What is Health Insurance Compared to Medical Aid?
South Africa has its very big subsidized public health
sector and a smaller, private health sector. It is the private sector that offers high-quality
healthcare.
It is natural that doctors want to work in the private
sector. The public health system is so corrupt and badly run that they only benefit the funeral sector.
When you land up in one you don't usually emerge alive.
SOME kind of health cover to avoid a public hospital
There is a big gap between public and private healthcare
facilities. People look at taking out either health insurance or buying a medical aid plan to avoid
having to make use of the public healthcare system.
Both medical aid and health
insurance can keep you from having to make use of public hospitals. You need to know however that there are
significant differences between the two.
They're two different medical-help options
It was in April 2017 that the
Demarcation Regulations came into effect. Their aim was to clarify the boundaries between what the medical
scheme offers and what health insurance offers.
Medical schemes and insurance products are governed by different legislation -
health insurance is governed by the Short-Term Insurance Act and Medical Schemes by the Medical Schemes
Act.
You have to do research therefore, as costs and benefits differ. Making the wrong
choice can turn out to be a costly mistake. You may discover to your alarm, that you don't have the appropriate
health cover when you need it.
For instance, if you have a serious medical condition, and you know you're always
at the doctor and hospital because of it, you would be wiser to go with a comprehensive medical aid
plan.
The flexibility of health insurance
The medical aid schemes are also obligated to provide
prescribed minimum benefits for a wide range of life-threatening emergencies and up to 26 chronic medical
conditions. Health insurance isnt obligated to cover you for these prescribed minimum benefits, and
because of this it is cheaper.
Health insurance then, is more flexible than medical aid. The reason for this is that it
allows its clients to choose from a list of benefits cover that suits their budget and health
needs.
So what is health insurance then
when you compare it to medical aid? A lump sum is paid out by a medical insurance company, but while it
seems like a cost-effective alternative, the amount you pay each month may not cover what you thought it
would.
Medical schemes have to maintain minimum solvency ratios.
This can give members some peace of mind that the medical scheme will be there for them when they require
costly medical treatments.
Sometimes a health insurance
company will refuse to cover you if they think that the risk of a claim will be too high.
Which cover makes you feel self-assured? As you can see, when it comes to knowing the difference
between a medical aid and health insurance, the pendulum swings in favor of the one, and then swings in
favor of the other. So it is up to you to do thorough research and to closely investigate the good and
the bad of both so that you're covered for all possible eventualities.
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