What is medical insurance and how does it work?
If you have found yourself wondering, “What is medical insurance?” and what having this means for you, then read this blog post that answers everything you need to know about your cover, from doctor’s visits to medication.
Discover: Affordable Family Health Insurance: It’s a Family Matter!
Are medical (or health) insurance and medical aid the same thing?
First things first, if you have ever wondered “what is medical insurance”, chances are, your first question has been this exact one. We get this question a lot, which is why we are pretty good at answering it by now.
What you might already know is that medical (or health) insurance is basically the affordable alternative to medical aid. But they are most definitely not the same thing.
Health insurance is a form of short-term insurance, and the reason why it allows for your premiums to be lower is that it is not based on the tariff codes and medical procedures that are regulated by the Council of Medical Schemes in SA.
Hippo describes the difference like this:
“Medical Aid provides in-hospital cover and pays for treatment according to the specific medical scheme tariff. Medical Insurance, however, traditionally pays out a set amount for each day spent in hospital or a set maximum amount per incident, regardless of the type of treatment that’s required.”
What this means is that our rates are often set and medical aid is determined by specified amounts that are strictly set and regulated, which is why it is more expensive.
Picture it this way, health insurance is like the Toyota Tazz that keeps going and gets you from point A to B. There is no glitz and glam, no frills or fuss – just a car that acts as your mode of transport that you can rely on.
Medical aid is like the fancy Porsche that costs more to run, but gives you a great and comfortable ride from A to B. There are more benefits in having a Porsche, but it still gets you to where you want to go.
Learn more: What Is The Difference Between Health Insurance and Medical Aid
Does health insurance allow me access to the same doctors and medical facilities as medical aid?
Yes! Of course!
Health insurance gives you access to the same private healthcare, facilities and medical professionals as medical aid.
You can see the same doctors, go to the same private hospitals and receive the same treatment and care on health insurance as you would on medical aid.
So, how does medical insurance work? Well, with Oneplan health insurance, we don’t give you a certain network of doctors you have to go to. We let you go to any doctor you choose, and it gets better… we pay you BEFORE you see the doctor thanks to our awesome Oneplan Claim Card which is like a debit card for you to swipe at your doctor’s office.
You can also use this card for prescription medication. All you have to do is log into the Oneplan App, load your claim details and we will transfer the funds to you, according to the health plan you are on, within seconds. It’s that easy.
Is health insurance basically just a hospital plan?
Certainly not!
Health insurance with Oneplan is SO much more. We offer amazing day-to-day care benefits (such as seeing your doctor for the flu) and emergency and illness cover in hospital, and so much more!
Read this: 5 Dos and 5 Don’ts of a Hospital Visit
Can I see a specialist if I have health insurance?
Yes!
If you have health insurance with Oneplan then we include specialist cover in our Executive Plan. We cover up to R2 215 per visit, and you are covered for 3 visits per family per year. You will need to be referred by your GP to see a specialist for this claim to be approved.
What is medical insurance cover for dentistry or optometry?
Of course! Each one of our Oneplan plans covers you for visits to your dentist and optometrist. Our most basic plan offers you up to R650 per visit for dentistry, with a maximum of 3 visits a year, and R1 130 in optometry visits!
(Please note that these prices are reflective of the date that this article was written. For up-to-date pricing, please follow this link)
We also have maternity cover, accident and injury cover, emergency services and much more.
Now that we’ve answered the question “what is medical insurance”, why not have a look for yourself and see what you think? And, if you have any more questions as a member of Oneplan, all you have to do is log in to our Oneplan App and chat to one of our team members or give us a call!
Your Health Insurance Family,
Oneplan
