They are regulated by two different acts:
– Medical Aid is defined as a medical scheme and is regulated by the medical Schemes Act and governed by the Council for Medical Schemes. Medical Insurance is defined as a short or long term insurance and is regulated by the long and short term act and governed by the Financial Sector Conduct Authority (FSCA). Day-2-Day benefits fall under the consumer Ombud.
-Medical Aid pays out a wide variety of benefits to contributing members.
– Medical Aid is based on tariff codes and procedures. Medical Insurance is based on stated event and specific procedure costs.
– Medical Aids cannot reject applications due to age or pre-existing conditions and have to, by law, cover certain procedures. This is according to the Medical Schemes Act, Section 29 (3) (a). Medical Insurance can reject applicants due to age and additionally can add on exclusions for specific or high risk procedures.
– Medical Aid has shortfalls most of the time. Medical Insurance may be used as a gap cover for shortfalls.
– Medical Aid does not have to disclose the amount payable for the procedure they will cover. Medical Insurance provides a person with a defined amount in case a specific event happen
You have the freedom to visit any General Practitioner within our network or non network. This allow you to maintain continuity of care with your preferred GP, with whom you have an long lasting relationship.
The benefits per policy are for each individual member on the policy. Therefore, should you be on the Green Day-2-Day plan each member would be allowed 4 GP visits per annum.
This is any medication prescribed by a General Practitioner
No. We provide you with R150 000 per annum per member limited to R300 000 per policy
Upon registration , you will receive your virtual card, accessible through our Mobi-App, which will been sent to you.
