South African consumers need to be aware that medical cover is not synonymous with medical aid. You may think that you are signing up for cheap medical aid but the cover is not administered by a medical scheme and does not offer the same benefits as medical aid. Instead you may be signing up for hospital insurance (also known as a hospital cash back plan) or medical insurance (similar to a hospital cash back plan with some out of hospital benefits).
If you have spotted a Facebook ad with medical cover offering hospital and doctor visits for just a few hundred rand a month and think that you have found the answer to medical aid, then be cautious. The ads can be misleading or conveniently exclude pertienent information that details how different the cover is from medical aid. You may only discover that this is not medical aid cover when you want to use it to see a doctor or be admitted into a hospital.
Hospital insurance and medical insurance is not without its merits. Both offer some degree of financial security for medical-related events. However, the payout may not guarantee admission to and treatment within a private hospital in South Africa. Some medical insurance products offer out-of-hospital medical and dental cover but this s only for treatment at select practitioners and there may be an accompanying co-payment that is required.
Network Doctors and Unlimited Visits
One of the selling points of cheap medical cover is the unlimited visits to network doctors. It is important to define a network doctor under these plans as it often differ from network doctors that are covered by some medical aids. Doctors who accept non medical aid products may charge lower fees or still require a co-payment by the patient beyond what the medical cover offers.
A network doctor may not necessarily be located near to where you live or work and you may therefore experience difficulty in conveniently getting medical care. Another factor to consider is that some medical insurers provide debit like cards which members can swipe at a doctor’s rooms. However, this does not mean that the full fee will be covered or that the doctor will accept the payment method.
Hospital Admission and Payment
Medical cover that is not medical aid may make promises about private hospital admission but there is no guarantee that all hospital and doctor fees will be covered. These plans often pay a fixed amount per event unlike medical aid that pays according to the tariffs that the hospital or doctor bills for specific medical conditions. Therefore the initial payment by the medical cover is similar to a cash deposit fee that non medical aid patients have to pay. In the end the patient is liable for all remaining bills.
Other types of non medical aid cover may only pay for each day of hospitalisation after a 2 to 3 day waiting period. This payment is not made directly to the hospital or doctor but to the patient. Therefore many hospitals or doctors will not recognise this type of cover in the same light as a medical aid. Furthermore the daily cash payout may not be sufficient to cover the medical bills accrued during hospital treatment. Ultimately it is the patient who is liable for the bill and not the insurer offering cheap medical cover.
Medical aid, whether it is a comprehensive plan or a medical aid hospital plan, is cover offered by medical schemes that are governed by the Council of Medical Schemes and regulated by the Medical Schemes Act. When buying cheap medical cover, it is always important to verify whether the product offered is a medical aid and whether the provider is registered with the Council of Medical Schemes. If not, then it is not medical aid but another type of medical cover that can still be beneficial for consumers but not to the same degree as medical aid cover.