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Other ways to cover your health
Medical aid isn't the only option. Here's what else is out there, and how each one differs.
For you
Worth reading about
- Employer (restricted) schemesIf you work for government, the police, a bank or a mine, your employer's scheme may cost less.
You can combine them
- Medical aid + gap cover: hospital bills plus specialist shortfalls
- Primary care insurance + state hospital: everyday care privately, serious care in the public system
- Primary care + accident cover: GP visits plus private care after an accident
Every option, explained
Medical aid (medical scheme)Pays your medical bills, with a legal minimum cover nobody can take away.Minimum cover by law: YesOn its ownMore
A non-profit fund you pay into every month. It pays hospitals, doctors and medicine according to the plan you choose. By law it must cover the Prescribed Minimum Benefits, a list of emergencies and serious and chronic conditions.
- Existing conditions
- Covered after any waiting period
- Pays the hospital bill?
- Yes, at the scheme rate
- Regulated by
- Council for Medical Schemes
Good for
- Hospital stays and operations
- Chronic conditions (the 27 on the Chronic Disease List must be covered)
- Having a baby
- Cancer and other serious illness
Watch out for
- Joining later in life can mean a late-joiner penalty
- New members can face waiting periods (up to 3 months general, 12 months for an existing condition)
- Specialists may charge more than the scheme pays: gap cover helps
Gap coverTops up your medical aid when specialists charge more than it pays.Minimum cover by law: Not applicableNeeds a medical aidMore
Insurance that pays the shortfall between what a specialist or hospital charges and what your medical aid pays, mostly for in-hospital treatment. Some policies also cover co-payments, like a scheme's per-admission charge.
- Existing conditions
- Often a 12-month waiting period
- Pays the hospital bill?
- Only the shortfall your medical aid leaves
- Regulated by
- Prudential Authority and FSCA (short-term insurance)
Good for
- Specialist and anaesthetist shortfalls in hospital
- Plan co-payments on admission
- People on hospital plans or network plans
Watch out for
- Only works alongside a medical aid
- Policies set limits per event and per year
- Waiting periods apply to existing conditions
Primary care insuranceAffordable GP visits and basic medicine, but not a medical aid.Minimum cover by law: NoOn its ownMore
A health insurance policy that pays for everyday care: a set number of GP visits, basic medicines, sometimes dentistry, eye tests and blood tests. Many add a fixed cash amount or limited cover if you're hospitalised after an accident.
- Existing conditions
- Often excluded or limited
- Pays the hospital bill?
- Usually not, or only up to a small limit
- Regulated by
- Prudential Authority and FSCA (health insurance under the demarcation rules)
Good for
- Seeing a GP without paying in full
- Tight budgets
- Pairing with state hospitals for serious care
Watch out for
- Does not have to cover the Prescribed Minimum Benefits
- Chronic and existing conditions are often excluded or limited
- Hospital cover, if any, is capped and may be accident-only
Hospital cash planPays you a fixed amount per day in hospital, not the hospital.Minimum cover by law: NoOn its ownMore
Insurance that pays you an agreed amount for each day you're admitted. You decide what to spend it on, like transport, lost income or part of the bill. It doesn't pay the hospital directly.
- Existing conditions
- Usually excluded at first
- Pays the hospital bill?
- No: pays you a fixed daily amount
- Regulated by
- Prudential Authority and FSCA
Good for
- Extra money while you're in hospital
- Covering lost income
- Adding to a medical aid or primary care policy
Watch out for
- A private hospital stay costs far more than the daily amount
- Short stays may not qualify
- Waiting periods and exclusions apply
Accident and trauma coverPrivate hospital care after an accident only.Minimum cover by law: NoOn its ownMore
Insurance that pays for emergency treatment and hospital care after an accident, sometimes up to a set amount. Illness isn't covered.
- Existing conditions
- Not relevant: accidents only
- Pays the hospital bill?
- Yes, for accidents, up to a limit
- Regulated by
- Prudential Authority and FSCA
Good for
- Young, healthy people on a small budget
- Pairing with primary care insurance
Watch out for
- Illness, maternity and chronic conditions are not covered
- Cover is capped per event
Public healthcareClinics and state hospitals, free or charged by income.Minimum cover by law: Not applicableOn its ownMore
Government clinics provide primary care free of charge. State hospitals charge according to your income, and many people pay little or nothing. Emergency treatment can't be refused.
- Existing conditions
- Treated
- Pays the hospital bill?
- Fees depend on your income
- Regulated by
- National and provincial Departments of Health
Good for
- Anyone without cover
- Chronic medicine through clinics
- Emergencies and serious illness
Watch out for
- Waiting times can be long
- You can't choose your doctor
- Quality varies between facilities
Employer (restricted) schemesMedical schemes only open to certain employers or professions.Minimum cover by law: YesOn its ownMore
Some of South Africa's biggest medical schemes are restricted, like GEMS for public servants, Polmed for the police and Bankmed for banking staff. They follow the same rules as open schemes and are often cheaper for members.
- Existing conditions
- Covered after any waiting period
- Pays the hospital bill?
- Yes, at the scheme rate
- Regulated by
- Council for Medical Schemes
Good for
- Public servants, police, mine and bank staff
- Professionals (Profmed)
Watch out for
- You must qualify through your job or profession
- Leaving the job can mean leaving the scheme
General information about types of cover, not advice and not a review of any provider's product. Insurance products don't have to cover the Prescribed Minimum Benefits. Check each policy's exclusions and waiting periods, or speak to an accredited financial adviser. Compare medical aid plans.