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What is Health Insurance?

Health insurance is a more affordable alternative to being part of a Medical Scheme. As many people cannot simply afford medical scheme cover, Health Insurance is an alternative option which provides limited access to quality Healthcare.

What’s the difference between Health Insurance and a Medical Scheme?

Health Insurance is limited by applicable legislation to cover defined events up to a maximum set of limits per events for Hospitalized procedures. Similarly there are limits for defined procedures and treatment out of hospital.

Medical Schemes, are governed by a separate set of legislation which sets out a minimum amount of coverage for all emergency treatment, and a list of defined procedures. Generally speaking, Medical Aid plans are much more expensive due to them being liable for far more comprehensive minimum coverage, whereas Health Insurance is able to limit the maximum coverage.

It is also important to understand that you cannot top up Health Insurance products with GAP cover, as the rules of coverage specify that you need to be part of a Medical Scheme to qualify. 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.

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Who should get Health Insurance?

Anyone that cannot afford Medical Aid should consider Health Insurance as an alternative to have access to a form of private healthcare cover.

What does Health Insurance cover?

Health Insurance covers a range of day-to-day medical and hospital 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.