In common with most countries that provide state-funded healthcare services for their citizens, South Africa’s public hospitals are overburdened and lack sufficient funding to rectify the situation. As a result, many of those patients who must rely on public health facilities are faced with increasingly long waiting lists to receive their treatment. Consequently, most of those who can afford it seek private treatment, while for at least some of those who can’t, there are medical aid schemes.
While these schemes operate on the principle of shared risk, like the nation’s short- and long-term insurers, it is essential to be aware of the difference between the services they each offer. Both offer products that provide financial assistance with healthcare expenses, but the extent and nature of the cover included in those products differ considerably. The main aim of medical insurance is to help fund primary care expenses like GP visits, prescription charges, optometry and basic dentistry. By contrast, medical aid products provide more comprehensive cover that includes primary care costs and the much larger expenses associated with hospitalisation and emergency treatment.
However, like the insurance companies’ policyholders, medical scheme members must also pay a monthly premium if they wish to retain their cover. Unfortunately, not all members can afford fully comprehensive cover. To help those with limited incomes meet the high cost of private healthcare when they most need it, medical aid schemes introduced the hospital plan. Once again, insurance companies offer a similar product, and, as before, it is essential to note the differences between the two.
Medical scheme members who choose this more affordable option can expect that the bulk of all costs incurred whilst they are undergoing treatment as an in-patient will be met under the terms of their hospital plan. These terms contrast sharply with the insurance product, which pays the policyholder a fixed cash sum for each day spent in the hospital and is solely a hospital cash plan.
The nation’s medical aid schemes and insurance companies fall under different regulatory bodies. This has a marked influence on the terms and conditions each is permitted to apply and the services it is obligated to deliver. For example, the former must honour the terms of the Medical Schemes Act of 1998, which states that all of their products, including hospital plans, must include cover for certain prescribed minimum benefits (PMBs), including twenty-six chronic illnesses such as asthma and diabetes. Insurers are under no such obligation.
Note also that medical aid schemes may not refuse anyone membership or load their premiums, even if they have a pre-existing illness. Instead, they are entitled to decline claims for treatment of pre-existing conditions, other than PMBs, for a pre-agreed period. By contrast, insurers can adopt the same criteria that they apply to motor insurance and may either hike their monthly premiums or suggest that they should seek cover elsewhere.
Your health and that of your family are important, and even if you all enjoy good general health, an unexpected accident or severe illness could leave you drowning in debt. Medshield offers some of the country’s most affordable medical aid options, including fully comprehensive products and hospital plans with some unique free core benefits.
