Health Insurance Vs Medical Aid

Health insurance is not a Medical Aid Scheme, but offers sufficient health cover and still making it affordable. Learn more about how Health Insurance works and the reason why it can work for you!


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Health Insurance Vs Medical Aid

Oneplan health insurance break down

Health Insurance is risk cover for unforeseen events according to cover limits

Health Insurance falls under the Short-term Insurance Act

Health Insurance do not cover PMB’s (Prescribed Minimum Benefits)

Health Insurance covers health events at fixed or specific amounts which is defined per specific identifiable events as per policy schedules

Health Insurance includes Personal Accident risk cover such as disability and loss of limbs cover, inability to work, salary protection.

Health Insurance's are allowed to and may include death and / or funeral covers

Health cover pays directly to the Insured

Health Insurance pays a cover amount according to the limit as per the plan selected to cover events as per the policy wording

Health Insurance may be used in conjunction with your medical aid to cover any shortfalls that you may have

Medical Aid schemes cover medical conditions according to scheme rules and managed health care protocols

Medical Aid schemes falls under the Medical Schemes Act

Medical Aid schemes is governed by the Council for Medical Schemes

Medical Aid schemes must by law cover PMB’s (Prescribed Minimum Benefits)

Medical Aid schemes have got specified and yearly limits and health events do not need to be specific identifiable

Medical Aid schemes is not allowed to include any Personal Accident disability and loss of limbs cover

Medical Aid schemes is not allowed to include death and / or funeral covers as part of the Medical Aid Scheme

Day-to-day benefits are paid from the Medical Savings Account (members own contribution) or as per agreement with specific contracted providers

Medical Aid pay in-hospital benefits according to Medical Scheme Rates (tariff rate determined by scheme) , specific providers and limits as per plan type

Medical Aids often have shortfalls due to the difference between the Medical Scheme Rate and the provider’s tariff