Essential Med Health Insurance is not Medical Aid
March 3, 2015
Essential Med Health Insurance is a medical insurance scheme that offers people access to both healthcare services and good quality medical care. However Essential Med Health Insurance is not a medical aid.
Primary Differences Between Medical Insurance and Medical Aid
One of the major differences between medical aids and medical insurance schemes like Essential Med Health Insurance is that medical aids are able to pay service providers directly, while this is not allowed by an insurance scheme. Instead, when there is a medical insurance claim, the money is paid to the holder of the policy.
The rate of cover, annual limits and benefits, as well as the laws that govern medical insurance versus medical aid are also quite different.
While medical aid policies are set up to pay largely undetermined amounts of money (ie not known in advance) that will be owed to hospitals, doctors, pharmacies and so on, medical insurance pays a daily rate that is set in advance. So if you are hospitalised, and you have a health insurance or medical insurance policy, you can anticipate how much will be paid out every day you are in hospital. If you have a medical aid, the rate of cover will depend on what has been agreed in the policy; it could be a percentage or it might cover everything you end up owing for medical care.
Medical aid policies also specify annual benefits and any limits; usually hospital cover is unlimited, though members might need to stick to network hospitals. When it comes to medical insurance, including Essential Med Health Insurance, the policy specifies a daily amount in rands (although this amount might relate to each medical “event”).
Medical aid companies are legislated by the Council for Medical Schemes [https://www.medicalschemes.com/] and by the Medical Schemes Act. Medical insurance companies are legislated by either the Long Term or Short Term Insurance Acts.
What Essential Med Health Insurance Offers
Essential Med Health Insurance has six forms of insurance cover:
- Dad to Day Cover for out-of-hospital medical care ranging from routine health checks and allergies to minor ailments including colds and flu. Doctors prescribe according to an Essential Med Health Insurance list of medication.
- Hospital Plan Cover that pays out a daily benefit for every day you spend in hospital after an accident or due to illness. The time frame covered by Essential Med Health Insurance is one to 21 days per beneficiary.
- Comprehensive Cover, a plan that incorporates hospital cover and other benefits; there are three options based on needs and budgets when you opt for this form of Essential Med Health Insurance.
- Student Protector, a plan design to cover the medical, dental and hospital costs of students.
- 55 Plus Cover for those over the age of 55; includes hospital cover, day benefits, dentistry, opticians and death benefits.
- Group Cover that attracts Essential Med Health Insurance discounts for companies with at least 10 members of staff.
There is more information about the different forms of health insurance on the Essential Med website.
Ultimately, an insurance plan is not the same as a medical aid scheme or normal hospital plan, and it cannot replace a traditional medical aid scheme. However a medical or health insurance scheme like Essential Med Health Insurance can provide you with a much cheaper option that will provide some cover if you need emergency care, are hospitalised, or if you are permanently disabled.
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All info was correct at time of publishing