In this article, we are touching on the different types of private health products and medical aid plans on offer as well as taking a brief look at wellness programs and gap cover.
Medical aid, medical insurance, gap cover and wellness programs
What is medical aid?
Medical Aid is a product that can cover the costs related to healthcare from getting medicine at your nearest pharmacy to the hefty bills after being hospitalised.
By paying a monthly contribution to a medical aid scheme either all or a portion of your healthcare costs are covered in the event of an illness or injury.
Not all medical aid plans are the same and each plan and provider offer different benefits. It is worth speaking to an independent specialist before choosing your medical aid plan.
How does medical aid work?
When joining a medical aid scheme, you start by choosing a specific medical aid plan for you and your dependents. Depending on income bracket and number of dependents, some plans will be better than others. The various medical aid plans are priced differently and also differ in the types of benefits you will receive.
Once joined, you will pay a monthly premium towards the scheme in order to access the benefits available. When you or your family fall sick or need treatment, you are able go to the doctor or hospital, get treated and the medical scheme will cover some or all of the costs of this medical event.
It is worth noting that all registered medical aid schemes include a set of prescribed minimum benefits set out by law. We will go into detail about medical aid plans and their benefits later in the series.
What is medical insurance?
Medical insurance is a short-term insurance product that covers certain medical events and surgical expenses.
The product is designed to pay out a lump sum amount in the event that you need the funds to pay for the likes of a medical procedure.
Medical insurance is an affordable alternative to medical aid but is less comprehensive.
How does medical insurance work?
Medical Insurance pays out an amount should your claim meet the criteria of the policy. The amount paid out does not change depending on the severity of your treatment. These pay outs are generally fixed per condition and it will be disclosed in the policy.
Unlike medical aid, who deals directly with the medical provider, medical insurance will pay you directly. You then have to settle your medical bills and cover any shortfalls.
Since medical insurance falls under the short-term product category like car and pet insurance, they do not have to include Prescribed Minimum Benefits they can medically underwrite clients and they can also impose different waiting periods and exclusions.
Something is better than nothing. Even though health insurance is less comprehensive than medical aid it is still far better than not having anything protecting one of your greatest assets.
Gap Cover and Medical Aid
If you have been a member of a medical aid without gap cover you are aware of the dreaded gap between what medical schemes cover and what private healthcare professionals charge.
What is Gap Cover?
If you have been a member of a medical aid without gap cover you are aware of the dreaded gap between what medical schemes cover and what private healthcare professionals charge.
Gap cover is a product that provides cover where there is a shortfall between your medical expenses and medical aid. The product covers the difference between what your doctor or specialist would charge and what your medical aid would pay. Gap cover works together with medical aid therefore you need to be a member of a medical aid to get gap cover.
How does Gap Cover work?
As a member of a medical aid, you will need to consider which gap cover is best suited for you. Depending on your choice of medical aid you would need to assess the various gap cover products to make sure the gap is covered (you see what I did there). This is because medical aid schemes pay out expenses according to a specific rate.
When the doctor or specialist is charging more than the medical aid rate, there is a shortfall. Gap cover generally covers the difference and will relieve you of the extra financial costs. With certain conditions, like cancer, the newer, more expensive treatments show significantly higher success rates however they are more expensive than the medical aid rate.
Like, with all products, we have to stress the importance of speaking to an independent specialist. Each product and provider is different and someone who is working for only one provider is not going to be able to compare what is best for you.
Encouraging self-care and wellness
What are Wellness Programs?
Wellness programs are initiatives that seek to sustain or improve your health and well-being. The programs are usually initiated by medical aid companies to encourage their members to stay healthy as well as increase customer loyalty. Examples of wellness programs are Discovery’s Vitality and Momentum’s Multiply.
How do they work?
Providers set up a tiered system, whereby the healthier and more active members are, the better the benefits they will receive. Members would pay a fixed monthly cost to access the basic benefits on offer which may include discounts on gym fees, flights, movies, food, etc..
Access to the different types of benefits would be determined by the rewards level the client is on. Maintaining reward levels is also lucrative as some providers offer a cashback on premiums as an added incentive or medical aid saving deposits.
Last things to consider
As much as it’s great to have insurance in place to cover your medical costs, it’s important to understand the different types of products on offer to decide which one best suits your needs. Medical aid is comprehensive but more expensive compared to medical insurance.
The best option for covering your health and well-being is to look at medical aid and gap cover. A combination of these two products will ensure maximum protection for illnesses and injuries. Speak to an independent specialist to discuss all of your needs and concerns before making any changes.
It is the collective pooling of members’ contributions, with the goal that the members can then access this money when needed to pay for medical expenses.
PMBs are Prescribed minimum benefits that every medical aid has to cover regardless of the plan and price – There are 270 conditions that all medical aids will cover.
This is a network of healthcare professionals that have an agreement with the medical aid to charge the agreed medical aid rate. Dependant of the medical aid option that you are on the medical aid will advise members to only use the designated service provider.
