Medical cover has become expensive. These days, even a minor operation can have you digging into your long-term savings. The high cost of hospital stays, specialist fees and other medical expenses makes it important to have at least some form of medical cover. With all this need for cover a friend or family member might mention to you, different medical aid options or that you must consider medical insurance. This may then get you to ask yourself, what is the difference between Medical Aid and Medical Insurance? Below we provide all the information you’ll need to make the right choice for you and your family. Regulation In South Africa, all medical aid schemes are regulated by the Medical Schemes Act and governed by the Council for Medical Schemes. Health insurance, on the other hand, is regulated by the long-term insurance act and governed by the Financial Services Board. Price One of the most noticeable differences between the two types of cover is the price. Medical aid schemes are notably more expensive, with higher monthly contributions. Medical insurance, however, is far more affordable, but this means there are limitations when it comes to what is covered. You should always consider your health needs when deciding which is best for you. Benefits Medical aids provide Prescribed Minimum Benefits (PMBs) for a list of chronic disorders. Medical insurance plans usually focus on daily health care, such as doctors’ visits and short-term medication. A more comprehensive health insurance plan may offer hospital care in the event of an accident or emergency, to a fixed sum. Although a medical aid plan provides more comprehensive cover, it doesn’t generally include personal accident disability or cover for loss of limbs. Health insurance does. It may also include death and funeral cover, which medical aid schemes do not offer. Medical aid schemes offer comprehensive hospital cover, usually for a large variety of in-hospital treatments, depending on your plan. However, there is often a shortfall between medical aid rates and the rates charged by the medical practitioners. (Therefore, Gap cover is always recommended, so to cover for any shortfalls that may occur) Medical insurance does not cover extensive hospital benefits. Hospitalisation is usually limited to accidents and emergencies and only covers specified costs. If costs exceed the limits, members will have to pay for the extra. Medical aids are also required to cover chronic medication, while medical insurance is not. Tax benefits Medical aid contributions are deductible for tax purposes whereas health insurance premiums are not. To apply for cover, contact our healthcare consultant Tammy email: [email protected] tel:(011)658-1333
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Given that COVID-19 is a global pandemic, all governments are required to coordinate and manage the response to the disease in the best way they can. As is the case in other countries, the South African Government has decided that it will source, distribute and oversee the rollout of the vaccination programme, and will therefore be the sole purchaser and distributor of the COVID-19 vaccines to provincial governments and the private sector, including medical schemes.
With the roll-out of the COVID vaccine, the South African government has also had relevant regulation, and different Medical Aid companies have their own relative ways to cooperate. The vaccines provided by the government are Johnson and Johnson (one dose) and Pfizer (two doses), and the Medical Scheme must be carried out according to the Government’s progress and allocation phase. As of 16 May 2021, people over the age of 60 are allowed to register on EVDS. South Africans must register on the Department of Health (EVDs) at the following website, when their age group is open to register: https://vaccine.enroll.health.gov.za/ Discovery Health In addition to the Department of health's online registration (EVDs), Discovery has launched its own registration and tracking program. Please refer to our article about the process and registration steps: https://www.daberistic.com/discovery_covid_vaccine_english.html Momentum Health Momentum is preparing to provide vaccines in an efficient way to assist members and the public to obtain vaccines in their allocated phase, the following has been established:
Momentum will communicate exact locations of the health care centres. Bonitas Health Bonitas Health did not give any special instructions, but for members who are qualified to register on EVDS, Bonitas has sent a SMS and an e-mail directly to the members. After receiving the invitation, they can register on the website of the Department of Health, and follow the process further. Discovery Health shares notes to guide clients on the steps to take in registering on the necessary portals for your vaccination journey. As part of the national vaccination programme, the National Department of Health’s Electronic Vaccination Data System (EVDS) is imminently expected to open to the public. What do you need to do? Everyone in South Africa who wishes to receive the COVID-19 vaccination must register on the National Department of Health’s EVDS. This registration process will be communicated and managed by the National Department of Health. You will have access to additional functionality and tailored support through the Discovery COVID-19 Vaccination Portal. Guidance about this portal and how to register with us will be sent to you next week. Why should you register with both systems?
