Medical Aid? Hospital Plan? Gap Cover?

When it comes to getting proper medical care, certainly a point for consideration for many adults is if they will need medical aid, and if so, what their options are for consideration.

For some, this cover would be only for themselves; others might need cover for their spouses and children.

However, another question might be: do I really need medical aid, and what happens if I do not have access to this service?

In today’s blog, we will be taking a closer look at want medical aid encompasses and what some other plans there are for those who are not keen to invest in a traditional medical aid.

Let’s start by looking into the definition of medical aid.

What is a medical aid?

When you choose to go on medical aid, you opt-in for a monthly payment for a type of insurance that can help provide financial cover for various medical conditions. What you are covered for depends on the premium and package you chose – for instance, some payment levels will have benefits such as significant cover for dental or optical, while others might not cover full amounts or not at all.

Also, in some medical aid package options, you might only be able to get benefits for cover from already approved providers, which means if you have a preferred physician, you could potentially pay more than if you went for a consultation with a doctor on your medical aid fund’s list.

Some of the most popular medical aids in South Africa include Discovery Health, Bonitas Medical Fund, Momentum Health, Medshield and Fedhealth, but there are also others to consider depending on your budget or experience with a certain service provider.

Why do I need a medical aid?

Simply put, with a medical aid, you have that extra layer of protection – from large unexpected expenses to even something as simple as a doctor’s or dentist visit that you would have otherwise needed to pay in full. Furthermore, when you are on medical aid, you have the option of going to a private hospital.

If I don't have medical aid, can I still use private hospitals? Are there cost implications?

Although not having a medical aid doesn’t mean you cannot use the services of a private hospital, non-medical aid members need to bear in mind that they will need to pay in cash and a potential upfront fee during admission - which can come down to a large fee. If you cannot afford the admission fee, you could be refused admission and be directed to a government hospital.

What is a hospital plan versus medical aid? Does a hospital plan fall under medical aid, or just under insurance?

A hospital plan is not quite the same as a medical aid. Where the latter provides cover for medical services that are not just limited to hospital visits, a hospital plan can only pay for treatments and medical costs in a hospital.

What is gap cover, and do I need it?

Gap cover does exactly what it says – bridging that shortfall that your medical aid might not cover for certain medical treatments. It is usually not that expensive, but ultimately, it depends on your budget and the cover that the medical aid level that you are on provides.

Final thoughts

Whether you choose to have medical aid, hospital plan or both, having medical cover can provide a layer of important protection for you and your loved ones. So, prioritise your health, and choose a medical aid option that fits into the cover that you require.