medical aid vs health insurance: family of three made out of paper with a stethoscope

Can’t afford medical aid? Here’s why you should consider health insurance instead.

There’s nothing more important than the health and wellness of your family, but with the escalating costs of medical treatment, quality healthcare has become a luxury many South Africans simply can’t afford. The solution? For some, it’s health insurance, which is more affordable and accessible for the average family.

What’s the difference between health insurance and medical aid? 

Health Insurance Medical Aid
Waiting periods Health insurance has a waiting period for claims that’s dependent on the particular products a member is covered for – so each product can have a different waiting period. This is something you’d need to check with your broker before signing-up for health insurance. The waiting period is usually three months, with a claims exclusion of up to 12 months for a pre-existing condition.
Hospital stays and surgical procedures Provides less in-hospital cover than medical aid plans and is usually limited to emergencies only. If a member is scheduled for a surgical procedure, they will need to provide the hospital with a guarantee of payment letter, before being permitted admission to the facility. Offers comprehensive hospital cover for a range of in-hospital treatments, the limits of which will depend on the member’s particular medical aid plan.
Benefits Offers limited cover, which is covered either as a Rand value per day or as an overall monetary limit per year. This makes health insurance more flexible than medical aid schemes as members can choose from a list of benefits to suit their budget and medical needs. This is often referred to as the ‘building block approach’. Are obligated to provide prescribed minimum benefits for a wide range of life-threatening emergencies and up to 26 chronic medical conditions. If you or a family member has a serious medical condition that may involve frequent hospitalisations or visits to a specialist, then a comprehensive medical aid might be the better choice.
Claims The member is paid directly, and they are then responsible for settling the bill with their service provider. Medical aid schemes tend to pay medical providers, like hospitals and doctors directly.
Cost Premiums will differ between individual members depending on several factors, such as existing chronic conditions, the member’s age and the size of their family. Medical aids are obligated to charge members the same premium for the same plan.

How much does health insurance cost?

Bloom Financial Services has partnered with Momentum’s Health4Me to provide affordable healthcare cover, with the entry-level health insurance option starting at just R395 per month.

Health4Me members can choose their healthcare provider, with day-to-day benefits covering GP and specialist visits, over-the-counter medication, maternity, dental and optical benefits, among others.

While health insurance has proven to be a more cost-effective option when compared to a medical aid scheme, there are benefit limitations for members so it’s advisable to discuss your options with your broker.

YOU MIGHT ALSO LIKE TO READ: 5 things all women should know about managing money

What next?

Always speak to an expert insurance consultant before making the choice between a medical aid plan and a health insurance policy If you’d like a Bloom consultant to contact you to help you make an informed decision based on your requirements and budget, visit Bloom and our trained team will provide you with all the information you need.

View our articles, competitions and promotions on BabyYumYum for all things parenting. SA's #1 Parenting Portal.