How to get health insurance in South Africa

health insurance
Updated 2020-04-23 13:41

No matter where or when you intend to move, you can't escape the need to know more about the local health insurance options available to you and your family. If South Africa is your future destination, then you will have two contrasting alternatives to consider: public healthcare or private healthcare. This post will shed some more light on both.

Public healthcare insurance in South Africa

To qualify for public health insurance, you need to register at a state-run hospital and create a profile on their system. There they will determine a specific patient fee structure based on your income and your situation. This rate will be used to calculate your contributions towards visits and medication. The costs are minimal when compared to that of private hospitals and clinics.

South Africa offers the highest standard of free public healthcare across the continent of Africa. However, because the public health system is under strain due to the high unemployment and budgeting restraints caused by failing parastatal entities, the healthcare sector has become understaffed and underfunded. The quality and speed of public healthcare services might differ from region to region, depending on factors like population density, remote location, or areas with a higher crime rate.

New National Health Insurance

The South African government is in the process of implementing a new and improved NHI offering. Full integration is sought by the end of 2030. It is believed that this revised public insurance will provide South Africans with access to a more comprehensive healthcare system. While it might bring about the demise of some smaller independent medical aid schemes, it should improve the current state of hospitals and result in the overall upgrading of all medical facilities.

Private healthcare insurance in South Africa

If you are relocating from a more developed country, you should consider private healthcare for an experience akin to what you might be used to. Cover usually range from a basic hospital cover plan to a more comprehensive package that covers the most mundane ailments. The price variance between the two extremes can be alarming. You can find adequate cover from as little as R500 per month to elite options in excess of R20,000 per month.

These figures all depend on your current health status, your living environment and your financial situation, as these could influence your risk factor. Applying for medical aid cover is not a complicated process. Most insurers offer telephonic or online application processes that are very user-friendly.

It is important to note that all documentation should be carefully read and thoroughly understood before committing to a health insurance. Read all the clauses about exclusions and claim timeframes. Familiarise yourself with the claims processes and the additional fees by studying the cover guidelines. Many health insurance complaints lodged with the Ombudsman for long-term insurance resulted from a misunderstanding of documentation, such as unclear definitions and exclusion clauses.

Claims process

For the most part, you will be able to provide your private medical aid insurance number and be able to enjoy medical assistance of most types without any complications. Some doctors, providers or facilities will request payment upfront but will issue you with an invoice which you can submit to your medical aid for reimbursement.

For those making use of public healthcare, you will only be assisted at public hospitals, clinics, or service providers. It would be beneficial to find out where all the state-owned establishments are located before having an emergency. It is important to note that you could face long waiting spells at a government hospital.

Below are some of the active and reputable private medical aid schemes in South Africa:

 Useful links:

Government of South Africa - Health
Brand South Africa - Healthcare in South Africa
Department of Health - National Health Insurance
Government of South Africa - National Health Insurance
Ombudsman for Long-Term Insurance

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