Difference Between Health Insurance and Medical Aid in South Africa

Look to benefits and shortcomings to figure out the difference between health cover and medical scheme members hips in South Africa.

The country's health system is full of problems. Apart from the ongoing corruption, there is also a massive shortage of good medical staff.

Therejust aren’t enough medical professionals for the massive human population. COVID-19 is just exacerbating the problem now too.

In spite of all the problems, you can’t get away from the fact that you need some kind of medical plan. But which? Health insurance or medical aid and what is the difference exactly? 

When you look at these two plans, for starters, they offer significant cover differences. Medical aid is the far more expensive of the two, but then health insurance provides less in-hospital cover than medical aid plans.  

Can you afford medical aid anymore?

COVID-19 has shaken many people and stripped them of their earnings. Health insurance these days is looked upon as the more cost-effective option when compared to a medical aid scheme.   

The high cost of living and sheer economic hardship has meant that many people choose medical insurance, even with its limitations.

Medical aids have to charge members the same premium for the same plan. With health insurance, premiums can differ according to the age of the person applying for medical insurance, the size of their family and their existing chronic conditions.

Medical aid schemes pay out to the medical providers such as doctors or clinics. Medical insurance will pay the member directly who has to be responsible for settling their own bills.

Gap cover, on the other hand, benefits medical aid members by covering shortfalls.

Make sure you understand the difference in benefits 

Consumers may look at the costs of medical aid and health insurance but fail to realize that the benefits will differ according to the costs. That is why if you’ve heard about how reasonable health insurance is, you need to first do thorough research. This will help you make an informed decision between the two.

Different regulators 

All the medical schemes in South Africa are regulated by the Medical Schemes Act. This means that they have to follow a certain list of rules.  Members pay a premium for a plan that suits them.

On the other hand, it is the Short-term Insurance Act that regulates medical insurance. Instead of covering specific treatments, a plan will provide you with a lump sum for each day you spend in hospital.  

When you receive your money, you can essentially use it the way you like. The wisest move would be to use it for your medical expenses. 

Difference in Waiting Periods 

Depending on the health insurance products you choose, health insurance has a waiting period for different products. With medical aid, you’ve usually got a general waiting period of 3 months and 12 months for an existing condition.  

Do research because some medical insurance will provide cover for certain day-to-day medical expenses. As an insurance policy, these plans can also include funeral cover.

Medical aid schemes offer comprehensive hospital cover, and the plan you choose will decide just how comprehensive. Most times, there will be a shortfall between medical aid rates and the rates that the specialist will charge you. This is when you will have to consider medical gap cover.  

Negotiating the best choice for you 

As a South African faced with a terrible public health system, it is absolutely important to have some kind of medical assistance. With medical aids making it so difficult in terms of expense, health insurance is worth a second look.  Make a difference to your family's health cover. Get a quote now.

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