Affordable private healthcare: Comparing Flexicare health insurance and medical aid

How private healthcare cover works in South Africa

Do you pay cash to see a private doctor, or dentist, to get your eyes checked or buy medicine and more? Thinking about getting healthcare cover but not sure which option is right for you?

In South Africa, there are two main types of private healthcare cover: medical aid and health insurance, such as Flexicare.

Both offer access to private healthcare services for a set monthly cost. But, they differ in important ways - from what they cover to how much they cost.

Here we explain exactly what Flexicare health insurance is, what it covers, how much it costs, and how it compares to medical aid, so that you can make the right choice for your health and your budget.

What is Flexicare?

Flexicare is a health insurance product that covers you when you see primary private healthcare providers like nurses, doctors, dentists and more. You pay one affordable monthly cost that stays the same each month.

To make getting primary private healthcare more affordable, Flexicare has special arrangements with groups of top-quality healthcare providers, such as doctors, dentists, optometrists, and pharmacies, who charge set rates for members. These are called network providers. Through these networks, members get access to private primary healthcare at lower costs than they'd pay without Flexicare membership.

When they go to Flexicare network providers, Flexicare members don't have to pay cash. The provider is paid directly by Flexicare.

Flexicare has a large network of private doctors, pharmacies, dentists, and optometrists across South Africa.

There are two different Flexicare plans to choose from.

For R459 per month, Flexicare Core gives you:

• Unlimited nurse visits
• Doctor visits if referred by a nurse
• Unlimited online doctor visits
• Acute and over-the-counter medicines
• X-rays
• Flu vaccine
• A Health Check
• Care during pregnancy
• Blood tests
• Small medical procedures done at a doctor
• HIV care

For R539 per month, Flexicare Plus gives you:

• Unlimited doctor visits
• Unlimited online doctor visits
• Visits to specialist doctors
• Acute, Chronic and over-the-counter medicines
• X-rays
• Flu vaccine
• Optometry (eye tests, frames and lenses)
• Dentistry (cleaning, scaling, polishing, extraction, fillings)
• A Health Check
• Care during pregnancy
• Blood tests
• Small medical procedures done at a doctor
• HIV care

By paying extra every month, you can add your family to your policy so they can get the same care.

Flexicare members can add emergency cover to their plan

Flexicare also gives members the option to add Discovery Emergency Cover (for a slightly higher premium), which pays for care at a private hospital in the case of accidents or life-threatening emergencies.

These benefits are optional add-ons that members can choose when they sign up for Flexicare or at a later stage. The member must already have a Flexicare Core or Flexicare Plus membership to be able to sign up for additional Discovery Emergency Cover.

There are three Discovery Emergency Cover options to choose from, each offering a different level of cover and adding a different amount to your premium:

Emergency Core, from R218 per month

Pays for care in a private hospital after an accident or injury.

Emergency Plus, from R313 per month

Covers everything in Emergency Core. It also pays to be stabilised at a casualty unit during an emergency, and for care in a private hospital after a heart attack or stroke.

Emergency Max, from R439 per month

Covers everything in Emergency Core and Plus. It also pays for private hospital treatment for these nine serious conditions: Acute appendicitis, acute asthma, ectopic pregnancy, acute inflammation of gall bladder, fit or seizure, acute pneumonia (serious lung infection), kidney stones, acute renal failure (kidney failure) and pulmonary embolism (blood clot in the lungs).

What is medical aid?

EMedical aid also gives cover for care at private healthcare facilities, but medical aid plans cost more than health insurance products because they cover you across a bigger range of healthcare types.

With medical aid, there are often many plan types to choose from, ranging from plans that are mostly for hospital cover to plans with medical savings accounts, to the most expensive plan types, which offer the most comprehensive coverage.

Medical aid covers the costs of everyday care as well as major medical expenses, such as going to hospital.

By law, all medical aids must cover a basic level of care for certain chronic conditions and diseases. This set of care options or benefits is called Prescribed Minimum Benefits (PMBs). Health insurance is not required to pay for care for PMBs.

Discovery Health Medical Scheme is an example of a medical aid.

Key differences between Flexicare and medical aid

Both Flexicare and medical aid help to cover the cost of private healthcare, but they are different types of cover when it comes to what they offer and how much they cost. p>

Flexicare covers basic medical needs like nurse and doctor visits, some medicines, maternity care, and basic dental and eye care. Flexicare will pay the healthcare provider directly if you use one that's in the Flexicare network. You won't need to pay upfront, and you won't have to make any co-payments.

Medical aid covers your costs for everyday care (the amount of cover you get for things like GP visits, specialist doctor visits, medicine, and more depends on your plan option). Medical aid also covers you for major medical costs, like when you need care in hospital. With medical aid, when you see a doctor to get care, the medical aid either pays the doctor directly, or you pay first and then the scheme pays you back. In some cases, the scheme will only pay for part of the cost and you will have to pay the rest.

Because medical aid covers a wider range of healthcare needs, it has higher monthly premiums than for health insurance products like Flexicare.

If you have Flexicare, you can choose to pay a little more every month to get cover for medical emergencies, such as being stabilised in hospital, or even for being admitted to hospital.

Which one is right for you?

The type of healthcare cover you should choose depends on the premium you can afford to pay every month and you and your family's healthcare needs.

Who is health insurance best for?

Health insurance is perfect for people who cannot afford the monthly cost of medical aid cover but want an affordable way to access private healthcare for everyday needs - with a chance to pay a little more for emergency and private hospital cover.

Who is medical aid best for?

Medical aid is a great option for people who can afford a higher premium than what they'd pay for health insurance. Medical aid is for people who want cover against unexpected medical events that cause large costs that few people can afford - such as extended hospital stays or long-term care after an accident, injury, or serious illness. Medical aid is also ideal for families, people who need regular medical care or have chronic illnesses, and anyone who wants broad cover for their healthcare needs now and into the future.

Learn more about Flexicare.