Medical Aid and Health Insurance – What is the difference?

    December 29, 2017

    Medical Aid and Health Insurance seem to be different names for the same thing. However, the Council for Medical Schemes govern Medical Aid and the Financial Services Act governs Health Insurance.

    Health Insurance costs less than Medical Aid. With health insurance you pay one premium for the family. With medical aid you pay a premium for each person .

    Health insurance doesn’t cover PMB’s whereas Medical aid has to cover them. Health insurance is based on stated benefits while medical aid is based on procedures and tariff codes

    Medical aid and Health insurance – Choose wisely

    Medical aid and Health insurance

    A medical aid scheme and health insurance are not the same. You need to know why because the choice you make will affect you. Once you know the difference, decide which is the better choice for you.

    A bit about Health Insurance

    Health insurance provides you with a sum of money each day you’re in a hospital. Regulated by the Short-term Insurance Act, this cover isn’t bound by the Medical Schemes Act, it offers cover for events that medical aid doesn’t.

    A bit about Medical Aid

    Medical aid pays out according to the National Recommended Price List (NRPL). Often this amount falls far short of what many healthcare professionals charge.

    Medical aid also don’t provide personal accident disability cover. They just cover Prescribed Minimum Benefits (PMB’s). Medical aid pay in-hospital benefits which also falls short.

    This is one of the reasons that so many medical aid members choose to supplement their cover with health insurance.

    More Medical aid and Health insurance Points

    Some medical aid members use healthcare specialists who belong to a network. However, health insurance ensures that when you need funds for medical purposes, you receive a fixed amount of money and you can use the doctor you want.

    Because the two plans fall under different governing bodies, health insurers have a different set of rules which are quite different to the protection that medical schemes offer.

    Also, medical aid cover has to provide PMB’s while health insurance providers aren’t subject to the same laws. Medical aid is costly. Health insurance on the other hand is affordable. Another huge plus with Health insurance is that it can also include death and funeral cover.

    Health insurance does not offer as much cover as Medical aid, but it is a vital plan to have. Health insurance can save you from large medical bills that can strike out the blue. And leave you wondering where the money to pay them will come from.

    All info was correct at time of publishing