I don’t get it - why is health insurance more affordable than medical aid?


Jade Poole from I Write Words


We explain the difference between the two and what makes health insurance a more budget-friendly alternative

If you have ever asked this question, then you are not alone. As health insurers, we get asked it regularly!

Before we get into why health insurance is more affordable compared to medical aid, let’s first define the difference between the two:

The difference between health insurance and medical aid

A lot of people might confuse the two or do not know what health insurance is.

Medical aid

Medical aid offers you in-hospital cover and will pay for your treatment according to specific medical scheme tariffs.

This means that medical aid has to cover your medical bills when you stay in hospital and these are defined according to the National Recommended Price List.

Medical aid will usually pay directly to your hospital or doctor.

Medical aid offers extensive cover compared to health insurance, depending on the plan you choose.

Health insurance (medical insurance)

Health insurance will typically pay you a set amount for each day spent in hospital or a set maximum amount per event.

Health insurance is often used as a stand-alone product, or you can have health insurance as a form of gap cover when your medical aid savings run out.

Both medical aid and medical insurance can provide you with cover for day-to-day care and routine care such as doctor visits and medication.

Health insurance will offer limited cover for these day-to-day costs and you might have to cover some of the costs yourself.

The biggest difference

The most significant difference between medical aid and health insurance is that medical aid is required by law to cover a certain amount of medical costs in the event of a claim.

Health insurance, on the other hand, gives you a set amount, also known as your limit, depending on the plan you choose. You then have to cover the rest if your chosen plan does not cover all of it.

Why is medical aid more expensive?

As we have said, medical aid is required by law to pay for what could be some very expensive procedures classified under PMBs (Prescribed Minimum Benefits).

“Prescribed Minimum Benefits (PMBs) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.” According to the Council of Medical Schemes.

Medical aids also have to provide you with specialist and in-hospital cover determined by specific tariffs.

Medical aid HAS to cover some very high amounts in the event of a medical claim - which is why your premium is usually a lot higher.

Why is health insurance more affordable?

Health insurance will give you set amounts they will pay for a claim, by capping this amount, health insurance is more affordable.

Health insurance will offer you a cash payout for specific health events at a fixed amount.

What will a health insurance plan cover?

There are a number of different health insurers out there and your choice on health insurer will depend on your budget and personal preference.

A word of advice: make sure you always read the fine print of your policy document before taking out a health insurance plan as there might be some terms and conditions that you may not know about, which can result in you thinking you are covered for something when in actual fact, you are NOT.

Oneplan Health Insurance (that’s us), cover a number of medical events and claims such as routine and primary healthcare, illness, accidents and emergencies.

We cover your basic health checks like dentist and doctor visits and we also cover you for the things you didn’t see coming that could land you in hospital. We also offer specialist cover on our Executive Health Plan.

How much does health insurance cost?

Each one of our health insurance plans offers daily care and accident cover.

Starting from R365 a month for our most basic plan and going up to R1180 a month for our most comprehensive plan.

Which one should I choose?

Both medical aid and health insurance have their benefits and setbacks, it is up to you to decide what best suits you.

If you are looking for affordable health cover, access to private healthcare and other benefits such as routine care, then health insurance is your best option.

If you have the money to spend and are more prone to health issues, then medical aid might be the option for you.

Why Oneplan Health Insurance?

There are a number of reasons why to choose us, here are some:

  1. Get paid BEFORE you see the doctor
  2. Easy claiming system all done through our Oneplan App
  3. Routine and daily healthcare cover
  4. Go to ANY doctor of your choice
  5. Team of nurses to chat with through the Oneplan App
  6. Amazing maternity cover and benefits

If you are wanting to know more about our awesome health insurance, give us a call and we can help get you started.

Yours in health,


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