News24 – 18th May 2023
- Do you know the difference between medical aid, health insurance and a hospital plan?
- Many use the term “medical aid” to describe any type of healthcare coverage they have, but there are significant differences between the three options.
- Turnberry Risk Solutions’ Brian Harris breaks down what each scheme does and how they differ.
Medical aid, health insurance or hospital plan – do you know the difference? Many people use “medical aid” as an umbrella term for any form of medical coverage they have, but there are actually a few options out there, and they all do different things.
In a recent press statement, Brian Harris, general manager operations at Turnberry Risk Solutions, took the time to break down what each of these schemes actually do and how they differ. With this information at hand, it’s easier for consumers to decide which form of medical cover best suits their lifestyle and pockets.
What is health insurance?
“Medical health insurance provides basic cover for general practitioner (GP) visits, dentistry, X-rays, and accident cover. Essentially, this helps patients skip the long queues outside government healthcare facilities,” explains Harris.
While health insurance provides access to private healthcare for the above-mentioned services, it does not provide cover for in-hospital procedures at private facilities.
If you’re on this plan, you’d have to make use of government facilities for in-hospital procedures, or if you decide to still use a private facility, you will be expected to pay the bill in full.
What is a hospital plan
A hospital plan is used for in-hospital procedures. It covers costs for treatment while the insured person is booked in hospital.
“This is often a defined amount, and in some cases will differ according to the type of illness or surgery required,” says Harris.
What is medical aid?
A medical aid has the benefits of both a hospital plan (covering in-hospital procedures) and health insurance (covering day-to-day expenses such as GP visits). It gives the insured access to the private healthcare system in South Africa.
“Depending on the type of plan the insured selects, it will cover a wide range of benefits from hospital costs, specialist consultations, GP visits, and additional tests and procedures.”
What is gap cover?
“Gap Cover provides cover to the insured person with a medical aid for a number of events, predominantly the difference between what the specialist charges and what the medical aid covers,” explains Harris.
Another benefit of gap cover is that it covers co-payments, non-designated service provider hospital cover and sub-limit cover.
Gap cover is only available to those with a registered medical aid. People with health insurance products are not able to make use of this service.
“There are many different gap cover plans designed to provide the ultimate level of healthcare for the insured based on both their medical aid option and affordability.
“The critical thing when researching a gap cover provider is that you want to know that they will pay you out for what your plan states. Choose a long-standing, reputable provider who has a track record of being there for its members in their time of need,” says Harris.
What is Gap Cover?
Excellent, easy and quick replies with quick payments, really no hassles. Must have Gap cover, without it we would have been in financial trouble, Turnberry makes it easy. Health and medical insurance are not easy and claiming has always caused us anxiety but we can honestly say we are impressed, from sending the claims, the communication, professional and friendly staff not to mentioned the quick payments has made a difficult situation so much easier. We have been so impressed by how quickly the claims have been processed which allows us to settle the service providers quickly and we are very grateful for this excellent service. We will be promoting Turnberry to family and friends as it has been a pleasure working with you and we look forward to dealing with your company. Wayne Mulle
My interaction with the claim submission was great. I have unfortunately not needed to deal with the Turnberry claim staff members. But from my experience, I would recommend Turnberry Gap Cover. What rating would I give Turnberry – ‘from the outcome, it would be 10’.
Len von Graevenitz
It is always a pleasure with Turnberry. My recommendation to anyone thinking of taking out Gap cover – ‘do not live without it – it is the best add on to having medical aid, reducing your headaches and stress. Always a great partner’. I would rate Turnberry 10 Plus.