Filling The Medical Gap

Kim Kardashian West donated R341 000 to the ongoing medical treatment of her personal photographer Marcus Hyde, following his car crash last year. For T-Pain, money is no object when it comes to the well-being of his family. Rapper and singer T-Pain helped pay his brother’s staggering hospital bill, which totalled over R11-million ($1,402,977). Former Real Housewives of Atlanta star Claudia Jordan launched a GoFundMe for her close friend, reality star Melyssa Ford who was severely injured from a car accident that left her with a fractured skull, a bleeding brain and a gaping head wound that was closed with staples and stitches. Melyssa’s medical bills amounted to well over R1-million.

“Medical cover is expensive and not everyone is aware that there is a distinct difference between a medical aid, a hospital cash back plan and a primary health insurance policy,” explains Hayley Parry, Money Coach and Facilitator of 1Life’s Truth Money Initiative. “If you’re worried about healthcare expenses for you and your family, have a look at some of the cheaper alternatives to medical aid, like hospital cash back plans and primary health insurance policies. They offer some cover for when you are in hospital and cover for primary healthcare. “

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Hayley explains the differences and how to choose the option that best suits your pocket:

What Is Medical Aid: A medical aid offers cover for your healthcare needs such as hospitalisation, medication, GP and specialist visits. There are a number of medical aid options available ranging from full comprehensive cover for most procedures at any doctor and hospital, to cover for certain conditions at certain doctors and hospitals. The more comprehensive the cover, the more expensive the premium. By law, medical aids are required to cover prescribed minimum benefits, known as PMBs. There are 27 PMB and 270 chronic conditions, including some cancers, high blood pressure, diabetes and asthma.

Hospital cash back plans and primary health insurance policies: These are a form of insurance and will cover a set amount in certain circumstances. They won’t cover all your healthcare costs and are not required to cover PMBs. Hospital cash back plans and primary health insurance policies pay directly to the member or life assured when there is a claim, they cannot pay the healthcare provider. Hospital cash back plans pay a set amount per day in hospital, usually after a certain time has expired such as 48 hours. These waiting periods vary from policy to policy. Hospital cash back plans can pay up to R3 000 a day while you are in hospital but the maximum amount you can receive each year is R20 000.

Health Insurance: Primary health insurance policies have set amounts of cover for primary health care services. For example, GP visits, dentistry, some blood tests, maternity care, optometry and medicines should be covered, but may be limited to a certain number of visits or Rands each year.

How much do they cost? The cost depends on how much cover you have, how many people are covered on your policy and the age of the people covered. Compared to medical aids, hospital cash back plans and primary health insurance policies are a lot more affordable but be aware that the cover is limited and there are waiting periods and conditions. Hospital cash back plans can only pay a maximum of R3 000 a day for a hospital stay or R20 000 a year lump sum payment.

Why are claims denied? Many claims are denied because the hospital stay is shorter than this. Your plan may also stipulate a full day in hospital – which is a full 24 hours – which could affect the amount you can claim. To use an example: you are in hospital for three and a half days and your hospital cash back plan pays out R2 000 for each full day after 48 hours in hospital. You may only claim one full day for your three and half day stay because the first 48 hours don’t count towards the claim, neither does the half day. Hospital cash back plans also usually have waiting periods for certain conditions ranging from 3 months to 12 months.

Care at a public hospital isn’t always free: You might be wondering if it isn’t more worthwhile to use South Africa’s public healthcare facilities, which are much more affordable when compared to private hospitals. While clinic visits in South Africa are free, if you are employed and earning more than R70 000 a year, you will be required to pay some or all of the costs of your care in a public hospital.

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