Your Medical Aid & Health Insurance options

What is Medical Aid?

To understand what you will be covered for under your medical aid, Graham advises the following:

Check the high-risk areas: Oncology benefits, joint replacement benefits, specialised radiology, scopes, and diagnostic procedures are good measures.

Check the list of in-hospital co-payments and exclusions:

• Co-payments are a common part of most medical aid options, where a portion of the cost of a procedure must be paid by the member.

• Co-payments are often also imposed on certain in-hospital procedures like scopes and scans or specialised dentistry.

It's important to understand how your medical aid is structured – do you have a savings account to cover out-of-hospital expenses, or the type of structure that has defined limits for all procedures?

What is Medical Insurance?

Medical insurance usually pays out a set amount for each day spent in hospital or for a specific incident, directly to the member, who must then settle accounts.

These policies are generally governed by short term insurance law and, as a result, they are structured differently to those offered by medical aid schemes.

There are a few different types of medical insurance products, one of which is a hospital cash-back plan. While this ensures that a member will be able to recoup expenses from a hospital stay, it doesn't necessarily guarantee hospital admission. For these types of medical insurance, the member usually needs to pay up-front.

Both medical aid and medical insurance products provide cover for day-to-day medical expenses, but medical insurance offers more limited primary care cover. On the other hand, since medical insurance products aren't subject to Prescribed Minimum Benefits, they are often cheaper. Medical insurance products are not considered by medical aids when evaluating history of cover to determine how a medical aid application will be underwritten.

Once you've assessed your health needs against the variety of options offered by different medical aid schemes and medical insurance plans, it's easier to make a decision about which you should sign up for. Deciding which medical aid or medical insurance option is best for you depends on what you can afford, and what your general level of health is. Using Hippo's comparative tool is a quick way to compare different medical aid and medical insurance policies, benefits, and costs and a good starting point to prepare for whenever a health calamity might strike.