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FAQs
Key Differences between Medical Aid & Medical Insurance
Making an informed decision
Choosing the right healthcare cover is an important decision that can have a significant impact on your health and financial wellbeing. The expert FinSide team guides you in understanding the distinctions between medical scheme cover and health insurance, you can make an informed decision that aligns with your healthcare needs and budget.
Medical scheme cover offers regulated benefits, lower out-of-pocket costs for network providers, and comprehensive cover for a range of medical services. Health insurance, on the other hand, provides flexibility, customisable cover options, and additional cover choices beyond medical scheme cover.
Herewith some helpful answers to the most frequently asked questions.
FinSide’s 10 Frequently Asked Questions (FAQs)
1.
What is the main difference between medical scheme cover and health insurance?
Medical scheme cover is overseen by the Council for Medical Schemes and offers comprehensive cover for various medical services, while health insurance falls under the supervision of the Financial Services Conduct Authority and provides more limited healthcare cover.
2.
What does medical scheme cover typically include?
Medical scheme cover, often referred to as medical aid, includes services like doctor visits, hospitalisation, and prescribed medication. It is designed to assist individuals and families in managing their healthcare costs.
3.
How does the cost and cover of medical schemes work?
The Council for Medical Schemes oversees medical schemes and mandates that they provide cover for a set of 271 Prescribed Minimum Benefits (PMBs), which must be factored into the premium costs. Medical schemes do not have an overall limit for hospital procedures and cover elective procedures.
4.
Do medical schemes accept all applicants?
Yes, medical schemes guarantee acceptance when joining, even if underwriting is applied. They cover the actual medical costs incurred by the member.
5.
Are there age-related differences in medical scheme premiums?
While medical schemes charge the same premium for the same plan to all members regardless of age, joining a medical scheme after the age of 35 may result in a higher premium.
6.
What does health insurance typically cover?
Health insurance covers limited day-to-day medical expenses like GP visits, dentistry, and optometry. Some plans provide hospital insurance, but they may not cover Prescribed Minimum Benefits (PMBs) like medical schemes do.
7.
How do health insurance policies pay for medical expenses?
Health insurance pays a specified benefit after hospitalisation, unrelated to the actual medical expenses. This benefit is aimed at covering incidental costs, such as loss of income.
8.
Are there exclusions for pre-existing conditions in health insurance?
Health insurers can exclude applicants with certain medical conditions, and premiums vary based on factors like pre-existing conditions, age, and family size.
9.
What factors should I consider when choosing between medical scheme cover and health insurance?
When deciding, consider factors like your cover needs, budget, provider preferences, additional cover requirements, and whether you prefer flexibility or regulated benefits.
10.
How can I determine which option is best for me?
To determine the best option, evaluate your healthcare needs, research available options, seek professional advice, review terms and conditions, and consider your long-term plans in relation to your chosen healthcare cover.