By: Episodic Health

With South Africans spending thousands of Rands on medical expenses annually, can they afford to be without some form of cover, especially in the current climate where every cent counts?

“While most consumers are aware of the wide range of medical aid schemes on the market, not many know that there is an alternative – health insurance. This is designed to provide cover for unexpected events when you need it most, like when you are injured in a car accident, fall extremely ill or require root canal treatment. Health insurance also covers basic or essential healthcare needs to encourage you to keep tabs on your health and maintain it before something becomes serious,” says Johan Josling, Chief Executive Officer at Episodic Health, the only personalised health insurance on the market today.

To help consumers make an informed decision when choosing the kind of medical cover that best suits their needs and their budget, he shares some of the differences between medical aid and health insurance:

Prescribed Minimum Benefits: All medical aids must provide full cover for at least the Prescribed Minimum Benefits (PMBs) - 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. These PMBs include any emergency medical condition; a limited range of 270 medical conditions; and 25 chronic conditions defined in the Chronic Diseases List. Health insurance, on the other hand, is not limited to PMBs and insurers can decide what to include in their products, and rate them accordingly.

Price: With medical aids having to cover PMBs and possibly even more, they become expensive. Insurance can be cheaper because of what it covers and how. The main aim of health insurance is to cover your basic, essential needs for those unexpected events and give you the opportunity to manage your health on a day-to-day basis.  

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Tariffs and Rates: Medical aids pay governed health rates for each of the procedures it covers. Medical providers can charge more than the governed health rates, and this can leave a shortfall in cover. This is where Gap Cover comes in to cover the shortfall. Insurance typically pays up to a stated amount per event, irrespective of the medical procedure performed. With health insurance, it’s simple, clear and easy to understand and you know upfront what will be covered and up to what amount.

Waiting Periods: Medical aids can impose a three-month general waiting period and/or a 12-month condition-specific waiting period for a pre-existing medical condition before members can claim. With health insurance, waiting periods vary from product to product and benefit to benefit.

Late Joiner Penalties: If you join a medical aid after age 35 and you didn’t previously have cover or had a break in cover, a medical aid will apply Late Joiner Penalties. This is not the case with health insurance. 

Income bands: Some medical aids have a premium that is based on your income whereas health insurance does not discriminate based on this.

Day-to-day cover: Medical aids use the Medical Savings Account to pay for day-to-day expenses like visiting a GP, purchasing medication or seeing an optometrist. This is a portion of your premiums held in a savings account by the scheme. Health insurance provides cover for these essentials since they are built into the product.

“If you previously enjoyed medical aid cover but can no longer afford it, then health insurance might just be the alternative you need,” concludes Josling. 

To get a quote, or for more information, go to https://www.episodic.co.za/health/

Note: The above is meant to be purely informative. In no way does Episodic Health compare health insurance against medical aid as they are different products regulated by the Financial Sector Conduct Authority (FSCA). Episodic Health is not a medical aid. Episodic Health is a registered Financial Services Provider (FSP 49319).

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