be upgraded and a national plan to implement a broad range
of preventive treatment protocols can be rolled out. The plan has many critics and it is not sure when appropriate
legislations will be passed.
Health insurance is
certainly a sensible option for people that cannot afford any form of medical aid and also for people that needs to
make provision for additional cost that will not be covered by their existing medical aid plans. © Medical Aid