What’s the Difference Between Medical Aid and Medical Insurance?

Contrary to what many people may think, South African “medical aid” and “medical insurance” are not the same thing. In this blog post, we help you decipher the difference so that you can make an informed decision about you and your family’s wellbeing.

South Africans are living through a time of economic uncertainty, and families are being forced to make some tough choices when it comes to their healthcare. Recent statistics indicate that medical aid options have priced a large proportion of the South African population out of the healthcare market. For many families, retaining their medical aid plans with high premiums is simply not a viable option.

However, NOT having any form of medical subscription can also have devastating consequences in case of unexpected medical emergencies. This is where medical insurance, a cost-effective alternative to medical aid, comes in.

What is medical aid?

With medical aid, you pay a monthly premium in return for financial cover for medical treatment and other related medical expenses.

Medical aid pays for medical expenses and treatment according to the specific medical scheme tariff. The level of cover you get depends on your choice of provider and medical aid plan.

Payment for medical treatment is usually made directly to the hospital and/or service providers.

One of the key factors causing the rising costs of medical aid premiums is that providers are encumbered, by law, to cover the entire costs of all medical costs attributed to chronic conditions and Prescribed Minimum Benefits (PMBs).

What is medical insurance?

Medical insurance provides significantly different healthcare package to medical aid. Medical insurance typically pays out a set amount for each day spent in hospital or a set maximum amount per incident, regardless of the type of treatment that’s required. With a stated benefit offering specific day to day and hospital cover, you and your family are financially protected in the case of unexpected illness or injury.

Medical insurance premiums are not inflated by the compulsory addition of Prescribed Minimum Benefit conditions which are placed upon medical aid companies by the Council of Medical Schemes. As such, medical insurance providers can offer tailored medical benefit plans at much lower premiums.

Why choose medical insurance?

The main reason people choose medical insurance is the cost – fewer benefits mean a lower monthly premium. It’s true that you get what you pay for, but it is more important to pay for what you need and can afford.

If you find you can no longer afford conventional medical aid cover, a more affordable medical insurance plan can be tailored to meet your specific needs. This can help you live within your means while still feeling reassured that your family has access to adequate healthcare in the event of an accident or illness.

How do I choose?

The best way to decide which plan is right for you is to assess your medical needs:

  • Are you generally healthy and unlikely to incur ongoing day-to-day medical costs? In this case, medical insurance may be adequate for your needs.
  • Are you are older and/or prone to health issues? In this case, medical aid might be a better fit, if you can afford it.

What do I get with medical insurance?

  • Medical insurance pays a specified lump sum for your hospital stay (the amount will vary depending on which plan you are on).
  • Death and funeral benefit payouts.
  • Some plan options also include accidental permanent disability payouts.
  • Primary and basic day-to-day benefits – such doctor’s visits, dentists, optometry, chronic medication etc.

What are some of the exclusions with medical insurance?

  • There is a 12-month waiting period for pre-existing medical conditions, and different plans will require specific waiting periods.
  • There is a specific list of hospital procedures that medical insurance is not compelled to cover.
  • There is often a network of medical practitioners, and you will only be covered if you visit those who are registered with your scheme.

Affordable medical insurance that helps you pay towards school fees

Medical insurance provider Day1 Health is committed to providing access to basic primary medical insurance and hospital cover that is not beyond anyone’s financial reach.

Day1 Health offers both comprehensive day-to-day and private hospital benefits at extremely affordable prices, starting from as little as R265 per month. When you’re a School-Days member, 5% of your Day1 Health monthly premium will be added to your School-Days bursary every month.

To find out more about Day1 Health’s different plans, please visit the Day1 Health website.

Not yet a School-Days member? It’s free to join online today.


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