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Medical Insurance vs. Medical Aid
Medical Aid and Medical Insurance are not the same. Medical Insurance is regulated by short-term insurance laws and is more focused on hospitalisation. This is a more affordable option compared to most Medical Aids. It typically pays fixed amounts per hospital stay or gives access to basic outpatient care through networks.
Medical Aid is regulated by legislation that requires coverage of Prescribed Minimum Benefits (PMBs), including specific chronic conditions and in-hospital treatments. It usually comes with more comprehensive coverage but higher costs.
The table below clearly lays out the differences between Medical Aid and Medical Insurance:
| Medical Insurance Benefits | Medical Aid Benefits | |
|---|---|---|
| What’s Covered | Reimburses you when something covered by your policy happens, like hospitalisation, and you have to pay out of pocket. | Various plans ranging from basic hospital cover to comprehensive plans that include day-to-day medical expenses. |
| Who Gets Paid | You get paid directly, and you settle your bills. | The provider pays hospitals and doctors directly. |
| Cost | Generally cheaper than Medical Aid. | More expensive but offers broader benefits. |
| Emergency Care | You may need to pay a deposit before being admitted to a private hospital. | You’ll be admitted directly to a private hospital or network hospital, depending on your plan. |
| Prescribed Minimum Benefits | Doesn’t have to cover PMBs (chronic conditions and emergencies). | Must cover about 270 listed PMBs in full. |
| Extra Benefits | May include funeral cover or accident/disability cover. | Can’t include funeral, accident, or disability cover. |
| Tax Benefit | No tax deductions. | Contributions can be deducted for tax purposes. |
| Legislation | Governed by the Short-Term Insurance Act. | Governed by the Medical Schemes Act. |
| Regulator | Overseen by the Financial Services Board. | Regulated by the Council for Medical Schemes. |
Who needs Medical Insurance?
To answer this question, let's look at what Medical Insurance usually covers. It is mostly focused on out-of-hospital, primary-care expenses such as general practitioner consultations, prescribed medication, basic dentistry and some optometry cover, which are subject to strict network provider rules.
A defined limit for emergency hospitalisation stabilisation or illness might be included, but this has an impact on the price of the product.
Remember that risk factors such as age, health status and/or income are considered, so applicants can be rejected.
Why is Medical Insurance important?
The cost of private healthcare is expensive. It’s important to ensure that you have some level of cover. Medical insurance is an affordable solution if you can’t afford medical aid.
Medical Insurance often provides comprehensive cover for common out of hospital costs through a network of providers. It can also be used as an add on product to your medical aid if your medical aid plan only covers hospital costs.
Medical Insurance vs Medical Aid
Medical Insurance and Medical Aid are two different products
Both products offer healthcare cover, but are guided by different sets of regulations.
If your Medical Insurance product pays you a set amount for each day spent in hospital, regardless of the type of treatment that’s required, a Medical Aid product typically provides in-hospital cover and pays for treatment according to the cost of the condition and mostly pays the supplier directly.
Medical Insurance is usually a cheaper option and can either be used as an alternative to medical aid or as an added benefit to your medical aid product, depending on your level of affordability.
Medical Insurance benefits
Both products offer healthcare cover, but are guided by different sets of regulations.
Medical Gap Cover
Gap cover is a form of medical insurance that can only be taken to supplement the hospital benefit shortfalls in your medical aid product. It’s a smart way of buying the best value for money medical aid product and taking affordable Gap cover to ensure you have all your bases covered.
More on Medical Insurance
Make sure you’re prepared to compare quotes by checking out our glossary and list of FAQs.
