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How can they do that?
After all these 2 conditions are probably the highest reasons members have when joining such an insurance.
And now they are excluded!

We have a client who received this notification:

Please note that effective 1 January 2025 the Emergency Department visits and In-Hospital Treatment benefits for the Heart Attack and Stroke Benefits will be removed from your Accident Policy.

You can buy additional cover for an emergency illness benefit but, it only covers limited qualifying conditions and heart attack, and stroke are not on the list! And if your condition does not qualify, or if you have spent the full benefit amount, you are then transported to a government hospital.

Medical insurance products are also excluded from having to offer Prescribed Medical Benefits, which medical aid must include.

So, make sure you are fully aware of what you are buying with a medical insurance plan!

Some differences between medical aid and medical insurance

Low-cost, network Medical Aid:

• Unlimited listed hospital cover.
• Mostly unlimited, essential day-to-day benefits.
• Benefits for a wide range of medical services, including maternity and chronic illness treatment, under the Prescribed Minimum Benefits (PMB).
• Covers all 27 conditions listed under the Prescribed Minimum Benefit (PMB) including essential conditions such as diabetes, hypertension, and asthma, ensuring members receive essential treatment without significant out-of-pocket expenses.
• Offer a comprehensive approach to chronic disease management and preventive care with programs designed to treat chronic conditions, including disease prevention initiatives that can detect early warning signs of serious illnesses.
• Disease prevention benefits such as the diabetes and cardio care programs. These programs provide additional consultations, pathology tests, and support from dietitians and health coaches, enhancing overall management of chronic conditions.
• Screening benefits that pay for various screening tests at wellness providers, important for early detection and management of chronic diseases.

Medical Insurance:

• Primarily focuses on basic day-to-day medical benefits and accident cover but may not provide extensive hospital benefits compared to medical aids. You may face higher costs for necessary treatments compared to a medical aid.
• Limited chronic benefits, not anywhere as comprehensive as medical aid benefits.
• Focuses on lifestyle benefits alongside basic medical insurance, including regular check-ups and access to private healthcare facilities.
• Some provide options for combining different covers for additional savings, but hospital coverage is still limited.

Medical aid is far more suitable for those looking for comprehensive hospital and chronic care benefits with listed providers.

Medical Aid clearly provides superior benefits compared to Medical Insurance.
It is much better value for money - in terms of chronic condition management - due to its comprehensive coverage of a wide range of conditions, unlimited GP visits, and affordable premiums.

Medical Insurance may offer more Hospital and pricing as it is focused on day-to-day medical expenses with additional accident cover options, however it is less suitable for individuals seeking robust preventative care for chronic health issues,
It lacks the depth of coverage necessary for effective chronic illness management.
It is therefore less suitable for individuals with ongoing health needs.

Your choice will always depend on your specific healthcare needs and financial situation.

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Send me your questions and concerns. I'll answer them for you.

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083 655 2164

You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.

Medical aid pays healthcare costs.
What if a disability stops your income?

YOUR TRUSTED, QUALIFIED ADVISOR:
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate

Planning.

Council of Medical Schemes

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Last update: January 18, 2025