What is the Difference between Medical Insurance & Medical Aid?
Below is the main differences between a Medical Aid and Medical Insurance Policy in order for you to make an informed decision on what will suit your specific need.
One of the main differences is that a medical aid in hospital benefit is normally much more comprehensive, but it pays out according to the medical scheme rate. Which could be either 100% to 300% depending on the plan. But this comes at a price which not everyone can afford. In the case of a Medical Insurance you are limited to amounts per annum or per event, but the premium is a lot less than a medical aid.
Medical insurance usually covers unlimited doctor’s visits within the prescribed network, but could also be limited on the lower plans. Medical aid’s benefits differ from plan to plan, it could also be unlimited but it also could be that there is no doctor’s visits as in the case of a hospital plan. The doctor’s visits could also be deducted from your savings account as it is in most cases. The premium on day to day benefits is normally less on medical insurance than opposed to medical aid, but keep in mind it is a network of doctors that has to be used.
Medical aid may impose a general 3 month waiting period and a 12 month condition specific waiting period for any pre-existing condition they may also load your premium up to 75% depending on how long you have not been on a medical aid after the age of 35.
On a medical insurance usually only 30 day waiting period (2 months) for any Day to Day benefits. Emergency and accidental cover has no waiting period. It is not very likely that a medical insurance company will impose a loading. A Loading will most probably only be applicable if you are over the age of 65 (55 for Unity Health). The Medical Insurance Plans that we have carefully selected for our clients start from R 405.00
What we offer in terms of Medical / Health Insurance?
Benefits of our Affordable Health Insurance:
- We offer Medical Insurance Plans with hospital cover that is limited to R1,000 000 Accident cover for in hospital treatment per family per year.
- An amount of R 5000.00 per incident is included for minor accidents in the hospital emergency unit.
What is an Accident?
An accident means bodily injury caused by violent, accident and external physical means. E.g Severe injuries resulting from a vehicle accident. An emergency in hospital benefit is limited to R 17 500.00 to stabilize the patient before being transferred to a public hospital if you have no Medical Aid / Hospital Plan in place.
What is an Emergency?
An event or unexpected health conditions, which if not treated immediately would result in death or serious bodily impairment. E.g. Heart attack / stroke.
Planned hospital & illness procedures are not covered. An additional medical aid hospital plan can be taken out separately for planned procedures.
What Day to Day Benefits does our plan offer?
- Unlimited GP visits within the 1700 network doctors Nationwide and counting. 80% of the network doctors dispense medication and if the doctor does not dispense and amount of R 2750.00 is available per member per year.
- Medication can be collected with your medical card at any Clicks or Dischem pharmacy where our providers are very well known. After 12 months you are able to apply for Formulary Chronic Medication through our network doctors for the 27 listed high impact conditions including HIV/AIDS and TB is available.
- Cover for Optometry, Dentistry, Pathology as well as Radiology is included.
- Accounts are paid directly to network providers as long as network providers & hospitals are utilised.
- Accidental death benefit of R 10 000.00 is available to principal insured or spouse.
- ER24 is available to you for emergency evacuation, including air or road as well as the Life and Mediclinic hospital network Nationwide is available in the event of an emergency or accident.
All In One Brokers has been in the insurance industry since 2006 with extensive knowledge in Medical Aid, Long Term and Short Term Insurance.