SOUTH AFRICAN MEDICAL INSURANCE THAT WON’T BREAK THE BANK
The COVID-19 outbreak is a stark reminder of the importance of health care especially for the less fortunate and under- privileged.
Currently only 9 million of the total South African population of 58 million people are currently covered by medical schemes – 15% of the population. That means 85% of the population had to face this pandemic uncovered and reliant on the public healthcare system!
The COVID- 19 pandemic has also clearly illustrated that employers do have a Duty of Care towards their employees to provide adequate and appropriate health care benefits. However, the problem is that the cost of medical aids is exorbitant and given the current economic climate, most employers do not have the financial resources to offer such expensive benefits.
Public sector health-care facilities are poorly managed, under strain and with the implementation of National Health Insurance still years away, employers do need to provide some health benefits.
Fortunately, there is an alternative option in the form of primary health-care insurance.
Accepted such plans do not afford as comprehensive cover as a medical-aid, they do however provide workers with access to unlimited private doctor visits, specialist visits, acute medicines, chronic medication cover, basic tests, optometry, dentistry, emergency services and private hospital cover for trauma and accidents according specified limits, at much-reduced contribution rates. Dependent on the plan elected by the employer, these health insurance solutions can be secured for as little as R185 per month.
A small price to pay for your Duty of Care.
Salient differences between health insurance and medical aid
“Health Insurance” and “Medical-aid” are often used interchangeably but they are significantly different. Medical aid is a more comprehensive form of health cover and the two offerings are subject to different legislation and regulators.
The salient differences between the two types of health benefits can be summarized as follows:
Medical aid would typically include private hospital care, doctors’ visits, medication and more.
- Medical Aid is governed by The Council for Medical Schemes and the South African Medical Schemes Act.
- Treatment cover is based on a specific medical scheme tariff.
- Must cover Prescribed Minimum Benefits in full. These are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected
- Does not offer additional benefits such as death or funeral cover.
- Sometimes has a financial shortfall, in which case the patient will be required to cover the price difference out-of-pocket or through additional “gap cover”.
Low-cost or Primary Care Health Insurance
Low-cost or Primary Care Health Insurance is an insurance product designed to provide access to quality private healthcare at an affordable price. These products focus on the essential healthcare needs of most South Africans and includes a range of primary healthcare and hospitalization benefits.
- Governed by the Financial Services Board and Short-term Insurance Act.
- More affordable than medical aid, starting as low as R180 per month for the entry level plans, but concomitantly these plans offer little less coverage.
- Covers treatment at fixed amounts. These payments are generally made to the member who will then decide how best allocate the funds.
- Covers only certain types of illnesses, injuries, or procedures.
- Is subject to waiting periods if a group scheme is not implemented.
- Members will generally pay one set fee or premium for their family.
- Often will allow you to add additional benefits (buy-up options) such as accident and emergency cover, hospital and maternity lump sum benefits, and death or funeral cover.
If your employees are among the 85% of the population who are not covered, are you furnishing your Duty of Care? Especially considering the low cost of providing some entry level health benefit.
If you would like some additional information on the low-cost medical insurance or want a quote, please contact Stuart Wilson at Stuart.Wilson@axioconsult.com