Registration for citizens 60 years and above opens at 16.00 on Friday, 16 April 2021. EVDS registration guideline and who must resgister All Healthcare workers (public & private), citizens 60 years and above or persons under 18 with co-mobilities whom intend to be vaccinated in Phase 1 and 2 must enroll on the Electronic Vaccination Data System (EVDS). Please click on the below button to take you to Government's EVDS Self Registration Portal User Manual. Source: Discovery Health
With healthcare costs growing at an average of 8-10% each year, beyond inflation, which leaves medical aid clients with little choice but to downgrade their scheme benefit options to manage their cost of living. The downgrade of scheme option results in less benefits covered. This is often met with an unexpected and unaffordable bill after consultation or procedures. This has given Gap cover insurance critical spotlight to ensure medical aid clients are not faced with exorbitant amount of out-of-pocket expenses. Gap cover pays the client back policy which provides shortfall cover where doctors and specialists charge above medical aid rates of cover. Gap cover works in conjunction with your medical aid. Gap cover cannot provide cover where medical aid does not pay towards a procedure or covers the full amount for a procedure. For example, if your medical scheme option only pays out at 100% of scheme rate, you will then be liable to pay the shortfall of the other 200% to 400% charged by your healthcare provider as an “out of pocket” expense. Here is a testimonial of one of our clients Mrs K I gave birth in a private hospital in Johannesburg. The hospital bill was R15,000, Doctor’s bill was R14,500 and the anaesthesiologist R4000. Medical Aid made the following payments:
I had to pay the shortfall of R9,000 and luckily, I was able to claim from my Sirago gap cover and got my R9,000 back. *Please note we changed the name to keep identity private Gap cover may cover the following instances:
At Daberistic, our preferred provider is Sirago. Why Choose Sirago?
2021 Sirago Gap Cover Premium To apply for Gap cover contact Tammy in our Health department, email [email protected], Tel 011-6581333, Option 2 for Medical Aid.
The world has really gone digital for anything and everything. Discovery has their app available for any person who has at least one active Discovery product. To start using the app you must be registered on Discovery website. If you have not registered you can click this link to take you through the steps Click here. You will use the same username and password for the app as for the Discovery website. To assist with downloading the Discovery App, please click link: How to download the Discovery App If you have a Discovery Medical aid you may do the following on the app;
See below for listed details: Digital cards
Please click here for list of screening and benefit covers Track Vitality status and goals
If you have any questions on Discovery health mobile app, please contact Tammy or Jo in our Health department, tel: 011 658-1333, email: [email protected] Prevention is always better than cure and that is the main objective of the screening benefit. Medical Aids strive to help their members in detecting medical conditions early. The Screening and Prevention Benefit covers preventive tests, screenings, and a seasonal flu vaccination (for members registered for certain chronic conditions and members over the age of 65) on all Discovery Health Medical Scheme Plans. Having these specific tests conducted (up to the specified number) will not impact your day to day benefits. 1. Tests covered by the benefit:
2. The Vitality Check, a group test done at network pharmacies include:
3. Seasonal flu vaccination – you qualify each year if you’re over age of 65 or registered for one of the below chronic conditions:
4. Screening for kids
You may have certain co-payments
Please be reminded that Medical aid upgrades for 2021 will end soon, please make sure you have submitted your change by 30 November. For clients on Discovery KeyCare plan, Momentum Ingwe plan, Bonitas Boncap plan and have been selected to do income verification, please make sure all required documents are submitted to prevent your service provider resulting to default to the highest income band and therefore the highest contribution will apply.
Please note: Members joining Momentum health Ingwe option with effect 01 October 2020 onwards will not be required to submit information for income verification (declaration and proof of income). They will remain on their current income bracket moving into 2021 and the new premium will automatically be applicable from 01 January 2021. For more information on medical aid plans, please see below videos, brochures and links to assist you with change of option decision. Discovery Plan series and videos
Below are Discovery Health Plan Guides Brochures for 2021
To help you stay healthy and informed on the COVID-19 situation, Discovery will continue to provide the most up-to-date information and guidance through COVID-19 Information Hub Below are Momentum Health Plan Guides Brochures for 2021 Below are Bonitas Plan Guides Brochures for 2021 |
AuthorKevin Yeh Archives
January 2025
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