Health insurance: save on medical costs in 2022

Health insurance is a pretty popular alternative to medical aid – with SA jumping on the bandwagon in recent years. With South Africa’s private healthcare costs being one of the most expensive globally, the cost of medical aid scheme payments is never under R1000 a month. 

Affordability

Most South Africans can’t afford to pay for medical aid, which covers prescribed minimum benefits, day-to-day care and hospital costs. 

Thus the better equipped private healthcare facilities are out of reach of most people’s pockets. The majority of people receive treatment for free at one of South Africa’s 696 health facilities – all taking strain due to a lack of resources, a shortage of doctors and a high demand for medical care such as emergency treatment, chronic medication, clinic visits, doctors’ consultations, surgical procedures and hospital stays. 

An above-average earner without medical aid or health insurance can access public healthcare, but they calculate their treatment costs on a sliding scale. They have to pay upfront for clinic visits and doctors’ consultations. At the same time, the bill for hospital stays and surgical procedures. 

According to Fin24, the key factors contributing to the country’s medical inflation are:

• Vat increases and the ripple effect felt by the medical industry.
• Shortages of doctors who specialise.
• The high cost of new medical appliances and technologies with hospitals and specialists having to foot the bill.
• Increased costs of medical supplies and pharmaceuticals and increased doctor’s indemnity insurance costs. 

This is further subject to the rand-dollar exchange rate. And as a result, medical aid scheme premiums increase by about 10 % every year while the inflation rate hovers around 4.9%. 

As a result, many South Africans seek alternatives and opt for health insurance instead to receive private care, which is considered on par with Western standards of care, reports Expatica.com.

The monthly premiums for Health Insurance can be as low as R250 for an individual and R800 for a family, and around R1600 for a combined plan. You have to be sure that you are signing for a long term policy and not an annual one which can leave you stranded without cover when the policy expires.

Key questions to ask

Once you have identified the relevant authorised financial service providers that should cater to all or some of your requirements, you should ask all the right questions as there are many options to choose from. 

According to Truthaboutmoney, these are the questions you should ask:

1. What is the plan long-term?
2. How much do you cover for GP visits?
3. Do you include dental cover?
4. Do you expect to be informed before that treatment is needed? 
5. Will you only pay for network doctors or specialists?
6. Do you cover specialist visits?
7. Will you cover medication?
8. Are there value-add benefits and are there top-up benefits?
9. Is it a family plan and are there any exclusions? 

Although you are expected to have a detailed medical history, health insurance generally does not include a pre-sign-up medical examination. 

Primary health care policies

Primary health care policies have the lowest monthly premiums, starting around R250 with limitations such as basic day-to-day care with a network-approved medical service provider. The more you add to your list of requirements to expand your coverage, the more you will pay. 

For as little as R250 and add-ons, you can get this coverage:

• GP and dentist visits which is the standard plan
• GP visits with added benefits for medication and chronic medication
• You can add benefits such as critical illness cover and funeral cover
• Service providers pay full cover only to doctors and dentists on their lists
• You are liable to pay your own costs if you use a doctor or dentist, not on the provider’s network list
• Premiums are much higher if you are over 55 years of age
• You aren’t covered for hospital care.  

For an advanced day-to-day cover of R700, you get:

• Doctor visits and basic dentistry and optometry
• GP network referral to radiology and pathology
• Casualty room treatment
• Prescribed acute medication
• Post-hospital private home nursing
• Nurse-led medical referrals and telehealth consulting

You can get a Hospital Cover from R1100

• Accident benefit and accident permanent disability benefit
• Daily illness hospital benefit.
•  24/7 emergency cover
• Dread disease cover
• Casualty room benefit.

If you pay about R1600, you can get a combined day-to-day and hospital plan to cover all bases.

Hospital cash back policies

This is how the hospital cash back policy works:

• You receive a daily amount for every day you are in hospital, and the stay is longer than three days.
• The amount is paid directly to you, to be used at your discretion.
• Day-to-day hospital expenses are not covered.
• The maximum amount paid annually from the hospital cash back policy is R20 000, which falls short of private hospital stays. This only covers post-operative medication and living expenses during recovery.
• You can add benefits that increase your premium to cover accidents and dread diseases such as cancer.

These policies can cover a sizable amount of your day-to-day medical costs and provide cover for any hospitalisation for you and your family. It also provides the assurance that you have to cover for any eventuality. 

Contact Affinity Health

Remember that even though most plans will have similar benefits, each medical insurer has its own limits and rules – so observe the differences carefully when choosing a health insurer that is best for you.

Affinity Health has made it very easy for you to find out if your prefered physician is on the network. 

Finding your nearest GP is as easy as going to our website and clicking on the Find a Doctor tab. You can find this tab under client resources. Now, type in your city or town. 

And just like that, you will have access to a full list of doctors listing their names, addresses and contact details. 

Affinity Health members can contact us on 0861 11 00 33 to consult with an Affinity Health primary healthcare consultant.