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Medical Aid vs Medical Insurance

There comes a time in your life when you start to consider your health. Maybe it’s when you say, ‘I do’, or the day your first child is born. Perhaps it’s after a health scare or accident. Whatever it is, when the moment comes, you’ll have to decide on a type of health care – medical aid or medical insurance. But aren’t these the same thing? Nope. While the general public tends to use these terms interchangeably, they are separate products and cater to different needs. Often consumers confuse the differences, leading to uninformed decisions. So, do you know the difference between medical aid and medical insurance? Let’s find out.

The difference between medical aid and medical insurance

When looking at medical aid schemes and medical insurances plans, it’s important to realise they offer separate cover options. Often, consumers look at the costs and fail to notice how the benefits differ. We want to help you make an informed decision. Whether you need one or the other, or both, you need to know the facts to make the best choice.

Medical aid

Here in South Africa, the Medical Schemes Act regulates all medical aid schemes. By law, the schemes have to follow a list of rules and regulations, from standard-rate fees to the cover of various prescribed minimum benefits. These benefits include treatment for chronic conditions and a list of in-hospital procedures. Members pay a premium and schemes cannot discriminate against anyone based on their age or health. While cover can be comprehensive, it does not include personal accident disability or loss of limbs. Medical aid schemes also have no authorisation to include death and funeral cover.

Medical insurance

On the other side of the spectrum, the Short-term Insurance Act regulates medical insurance. Instead of covering specific treatments, a plan provides a lump sum for a set of defined risks. Plans are not bound to incorporate cover for the prescribed minimum benefits. In other words, medical insurance offers a list of stated benefits, often with a monetary value attached. Plans provide day to day healthcare as a preventative service, and specialist services are usually limited. As an insurance policy, these plans can include death and funeral cover. They can also provide cover for accidents and emergencies – usually within clearly defined boundaries.

3 key areas where medical aid and medical insurance differ:


1. Price versus benefits

One of the most noticeable differences between the two types of cover is the price. Medical aid schemes are notably more expensive, with higher monthly premiums. As a result, many South Africans cannot afford the high cost of medical aid. Medical insurance, however, is far more affordable, but this means there are limitations when it comes to what is covered. You should always consider your health needs when deciding which is best for you.

2. Types of cover

Medical aids have to provide full cover for a list of treatments and conditions. In contrast, medical insurance can specify its benefits and pays out a defined amount towards them. Medical insurance plans usually focus on daily health care, such as doctors’ visits and short-term medication. But, a more comprehensive health insurance plan may offer hospital care in the event of an accident or emergency, to a fixed sum.

3. Hospital and chronic benefits

Medical aid schemes offer comprehensive hospital cover, usually for a large variety of in-hospital treatments, depending on your plan. However, there is often a shortfall between medical aid rates and the rates charged by the medical practitioners. (Discover how to compensate for the shortfall with medical gap cover.) Medical insurance does not cover extensive hospital benefits. Hospitalisation is usually limited to accidents and emergencies and only covers specified costs. If costs exceed the limits, members will have to pay the extra. Medical aids are also required to cover chronic medication, while medical insurance is not.

Why choose Elixi Medical Insurance


In general, medical aid is expensive, and the majority of our population doesn’t have access to costly medical schemes. Elixi offers an affordable healthcare option to ensure you still have access to primary care benefits if medical aids are beyond your budget. We work with well-known service providers, making sure you receive the highest quality care at all times. Not only do we cater to your daily health needs, but we also offer plans with hospital care benefits in the event of an accident or emergency at private healthcare facilities. Our advanced plans also include a chronic medication benefit for selected medical conditions.

Ultimately, the choice between a medical aid scheme and medical insurance plan is a personal choice. Your budget and healthcare needs will play a key role in deciding which one is right for you and your family. The best news is, you can have both. But don’t go without, there is always an option suited to your needs. Take care of your health today and join Elixi Medical Insurance. Request a call back to find out more about our plans.