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

What is the difference between health insurance and medical aid?

Medical aid and health insurance are not the same. The one you should choose depends on the premium you can afford to pay every month and you and your family's healthcare needs.

It is true that both health insurance and medical aid give people access to private healthcare for a set monthly payment. What is different is the kind of private care that members have access to through each product (and so the monthly costs of the products are different too).

When you have health insurance:

• You pay the same amount every month to have everyday access to primary healthcare (and not pay more for this care) such as doctor (GP) or nurse visits, basic dental and eye care, some medicines, and care for some medical emergencies in a private hospital.
• By paying extra every month, you can add your family to your policy so they can get the same care.
• Health insurers usually have arrangements with groups of doctors, nurses, dentists and other healthcare providers to help members get quality care at lower prices. These are called provider networks.
• Health insurance is a product governed by South Africa's insurance laws and regulated by the Financial Sector Conduct Authority (FSCA).
• Flexicare is an example of a health insurance product

Who is health insurance best for?

Health insurance is perfect for people who cannot afford the monthly cost of medical aid cover but want an affordable way to access private healthcare for everyday needs - with a chance to pay a little more for emergency and private hospital cover.

When you have medical aid:

• You pay the same amount every month to be on the plan type that you choose.
• Medical aid plans cost more than health insurance products because they cover members across a bigger range of healthcare types.
• There are often many plan types to choose from, ranging from plans that are mostly for hospital cover to plans with medical savings accounts to the most expensive plan types, which offer the most comprehensive coverage.
• You can add your family to your policy for a higher monthly premium.
• When you see a doctor or get care, the medical aid either pays the doctor directly, or you pay first and then the scheme pays you back.
• This covers your costs for everyday care (the amount of cover you get for things like GP visits, specialist doctor visits, medicine, and more depends on your plan option). Medical aid also covers you for major medical costs, like when you need care in hospital.
• By law, all medical aids must cover a basic level of care for certain chronic conditions and diseases. This set of care options or benefits is called Prescribed Minimum Benefits (PMBs).
• Medical aids are governed by the Medical Schemes Act and regulated by the Council for Medical Schemes.
• Discovery Health Medical Scheme is an example of a medical aid.

Who is medical aid best for?

Medical aid is a great option for people who can afford a higher premium than what they'd pay for health insurance. Medical aid is for people who want cover against unexpected medical events that cause large costs that few people can afford - such as extended hospital stays or long-term care after an accident, injury, or serious illness. Medical aid is also ideal for families, people who need regular medical care or have chronic illnesses, and anyone who wants broad cover for their healthcare needs now and into the future.

Key differences between health insurance and medical aid:

So, now that we understand the difference, what is Flexicare health insurance? What does Flexicare cover you for, and what does it cost?

Flexicare is a health insurance product offered by Discovery and underwritten by Auto & General. Flexicare is designed to make every day private healthcare more affordable and easier to access

How does Flexicare make getting care more affordable? Wouldn't I pay the same if I went to the same doctors without a Flexicare membership?

Usually, no; you'd pay a bit more for the consult and medicine if you were not a member. Flexicare makes getting private healthcare more affordable because Flexicare has special arrangements with groups of top-quality healthcare providers, such as doctors, dentists, optometrists, and pharmacies, who charge set rates for members. These are called network providers. The idea is to give members access to private healthcare at lower costs than they'd pay without Flexicare membership.

At network providers, Flexicare members don't have to pay cash. The provider is paid directly by Flexicare.

There are two different Flexicare plans to choose from.

For R459 per month, Flexicare Core gives you:

• Unlimited visits to a nurse as needed
• Doctor visits when a nurse says it is needed
• Online doctor visits
• Acute and over-the-counter medicines
• X-rays
• Flu vaccine
• A Health Check
• Care during pregnancy
• Blood tests
• Small medical procedures done at a doctor
• HIV care

For R539 per month, Flexicare Plus gives you:

• Unlimited visits to a doctor as needed
• Unlimited online doctor visits
• Visits to specialist doctors
• Acute, Chronic and over-the-counter medicines
• X-rays
• Flu vaccine
• Optometry
• Dentistry
• A Health Check
• Care during pregnancy
• Blood tests
• Small medical procedures done at a doctor
• HIV care

What private hospital emergency cover options can be added to Flexicare?

Flexicare gives members the option to add Discovery Emergency Cover (for a slightly higher premium), which pays for care at a private hospital in the case of accidents or life-threatening emergencies. This optional benefit makes sure members can access urgent private hospital care when it's needed most.

These benefits are optional add-ons that members can choose when they sign up for Flexicare or at a later stage. The member must already have a Flexicare Core or Flexicare Plus membership to be able to sign up for additional Discovery Emergency Cover.

There are three Discovery Emergency Cover options available, each offering different levels of cover.

Emergency Core, from R218 per month

Pays for care in a private hospital after an accident or injury.

Emergency Plus, from R313 per month

Covers everything in Emergency Core. It also pays to be stabilised at a casualty unit during an emergency, and for care in a private hospital after a heart attack or stroke.

Emergency Max, from R439 per month

Covers everything in Emergency Core and Plus. It also pays for private hospital treatment for these nine serious conditions: Acute appendicitis, acute asthma, ectopic pregnancy, acute inflammation of gall bladder, fit or seizure, acute pneumonia (serious lung infection), kidney stones, acute renal failure (kidney failure) and pulmonary embolism (blood clot in the lungs).

Is Flexicare the same as medical aid?

No. Flexicare is not the same as medical aid and doesn't offer the same kind of cover.

Flexicare is a health insurance product, not a medical aid scheme. Flexicare does not pay for PMBs or full hospital cover. Instead, it pays for specific day-to-day healthcare services and emergency treatment, based on the plan chosen.

Flexicare is a good option for people who want reliable, low-cost cover for everyday private healthcare - but can't afford medical aid.

Making the right choice for your health and budget

There's no one-size-fits-all solution when it comes to healthcare cover. What matters most is choosing an option that meets personal needs and fits within a monthly budget.

Health insurance and medical aid offer different levels of cover for private healthcare. Flexicare is a smart and affordable choice for people in South Africa who need help with everyday medical costs and want peace of mind in case of emergencies.

Flexicare is:

• Affordable.
• Easy to understand.
• Designed for day-to-day healthcare.
• Backed by a trusted provider network.

Flexicare helps more people in South Africa take care of their health, without the stress of large monthly payments or medical bills.

Learn more about Flexicare.