29 April 2022
The cost of medical aid in South Africa is at an all-time high with many members battling to pay their premiums. This is where medical insurance comes in and offers a potential solution to reduce the financial burden experienced by many.
However, there is a stark difference in benefits offered and level of cover when deciding between the two. This is not as clear to the consumer as one would hope for.
So, let’s get into it…
The most important difference between Medical Aid and Medical Insurance is that Medical Aid’s are obligated to provide cover for the diagnosis and treatment of PMB’s.
What are PMB’s?
Prescribed Minimum Benefits (PMBs) are a set of predefined conditions that form part of South Africa’s Medical Schemes Act. With PMBs, anyone who is part of a medical scheme can receive treatment for 270 hospital-based and 25 chronic conditions. The price of these will be covered in full.
These conditions are usually your most life-threatening conditions. Examples are heart disease, cancer, childbirth, hypertension and diabetes– click here to view the list of PMB conditions.
So, you may be asking the question – what cover do I get on Medical Insurance then?
Medical Insurance mainly offers benefits for daily health care needs such as GP visits, scripted medication, dentist visits and optometry with the option to add on hospital cover.
The hospital cover offered by Medical Insurance companies is not extensive. It is usually limited to accidental and emergency cover only. They only cover certain procedures at a fixed rate per day spent in hospital.
The Medical Insurance companies are not obligated to cover any conditions in full no matter the severity thereof. They are only obliged to pay the set rand value as per the policy chosen. This usually results in many members experiencing major out-of-pocket expenses when hospitalised.
Whilst Medical Insurance may offer South Africans financial relief in comparison to Medical Aid, the differences in benefits need to be analysed and given careful consideration before a decision is made.