Medical Aid & Gap Cover
What is Medical Aid
Medical aid schemes are a type of insurance that covers part or all of your medical costs when using a private medical provider.
South Africa has two healthcare options:
Public healthcare – This is funded by the government and is free.
Private healthcare – This consists of privately owned medical facilities and they charge for the use of their services.
Medical aids are regulated by the Medical Schemes Act (1998). They are essentially non-profit organisations and belong to their members.The legal definition, as per the Medical Scheme Act (1998) is:
- The “business” of a medical aid means the business of undertaking liability in return for a premium or contribution,
- to make provision for the obtaining of any relevant health services,
- to grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health services, and
- where applicable, to render a relevant health service, either by the medical scheme itself, or by any supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical aid.
How to choose your Medical Aid Plan
Within a medical aid, you will have various plans you can choose from. The medical schemes put plans together in a package form and you need to choose the plan that best suits your needs. If the incorrect package is selected, you could end up paying for benefits that you don’t need and not having the ones you need to be covered.
Types of Plans
Comprehensive Medical Aid
This plan covers the majority of medical expenses, ranging from your doctor & dental visits, most medication, through to hospital visits (Subject to the rules of the individual scheme). Generally, these options are the most expensive.
Hospital Plans and Hospital with Savings
This plan covers the majority of your expenses when you are hospitalised. It does not cover your day to day medical expenses, like a doctor and dental visits. Some plans have an optional savings account, which is designed to assist with day to day expenses. This amount may not exceed 25% of your annual premium, as per the medical scheme regulations. Once your benefits have been depleted, you will once again be liable for the day to day costs. These options are normally more affordable.
Network Option
This type of plan offers limited day to day, as well as in hospital cover within a specified network of medical facilities and service providers. Some of these plans are income based, this means that your monthly premium and benefits are linked to your monthly income.
Gap Cover
This type of plan is there to cover the shortfall between what the National Health Reference Price List (NHRPL) recommends and what the medical professionals charge. The NHRPL is a pricing system maintained by the Department of Health and the Council for Medical Schemes.
Hospital Cash Insurance
This is an insurance policy that will pay out a daily cash amount if you are hospitalised for a specified period. It is not a medical aid or hospital plan.
SO MANY OPTIONS, SO CONFUSING. LET US SIMPLIFY IT FOR YOU.
What you get from us
A team of skilled advice and support staff that are passionate about helping our clients.Access to an advanced software solution to find your perfect plan.We will contact you towards the end of each year to offer a review of your needs.We ASSIST you with your claims, thereby SAVING you TIME and MONEY.