They are regulated by two different acts:
– Medical Aid is defined as a medical scheme and is regulated by the medical Schemes Act and governed by the Council for Medical Schemes. Medical Insurance is defined as a short or long term insurance and is regulated by the long and short term act and governed by the Financial Sector Conduct Authority (FSCA). Day-2-Day benefits fall under the consumer Ombud.
– Medical Aid pays out a wide variety of benefits to contributing members. Medical Insurance pays out a fixed amount for a specific listed event.
– Medical Aid is based on tariff codes and procedures. Medical Insurance is based on stated event and specific procedure costs.
– Medical Aids cannot reject applications due to age or pre-existing conditions and have to, by law, cover certain procedures. This is according to the Medical Schemes Act, Section 29 (3) (a). Medical Insurance can reject applicants due to age and additionally can add on exclusions for specific or high risk procedures.
– Medical Aid has shortfalls most of the time. Medical Insurance may be used as a gap cover for shortfalls.
– Medical Aid does not have to disclose the amount payable for the procedure they will cover. Medical Insurance provides a person with a defined amount in case a specific event happens.
– No. You are able to see any GP. This makes it possible to see your current GP who you have a long lasting relationship with.
–The benefits per policy are for each individual member on the policy. Therefore, should you be on the Green Day-2-Day plan each member would be allowed 4 GP visits per annum.
– This is any medicines prescribed by a General Practitioner.
– No. We provide you with R150 000 per annum per member limited to R300 000 per policy.
– Once we receive first premium which will include a R150 admin fee, we will immediately order your card. You will be contacted prior to card being dispatched to confirm your closest pick up point. The whole process takes approximately 3 weeks from first premium collection.