Medical scheme vs Medical insurance

As financial intermediaries, we are often asked why medical scheme cover is so expensive compared with health insurance.The legislation governing the medical scheme industry states that all registered medical schemes must accept any person who wishes to join the scheme , and that the scheme may not discriminate against the person in any way except in terms of income and the size of the person’s family.

If the scheme imposed a 12-month exclusion on a particular medical condition and the 12-month period has lapsed, the scheme must cover the condition according to the plan member’s choice. Top of the range plans can include comprehensive day to day benefits and private emergency hospital stabilisation benefits. Entry-level plans normally include basic day to day benefits only.

Joe would not be covered for PMBs, and he would primarily be covered for basic day to day medical services and have a low rand limit for emergency admission into a private hospital if the admission was because of an accident.

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