Healthcare Insurance

Many people do not understand the difference between medical aid plans and healthcare insurance. Medical aid plans offer specific benefits and require membership with one of the many medical schemes in South Africa.

Many people simply cannot afford this type of cover and they are dependent upon the public health care system. There is an alternative, however: health insurance.  

What exactly is health insurance?

Medical health insurance is a completely different concept. The main differences between medical scheme plans and medical insurance can be summarized as follows: 

• Medical scheme plans offer very specific benefits to their members. In order to enjoy these benefits it is necessary to become a member of a scheme and to choose a specific plan. The benefits differ from plan to plan. Medical insurance do not offer any specific benefits; instead, it offers a cash pay-out when the policy holder is hospitalized.
• It is against the law to be a member of more than one medical aid plan but there are no restriction regarding health insurance. It is even possible to be a member of a scheme and to have medical insurance at the same time.
• Medical schemes are strictly regulated by the Medical Schemes Council while health insurance policies are regulated by insurance laws.
• Medical schemes do not pay the member. Instead they pay the medical service provider such as the hospital, doctor, dentist or pharmacy that provided health care services to the member. Medical insurance policies pay the cash benefit directly to the policy holder. This money can be used for anything and there is no obligation to use it to pay for the hospital treatment.

Who should consider healthcare insurance?

While many people simply cannot afford to become members of medical schemes, most people are able to opt for some form of affordable health insurance. The cost of policies varies and there are products that cost less than a hundred rand per month. Such cover may be suitable for the following people:

• Many medical schemes do not offer full cover for hospitalization cost. In most instances, the plan will only pay the approved medical aid rates while most of the time the actual cost is much more; as much as four times higher! The cash pay-out received from a health insurance policy can help to cover the shortfall.
• Even those people that are dependent upon the public health system can benefit greatly from these policies. Many people do not earn an income when they are hospitalized and the cash received can go a long way in helping to keep the family going while the breadwinner receives hospital treatment.

When considering healthcare insurance it is important to carefully study the products offered by the various insurance companies. The size of the cash pay-outs vary from company to company. Many policies will only pay if the policy holder spends a certain amount of time in the hospital. It is therefore vital to study the terms and conditions before making a final decision. © Medical Aid Plan

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NOTES:

Your medical aid quote will include options to suit your pocket. Please ensure that the cover you select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to ask questions about the medical aid or hospital cover you choose.