Medical Aid vs. Hospital Plans vs. Medical Insurance vs. Gap Cover in South Africa

We are all aware of the importance of having a reliable medical scheme or hospital plan. If it happens that you or a family member ends up in the hospital, you do not want to worry about getting sufficient finances to pay the hospital fees.

The biggest problem is that there are so many different plans to choose from, each with a different name. Some are R3,000 a month, and some are R300 a month. How do you know which one will provide sufficient cover in the event of an accident or hospitalization? Here we will try to explain the different types of schemes and what they cover.

Medical Aid Schemes

This is probably the option everyone is the most familiar with. A medical scheme usually consists of two parts, a hospital plan, and a savings plan. It may differ from provider to provider, but generally, it works as follows – the hospital plan covers in-hospital expenses, and the savings plan covers everything else. The savings plan is the part of the medical scheme that gets exhausted. It is used for GP visits, medication, dental, etc.

A medical aid scheme is generally the most expensive option, but it offers the most comprehensive cover. Remember that your medical plan may not cover your medical bills in full, and you will have to pay an extra out of your pocket.

Hospital Plans

This is basically a medical scheme without the savings option. It will cover all in-hospital expenses like surgery, maternity, joint replacements, etc. 7 Day take-home medicine is also covered by some providers. Everything out of the hospital will be paid from your pocket.

Medical Insurance

This option is less expensive than medical aid and may even be used in conjunction with your medical scheme. It focusses more on significant life events like critical illnesses, disability strokes or heart attacks and will pay out a fixed or stated amount.

The big difference between medical aid and medical insurance is that medical insurance will make a payment directly to the member, where medical aid will pay the medical service provider. You can also use medical insurance as gap cover if your medical aid does not cover the full amount.

Health Insurance /Health Event Life Plans (HELP)

Until the end of March 2017, this was known as a hospital cash back plan, but the law required that the name should be changed. This is why you suddenly hear the terms Health Insurance and HELP Plans a lot.

Health insurance requires that you are hospitalized for a couple of days. After X amount of days in the hospital, the plan will pay out a fixed amount every remaining day you spend in the hospital. The payment will go directly to the member and can be used as you wish, whether it is to cover medical bills or to buy groceries.

Please note that this plan is not meant to cover your hospital bills and should not replace a medical scheme or hospital plan.

Gap Cover

Usually, with a medical aid, there are shortfalls which will result in co-payments out of your pocket. GAP cover exists for this reason. It is generally very inexpensive and will cover shortfalls from your medical aid (up to specified amounts).

Other Types of Cover

Dental Plans

As the name states, it will cover dentists visits, dental hygiene, etc.

Final Words

If you are looking for more information about the different types of hospital and medical plans, it is recommended that you visit