Having medical insurance and belonging to a medical aid often sounds like exactly the same thing; but there are actually a few differences between them. There are difference sets of legislation that governs them and they have different characteristics as well.
Medical aid is a non-profit scheme and they specifically cover the costs of various medical procedures. Medical aids offer certain benefits such as dentistry, hospital, day to day medical expenses, chronic medication and more. The plan requires you to pay a premium and if you need medical cover, the medical aid will check to see if you are covered in terms of the specific procedure or incident. They will then pay the hospital, doctor, etc. The amount can vary and the bill is settled directly with the doctor or hospital. The amount that the medical aid pays out will differ according to the plan that the client is on, and not all procedures will be covered necessarily. Clients can choose from a variety of medical aid plans and they will receive different benefits and pay different amounts every month towards their chosen plan. Every year, the medical aid will change their benefits unilaterally and they will also increase their premiums. Medical aid clients can choose or change their plans at any time, and then continue with the new plan for the rest of the year. This is ideal if your financial situation changes, or you need to increase your cover.
Medical insurance in general focuses more on major events such as hospitalization and larger procedures, and works on the same principles as household insurance where you are insured for any damage or loss that you may incur with these household items. With medical insurance, you are covered for certain medical events, for e.g. if you need to go to hospital, your medical insurance will pay out, in the same way that your car insurance will pay out if your car got stolen. Medical insurance is a great benefit to have and you know that you will be covered up to a certain amount. If the medical bills are more than the amount you are insured for, you will need to pay in the difference. With medical insurance you are covered for a certain amount, and everything more than that you will need to pay for. This is different from medical aids, since medical aids will check to see if you are covered for a certain event and then pay the doctor or hospital directly. Medical insurance has a board of directors; whereas a medical aid is run by a board of trustees.
Whether you choose to go with a medical aid plan, or medical insurance; you need to have cover in case you need urgent medical attention, or if you have a family and you want to be sure that their medical expenses will be paid for. There are almost 100 medical schemes available in South Africa and they offer a wealth of choices between medical aid benefits, plans and insurance that will certainly fit anyone’s needs.
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