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Medical Insurance
Medical Insurance for daily health care needs
What is Medical Insurance?
Medical Insurance provides daily health care benefits, including GP visits and medication, with optional limited hospital cover for emergencies and certain procedures at a fixed rate. It does not fully cover all conditions, often leading to out-of-pocket expenses for hospitalization. While it can be more affordable than Medical Aid, the differences in benefits require careful analysis before choosing.
Benefits of Medical Insurance
Health insurance provides a limited lump sum or daily rand amount for hospitalisation costs, but it is usually a rand amount of events per year for Accidental and Emergency cover only.
This covers the cost of surgery, including the surgeon's fees, hospital fees, and anaesthesia for Accidental and Emergency procedures.
Medical Insurance typically includes cover for prescription medications, which is a vital component for managing health conditions and ensuring overall wellbeing. This cover operates based on a formulary—a predefined list of medications that the insurance policy agrees to cover.
These benefits are related to your general practitioner visits, basic dentistry, and optical benefits at designated network providers, ensuring accessible healthcare services for routine medical needs.
Key differences between Medical Aid
and Medical Insurance
Medical Aid
Regulation: Medical Schemes Act
Range of Cover: Wider
Premiums: Typically Higher
Claim Processing: Typically Faster
Medical Insurance
Regulation: Long-Term Insurance Act (LTIA)
Range of Cover: Narrower
Premiums: Typically Lower
Claim Processing: Typically Slower