What is health insurance?

Discovery Health offers Flexicare in partnership with Auto&General. Flexicare is an innovative and affordable health insurance product for people who live in South Africa. Flexicare members get access to high-quality yet affordable private primary healthcare which takes care of their day-to-day health and medical needs.

And, Flexicare is available at highly competitive monthly fees, starting at only R350 a month.

So, what is health insurance?

"The terms 'medical aid' and 'health insurance' are often used as though they mean the same thing," says Maria Makhabane, Chief Growth Officer at Discovery Health. "However, there are big differences between them."

"For example, Flexicare is not a medical aid product but a health insurance product which give its members affordable cover for private primary healthcare - so healthcare that meets their day-to-day needs. For a fixed monthly amount, Flexicare covers day-to-day medical expenses such as a consultation with a nurse or GP with access to medicine. If you use a healthcare provider on the Flexicare network, we will pay the healthcare provider directly, so you don't have to worry about the cost. All you pay is your monthly premium."

"You can also get an additional trauma benefit by paying a little extra each month. This covers you at a private hospital facility in the case of an accident or emergency."

"Flexicare - or health insurance in general - is also not an alternative to or replacement for medical aid - a product that provides far broader cover, and costs more to access than health insurance."

These are the main features of health insurance products like Flexicare

Health insurance is governed by long-term and short-term insurance laws.

Waiting periods

A health-insurance product may come with waiting periods for:

• Healthcare services related to specific conditions or treatment types
• General access to benefits

This means that you won't be able to claim for medical treatments for a certain amount of time after your health insurance cover starts.

And, some health insurance products might not be available to people who are over a certain age.

Contributions and payments

Health insurance is available for a fixed monthly amount.

Health insurance pays out a set amount for your medical expenses (either to you or to your healthcare provider).

To keep health insurance products affordable, they focus mostly on out-of-hospital, day-to-day healthcare expenses such as going for a consultation with a nurse or GP, getting medicine, and basic dentistry. Usually, they have strict rules about using specific healthcare providers in their network. If you don't use these providers, then the health insurance won't pay out.

Some health insurance products include a fixed payout for being stabilised in hospital in an emergency.

Health insurance can also include additional cover options, such as personal accident disability cover, death cover and funeral cover. These extra benefits may cost you a little more each month.

And, what is medical aid (and how does it differ from health insurance)?

Medical schemes are governed by the Medical Schemes Act. Under this Act, all schemes must pay for a basic level of care for 27 chronic conditions and 270 diseases. These are called Prescribed Minimum Benefits, or PMBs.

- Health insurance products do not have to cover for treatment for conditions on the PMB list.

As a member of a medical scheme, you pay a monthly contribution for financial cover for your medical expenses. The amount you pay depends on the medical plan you have chosen. Medical aid membership costs more than health insurance because it gives you access to a wider range of benefits and cover options, from cover for day-to-day care like visits to GPs, nurses, dentists, optometrists and so on, all the way to covering hospital stays.

To avoid paying over and above your monthly premium to access care, you may have to use healthcare providers and facilities that belong to your medical scheme's networks - again this depends on the medical plan you have chosen. Contributions to a medical aid are tax deductible in South Africa.

What does Flexicare health insurance give you access to?

Flexicare offers two plans:

• - Flexicare 
• - Flexicare Plus

1. From only R350 a month, Flexicare gives you access to:

• Cover for unlimited nurse consultations, to see a nurse in Flexicare's primary care clinic network.
• Cover for unlimited face-to-face or online consultations with a GP in Flexicare's network when you have been referred to the GP by a nurse.
• Prescribed medicine, HIV medicine and over-the-counter medicine.
• Blood tests and X-rays are covered when requested by a network GP.

2. From R469 a month, Flexicare Plus gives you access to:

• Cover for unlimited face-to-face or online consultations with a network GP. Members are fully covered for these consultations and don't pay anything extra.
• Prescribed medicine, chronic medicine and over-the-counter medicine.
• Basic dentistry: Cover for dentist visits, fillings and tooth removal by a network dentist.
• Basic optometry: Cover for one eye test every year and one pair of glasses every 24 months from a healthcare provider in the optometry network.
• Blood tests and X-rays are covered when requested by a network GP.

3. There is also the option to access trauma cover (for care in a hospital):

Flexicare offers a trauma benefit - available on both plans - which covers you for emergency private healthcare services at any private hospital facility.

There are two choices under this benefit:

• Burns
• Head injuries
• Chest injuries or severe fractures caused by a fall
• The loss of an arm, hand, leg or foot
• Near-drowning
• Poisoning or a serious allergic reaction that may cause death
• Injuries resulting from a crime, sexual assault or a car accident, or an injury at work.

Maria adds: "In summary, health insurance products like Flexicare really provide excellent value for money in giving members very affordable access to high-quality private care for a predictable, fixed monthly amount."

Find out more

For more information about Flexicare, visit our website.