Maximising Your Medical Aid Cover

Feb 11, 2021

This article was originally published in Women on Top

Recent events have woken the world up to the fact that medical issues can be unpredictable and cause financial upheaval. However, what most South Africans don’t know is that by combining healthcare cover products, they are able to maximise the amount of cover they have to deal with medical events and minimise the impact on their pockets.

This is according to Johan Josling, Chief Executive Officer at Episodic Health, the only personalised health insurance on the market today.

With the country’s medical aid schemes having 4.05 million registered members and serving a total of 8.94 million beneficiaries, according to the Council for Medical Schemes’ 2019/20 annual report, many consumers are aware of medical aid. Some also know about and might have gap cover, which takes care of the shortfall between what your in-hospital charges might be, and what the medical aid will pay for.

Additionally, there is health insurance which is designed to provide cover for unexpected events when you need it most. It also covers basic healthcare. “These three products can be used together to give South Africans access to comprehensive cover,” says Josling.

He explains that one of the advantages of supplementing your medical aid with health insurance is out-of-hospital benefits. “Health insurance covers things like doctors, dentists and pathology, whereas medical aids typically pay for these from your Medical Savings Account. The Medical Savings Account is accumulated through your premiums, but it can run out. With health insurance however, these day-to-day benefits are built into the offering.”

Josling shares that even with the National Health Insurance (NHI) being set to come into effect in 2026, health insurance could still be beneficial. “Once NHI is implemented, everyone in the country will have access to healthcare but it can’t cover everything – this is where health insurance could come in, but this depends on the framework which is still being developed.”

He concludes: “Maximising your medical aid with health insurance is not only a cost-effective choice but a smart one too.”

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