Paul Cox

Since the start of the national lockdown in mid-March, almost all South Africans have had to tighten their belts. Despite the lockdown now easing to level 4, many people will still not be able to return to work and earn an income, forcing them to tie their purse strings even tighter. This has pushed people to look at ways of saving money, leading medical aid and health insurance members to consider lapsing or cancelling their policies to cut this cost.

“While we understand that folks are struggling, they are putting themselves and their families at risk should they need medical cover. If a health issue does arise, they will end up having to pay far more to treat it than they would have spent on their premiums,” warns Paul Cox, Managing Director at the Essential Group of Companies which includes EssentialMED – an Underwriting Management Agent that has supported South Africans with innovative health insurance products since 2005.

He continues: “Having peace of mind is priceless which is why there are options out there that enable people to change their policies to suit their needs – be they financial, or health-related. Health insurance, like that offered by EssentialMED, is not only far more affordable than a medical aid, our members are also able to pick and choose the benefits they need and the level of cover they want.”

Explaining the difference between medical aid and health insurance, Cox says that while the former is a far more comprehensive offering, the latter covers the basics such as GP visits, optometry, pathology, radiology and general hospital stays, amongst others. “Ours is an event-based insurance, so if you think about medical or health insurance in the same way as household insurance, if something happens, we pay out.”

Asked about the trend of people requesting payment holidays from medical aids and health insurers, he  shares that unfortunately, unlike the medical aid industry which operates using a pooling structure, health insurers do not have that luxury. “We’d be subsidising members ourselves as a company which then impacts our ability to operate, pay staff and continue supporting the economy.  While many in the insurance field have been forced to adopt the seemingly harsh policy of ‘no payment, no cover’, we pride ourselves on being more accommodating of people and their ability to pay. In fact, we are offering members who are struggling but have been with us for a long time and are regular payers the option of suspending their policies and will ensure that, when they do come back, there are no waiting periods and they can carry on as usual following the break in their policy. However, we would only recommend taking this option in dire circumstances.”

His advice for South Africans struggling financially is to be the hero and ensure that they are doing the right thing for their family. “Defaulting or choosing not to pay your health insurance premiums would be ill-advised  especially with the winter months ahead of us – which is typically cold and flu season.  I would also suggest that you define your needs and wants very carefully  and apply for  whatever is available in terms of government assistance,  as soon as possible.”

“This is a tough time for everyone, but EssentialMED is there to give you and your family  tailor-made access to quality private healthcare at a price you can afford,” concludes Cox.