Affinity Business Network

Medical Aid Schemes vs Medical or Health Insurance: Be informed and know your product
The increasing costs tied to healthcare has served as encouragement to seek medical cover whether it be in the form of a medical aid scheme or health insurance to ensure medical expenses are taken care of in the event of a medical emergency. However, the key differences between these options still cause confusion and in order for you to make an informed choice between medical aid schemes vs medical or health insurance – this is what you need to know:
Medical Aid Schemes

-Medical Aid schemes are governed by The Council for Medical Schemes and are registered as non-profit entities.
-Medical Aid contributions can’t be linked to age or health status of prospective members
Medical Aid cover is based on tariff codes and procedures.
-By law, Medical Aid must cover Prescribed Minimum Benefits (PMBs) to members – a list of 270 medical conditions, 26 chronic diseases and various emergency conditions.
-Provides Day-to-Day benefits for low-cost, high-frequency events. These benefits are paid according to the National Recommended Price List (NHRPL).
No cover is provided for personal accident, disability or loss of limbs.
-Medical Aid schemes are not authorised to provide any death or funeral cover as part of the scheme.
-In-hospital benefits are paid according to the NHRPL and only the benefits listed in the plan are covered.
-Medical Aid schemes impose waiting periods (3 month general waiting periods excluding pre-existing conditions for up to 12 months) on all new members.
-Medical Aid schemes provide cover for benefits based on the scheme chosen and not on a per person base.
-Medical Aid provides payment directly to medical professionals.
-Medical Aid contributions are deductible for tax purposes.

Medical Aid schemes are most suited for people who stand to benefit from high-frequency medical events.

Medical- or Health Insurance

-Medical- or Health Insurance is based on a contract that offers insurance to clients for certain events and stated benefits.
-Regulated by the long- and short term insurance acts
Governed by the Financial Service Board (FSB).
-Medical- or Health Insurance policies insure against specific medical events or conditions.
-Predominantly provides insurance for infrequent events but with Affinity Health, this has been adapted into various benefits that, depending on the policy you take, cover day-to-day costs for GP visits, dental consultations as well as optometry.
-Provides cover for stated amounts.
-Medical- or Health Insurance can be used as gap cover in conjunction with a Medical Aid scheme to ensure cover for any shortfalls on behalf of the Medical Aid scheme
-Medical- or Health Insurance policies have specified benefit limits.
-Premiums are based on age, health risk, habits and hobbies that are underwritten.
-Medical- or Health Insurance provides cover for events at a fixed or stated amount that is generally paid directly to the insured member as opposed to medical professionals; however, Affinity Health does have an extensive practitioners network that, in most cases, pays the medical service providers directly.
-Medical- or Health Insurance cover may include personal accident risk cover for events such as disability, loss of limbs, dread diseases.
May provide life cover and funeral benefits.
-Medical- or Health Insurance withholds the right to decline applicants based on their current state of health, their occupation or any other reasons that are considered high-risk.
-Medical- or Health Insurance offers stated benefits as per the selected cover for specified events.
Medical- or Health Insurance is an insurance product, much like life insurance where a monthly premium is paid for a previously set, fixed pay-out amount as per a policy schedule to insure the member against various stated events.

Medical- or Health insurance companies can, unlike medical aid schemes, provide opportunities for members to receive funeral cover, personal disability-, and loss of limbs cover.
For affordable Medical- or Health Insurance that matters, contact Affinity Health today.
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ABN ambassador
Bianca Dodgen