When looking for a medical aid option that best suits your needs, you will usually find choices where one may seem better than the other in some aspects and then lack in other ways. One plan might cover doctor visits and various day procedures but might not cover hospital bills. Other plans may fully cover in-hospital procedures, but then you have to pay separately for medication and day to day doctors’ visits. Most of us are looking for the cheapest medical aid rates, with the most extensive cover possible. So what is the difference between aid and insurance?
Medical aid, which is regulated by the Medical Schemes Act, is essentially cover that is based on pricing codes and procedures – higher cost of cover means a higher level of cover. As an aid to your health, providers must allow for a basic level of service that must be made available to all clients (as determined by the Council of Medical Schemes). Medical aid does have specified, yearly limits for use, whether visits to hospitals or pay-outs to doctors, or any ailment that does not need to be specifically stated in the agreement. Medical aid schemes don’t usually include any personal accident disability or loss of limbs cover, these must be covered in other services and added extras. These aids are not authorised to include death or funeral cover as part of the medical aid offering. Medial Aid will, however, pay in-hospital benefits according to the National Recommended Price List, but the amounts are limited in line with the benefits laid out in your chosen plan.
Medical insurance, on the other hand, is governed by the Long Term and Short Term Insurance Acts and focuses more on life-changing events. This is done by effectively paying out cash to cover the costs incurred by an event. While it may not fully cover pre-existing conditions, it is helpful in cases of accidental injuries, paralysis or illnesses that may occur after you have taken out the insurance. These include things like hospitalisation and larger procedures. As the name suggests, this insures your health, protecting you in your day to day life. If, for example, you are covered by insurance and suddenly experience a stroke or heart attack, medical insurance will pay out, in the same way that your car insurance will pay out if your car was stolen or damaged. With medical insurance you are covered for a certain amount and everything more than that you will need to pay for. This system tends to afford lower premiums, but covers health care to a different extent when compared to a medical aid package.
As two tools to cover the health of you and your family, understanding the differences is important to ensure you get the cover you need for your loved ones. They say knowledge is power, and no power is better than being able to protect your family at all times.