Given the high cost of medical aid cover in SA, there is growing demand for health insurance products that offer affordable solutions for basic primary medical care. These plans typically cover day-to-day general practitioner consultations, dentistry, optometry, acute and chronic medication and certain defined hospital events.
Medical aid and health insurance are not the same thing. Medical aid schemes provide comprehensive health benefits, including prescribed minimum benefits PMBs, which are a set of conditions that medical schemes are legally required to cover. Health insurance, on the other hand, pays a fixed amount for specific health events as outlined in the policy.
Unlike medical aid schemes, health insurance products are governed by short-term or long-term insurance laws and not medical aid regulations. This means they aren't required to include PMBs and can impose different waiting periods and maximum entry age limits.
To maintain affordability, they primarily focus on out-of-hospital primary care expenses like GP consultations, prescribed medication, basic dentistry and some optometry, often with strict network provider rules. They may also include a defined limit for emergency hospitalisation or stabilisation due to illness.
In collaboration with Discovery Health and Auto General Insurance, Clicks offers an affordable health insurance product called Flexicare. Chief marketing officer at Clicks, Dr Melanie van Rooy, says that Flexicare is not a medical scheme, nor is it intended to be a substitute for medical scheme membership.