Understanding the Key Features of Medical Insurance Policies | Dis-Chem Health

Dis-Chem Health

your care covered

Home Info Hub Medical insurance Understanding the key features of Medical Insurance policies in South Africa

Understanding the key features of Medical Insurance policies in South Africa

Article Sections

In the dynamic landscape of healthcare, getting the right Medical Insurance is an important part of financial planning and well-being. In a diverse healthcare system like South Africa’s, you can find many medical coverage policies that are tailored to your needs.

We will be shedding light on the key features of medical insurance policies in South Africa, so that you can make informed decisions for your health and financial security.


The landscape of Medical Insurance in South Africa

South Africa’s healthcare system is a blend of public and private sectors. The public sector provides essential services, while the private sector offers a more comprehensive and often faster healthcare experience.

The private sector has seen medical insurance being introduced, which provides cover at an affordable price. A medical insurance policy pays the cost of daily healthcare services, with providers having access to a network that makes sure you get quality medical treatment.

The competition among key players has led to a long list of different plans, making medical insurance in South Africa a dynamic and evolving industry. Key players in medical insurance right now include Flexicare (Also known as Discovery Health), KeyHealth, and OnePlan. Along with Dis-Chem Health, these providers play a role in making healthcare more accessible and affordable for South Africans.


Understanding Medical Insurance policies

Just like with car or life insurance, there are many different types of medical coverage. Understanding what Medical Insurance does becomes easier when you’re able to compare it to different types of plans:

Medical Aid 

A plan that covers a wide range of medical expenses according to the National Recommended Price List and Prescribed Minimum Benefits (PMBs)

Medical Insurance 

A plan that covers day-to-day medical needs. This can include a routine doctor’s visit, getting X-rays and blood tests or getting access to medicine. Depending on the medical insurance policy, you can also have access to specialists like paediatricians and gynaecologists

Hospital Plan 

Usually included in Medical Aid plans, it covers in-hospital expenses whilst admitted to hospital like theatre, X-rays, blood tests, doctor’s account and other accounts related to your hospital stay

Accident Cover 

A plan normally combined with Medical Insurance, this policy gives you access to private healthcare in case of a medical emergency caused by accidents. Benefits include ambulance services, emergency department visits and hospitalisation

Even though Medical Insurance is not the same as Medical Aid, you still get access to private healthcare providers dedicated to keeping you healthy. With some plans costing less than R500 per month in premiums, the power of Medical Insurance is easy to see: It has made private healthcare reachable in a way it never has been before.


Decoding policy features

When you choose a medical insurance policy, understanding the features and benefits is key. Plans have limits and exclusions, so you need to know what you’re covered for.

Core features like the number of doctor visits available and the chronic medicine lists show the value of a policy up-front. If a standard plan isn’t enough, some providers give you the chance to combine it with Accident Cover. Doing this makes sure that your daily healthcare needs and accidental medical emergencies are covered.

Other key features involve waiting periods and claims processes. With waiting periods, a policyholder can’t claim certain benefits under their new policy. The best providers have a general waiting period of 1 month, but there are factors that could make this period shorter or longer.

The claims process with Medical Insurance is pain-free. If you’re using your primary benefits in the right network without exceeding the limits, you can consider your visit already paid for. Your chosen plan may need pre-authorisation for certain benefits, but these details are discussed when you join.

Policy documents cover all of this and more, which is why it’s always important to go through them. They are rarely interesting to read, but they give a clear idea of where you will get the most value.


Navigating cost concerns

Navigating costs is one major reason medical insurance exists. Even so, opting for a standard plan or saying no to the buy-ups that are offered are good budgeting tips. Some providers even include rewards programs where the potential savings could cover the cost of your premiums – Make sure this is something you are asking about!

But choosing the right level of medical coverage isn’t just about cost: It’s about evaluating your health needs with your finances to determine the best policy. It’s tempting to go for the standard plan, but it may not be enough to cover your medical expenses.

Luckily, a premium medical insurance policy is still not as expensive as Medical Aid.


Streamlining the research process

Getting information these days is as easy as ever. Some providers have online calculators that make it easy to see how much a plan costs. Take advantage of user-friendly websites to explore policy details and customer reviews. You might even want to reach out to online communities, where people who have used Medical Insurance can give you first-hand details.

Making a long-term commitment like becoming a policyholder always feels better, after going through your options.


You can take care of your daily medical needs with private healthcare

In a world where uncertainty is constant, taking the time and effort to understand medical insurance policies can be a game-changer.

With budgets under so much pressure these days, it’s natural to compromise on the things you need. Medical Insurance can be the perfect way to compromise with your budget, without compromising on your healthcare. To learn more about the plans you can get, click here.

Not all Medical Insurance plans are the same and benefits as well as limitations may vary. Descriptions of benefits given are meant to be for general educational purposes only and you must ensure that you seek the advice of a broker to ensure any product choice you make suits your individual needs.

Other Articles


Want to speak to a Broker for Advice?

By filling in your details you agree to our  Privacy Policy

"*" indicates required fields


Recent Articles

Leave a Reply

Your email address will not be published. Required fields are marked *

The reCAPTCHA verification period has expired. Please reload the page.