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What is Health Insurance Compared to Medical Aid?

South Africa has its very big subsidized public health sector and a smaller, private health sector. It is the private sector that offers high-quality healthcare.

It is natural that doctors want to work in the private sector. The public health system is so corrupt and badly run that they only benefit the funeral sector. When you land up in one you don't usually emerge alive.

SOME kind of health cover to avoid a public hospital

There is a big gap between public and private healthcare facilities. People look at taking out either health insurance or buying a medical aid plan to avoid having to make use of the public healthcare system.

Both medical aid and health insurance can keep you from having to make use of public hospitals. You need to know however that there are significant differences between the two.

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They're two different medical-help options

It was in April 2017 that the Demarcation Regulations came into effect. Their aim was to clarify the boundaries between what the medical scheme offers and what health insurance offers.

Medical schemes and insurance products are governed by different legislation - health insurance is governed by the Short-Term Insurance Act and Medical Schemes by the Medical Schemes Act.

You have to do research therefore, as costs and benefits differ. Making the wrong choice can turn out to be a costly mistake. You may discover to your alarm, that you don't have the appropriate health cover when you need it.

For instance, if you have a serious medical condition, and you know you're always at the doctor and hospital because of it, you would be wiser to go with a comprehensive medical aid plan.

The flexibility of health insurance

The medical aid schemes are also obligated to provide prescribed minimum benefits for a wide range of life-threatening emergencies and up to 26 chronic medical conditions. Health insurance isnt obligated to cover you for these prescribed minimum benefits, and because of this it is cheaper.

What is Health Insurance in South AfricaHealth insurance then, is more flexible than medical aid. The reason for this is that it allows its clients to choose from a list of benefits cover that suits their budget and health needs.

So what is health insurance then when you compare it to medical aid? A lump sum is paid out by a medical insurance company, but while it seems like a cost-effective alternative, the amount you pay each month may not cover what you thought it would.

Medical schemes have to maintain minimum solvency ratios. This can give members some peace of mind that the medical scheme will be there for them when they require costly medical treatments.

Sometimes a health insurance company will refuse to cover you if they think that the risk of a claim will be too high.

Which cover makes you feel self-assured? 

As you can see, when it comes to knowing the difference between a medical aid and health insurance, the pendulum swings in favor of the one, and then swings in favor of the other. So it is up to you to do thorough research and to closely investigate the good and the bad of both so that you're covered for all possible eventualities. 



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