Health insurance is a less comprehensive, more affordable alternative to being part of a Medical Scheme. As many people cannot simply afford medical scheme cover, Health Insurance is a way that ensures that the majority of South Africans are able to be covered and receive quality healthcare. There are many great benefits, it covers more of the ‘everyday’ sort of medical visits.
What’s the difference between Health Insurance and a Medical Scheme?
If you are on health insurance, everything has a defined limit and overall maximum limit which means it will only cover accident-related incidents or emergencies. Health Insurance will not cover any planned admissions into hospital for procedures. Medical Schemes, on the other hand, have to cover a minimum of the PMBs for non-emergencies and any life-threatening event in full with no co-payments and no limits.
Health Insurance and Medical Schemes are structured differently. Health Insurance is a pay-out per event plan. This means that the Health Insurance product will cover a maximum for any event which is on a list they provide – it consists of different diseases, illness or certain events that they cover. For example, if you break your leg and need to go to the hospital, a Health Insurance may say to cover a broken leg will cost R5 000. Health Insurance will pay out that R5 000 and you can go to see whoever you need to with that money to fix your broken leg. Whereas a Medical Scheme will cover all the costs related to your broken leg when you go to the hospital.
You are not able to take out Gap Cover on your Health Insurance plan. It is a different product altogether. Gap cover can only be taken out if you are on a Medical Scheme.
Who should get Health Insurance?
Anyone that cannot afford to go onto a fully comprehensive medical scheme that wants something that will cover you for a small monthly fee. Having at least a primary health care benefit will ensure that if a medical emergency does happen, you will be covered for most everyday medical emergencies.
What does Health Insurance cover?
Health Insurance covers a range of day-to-day medical costs. There are different structures that cover certain aspects. These include:
- Primary Care - this covers anything that happens before you are admitted to hospital, such as access to general practitioners, essential medicines for both acute and chronic conditions, diagnostic services such as pathology and radiology, basic and emergency dentistry, optometry, health screenings and pre-birth maternity benefits.
- Emergency Care – this covers anything accident-related, which includes hospitalisation benefits for accidents and emergencies.
- Primary and Emergency Care – this option is a combination of both and covers you for any GP consultations as well as basic casualties going into hospital.
What is the average cost of health insurance?
Health Insurance is an affordable option for having a basic medical cover. The cost of Health Insurance can range from anywhere between R160 per month to R470 per month. It depends on the option you choose and the one that will best suit your needs.