The A-Z of Medical Insurance

Quality healthcare is expensive and the costs associated with a major medical event could be financially crippling. In this case, it is essential to have medical insurance which will cover any gaps where medical aid schemes may fall short. Medical insurance can include a funeral plan, disability cover, as well as cash payments for lengthy hospital stays, disease and long-term illness cover.

Medical insurance can be defined as coverage that provides for the payments of benefits as a result of sickness/injury. It includes insurance for losses due to an accident, medical expense, disability, or accidental death and dismemberment. Typically, a medical insurance policy provides for loss of income and contingency expenses associated with a health event but are not directly related to medical expenses.

The difference between hospital insurance and medical insurance

Hospital insurance is specifically for hospitalisation and provides coverage for your hospital bills for the duration of your stay there, should your medical insurance not include a hospital plan. Medical insurance is a fund that is provided to you to use whilst in hospital, this can cover additional expenses that hospital insurance may exclude.

The difference between medical aid and medical insurance

The difference between the two is in the amount of cover that one receives. Medical aid covers sickness irrespective of costs as these are linked to scheme tariffs. Medical insurance pays a fixed lump sum irrespective of the service levied by hospitals, specialists and other providers of healthcare services. Medical aid does not include Personal Accident disability or loss of limbs cover.

Medical insurance

A medical insurance policy is a contract between an insurance provider (insurance company) and an individual. This contract can be renewed annually or can be lifelong in the case of private insurance. The type and amount of healthcare costs that will be covered by the healthcare insurance provider are specified in writing, in a contract. Medical insurance offers stated benefits and a formulary that may not cover PMBs (Prescribed Minimum Benefits). It may or may not include death and/or funeral cover, but includes Personal Accident risk cover, such as disability, loss of limbs and dread disease cover. It covers health events at a fixed or stated amount which pays directly to the member as opposed to the medical services provider.


Having medical insurance will put your mind at ease, knowing that you have comprehensive medical cover for you and your family. In a medical emergency, you will never be left with the burden of added costs for funerals, hospital stays, disability, long-term illness and disease. You can rest assured that your financial assets will be protected. In the event of an accidental injury, medical insurance can cover your salary when you are unable to work. It also gives you the option of including death and/or funeral cover to your plan.


Regardless of whether one buys a short or long term policy, the premium one pays will be dependent on the individual’s state of health. Older individuals or those who have pre-existing health conditions will pay more for medical insurance cover. In extreme circumstances, an insurance company that offers medical insurance may even refuse to cover one if they consider that the risk of claiming will be too high.

Medical insurance has become very popular in South Africa in recent years, which has led to insurance providers being innovative in devising schemes that people can actually afford. With so many medical insurance packages on the market, one should research which packages would benefit them more. Most comprehensive packages are more ideal as they offer you everything you need and more. While the internet has made it easy to research these different packages offered by the many insurance companies in South Africa, this is often takes time.

In conclusion, good health is vital to our success in life. We can also play our part in it by eating healthy, exercising and visiting medical facilities for checkups. Beyond leading a healthy lifestyle, it is imperative that you purchase medical insurance to cover any unexpected costs brought about through poor health.


Insurance Guru

Insurance Guru is here to help you simplify the complicated world of insurance, so you can make smart insurance decisions and get the best insurance deals for your situation.

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