Medical Insurance 101 — Know the Basics

‘Nothing in life is free.’ At Day1 Health, we agree — even basics, like bread and milk, will cost you something. We also believe that certain things, though not free, are a basic human right and should not be so unaffordable that they become inaccessible. Medical Insurance should be one of these.

Statistics indicate that Medical Aid options have priced a large proportion of the South African population out of the healthcare market. At Day1 Health, we are committed to providing access to basic primary medical insurance and hospital cover that is not beyond anyone’s financial reach.

But when it comes to healthcare options, terminology can be confusing, misdefined and easily misrepresented.

Medical Aid and Medical Insurance are not interchangeable terms.

Despite the belief that ‘an apple a day may keep the doctor away’ — when it comes to Medical Aid and Medical Insurance — we are not comparing apples with apples. They are two completely different paid-for services that have ‘medical’ in common but offer very different benefits.

If you carefully investigate Medical Insurance for its unique benefits, you are likely to come away pleasantly surprised.

What does it cost? (Pricing)

At first glance, the biggest difference is that Medical Insurance is generally priced at a considerably lower rate than Medical Aid options in South Africa. This is significant, but you need to know what you are paying for and what your money will buy you.

It is true that you get what you pay for, but it is more important to pay for what you need and can afford.

As a Medical Insurance provider, Day1 Health offers primary medical cover from as little as R265/month and hospitalisation options from R385/month — regardless of age, stage of life or economic bracket. (But please be aware that there is a price increase on your monthly premium for each additional dependant.)

Addressing the needs of those who cannot afford conventional Medical Aid cover and their rights to access affordable healthcare is the primary focus for Day1 Health. This puts you in control of your medical care.

What do I get? (Benefits)

This is where you need to look closely and understand what makes Medical Insurance tick.

Note the following unique benefits:

Pays a specified lump sum for your hospital stay which will vary depending on which plan you are on.
Focuses more on major life events and is very helpful in the case of accidental injuries, paralysis, permanent disability, or illnesses that occur after you have joined.
Includes death and funeral benefit payouts. (This is a huge advantage). Some plan options also include accidental permanent disability pay-outs.
Offers primary and basic day to day benefits, including doctor’s visits, pathology, radiology, dentists, optometry, chronic medication et al.

What don’t I get? (Exclusions)

It is always advisable to read the fine print of any Medical Insurance scheme you are considering. Make sure you are advised of exclusions and waiting periods:

All pre-existing medical conditions carry a 12 month waiting period.
There is a specific list of hospital procedures that are not covered. Medical Insurance is not, by law, compelled to cover these medical procedures.
The different plans will require specific waiting periods before certain benefits kick in. Make sure you are aware of these when you sign on.
With Medical Insurance, there is often a network of doctors and dentists, and you will only be covered if you visit those who are registered with the scheme you are on.

Day1 Health

Medical Insurance provides significantly different healthcare package to a Medical Aid. It has affordable pricing and excellent benefits that make it a good fit for the majority of South Africans. You won’t be left unprepared or uncovered when medical emergencies occur or medical treatment is required!

To find out more about Day1 Health’s different plans, please visit us to learn more so you can make an informed decision that will suit your budget, your age and your specific health needs. You can’t afford not to.

SENIOR COMPREHENSIVE PLAN — MEDICAL AID PENSIONERS

DAY TO DAY BENEFITS INCLUDE

Unlimited Managed Doctor Visits

Via a registered 1Doctor Health Network Provider. A co-payment of R75.00 will apply for all additional visits after the 5th visit. A 1 month waiting period applies.

Acute Medication

Acute medication is covered according to the 1Doctor Health formulary. A 1 month waiting period applies.

Chronic Medication

Chronic medication is covered according to the 1Doctor Health formulary. A 3 month waiting period applies on chronic medication for unknown conditions and a 12 month waiting period on pre-existing conditions. A standard 12 month waiting period applies for persons aged 65 and over for chronic medication. (All chronic medication is subject to preauthorisation. An additional administration fee is levied on all approved chronic medication).

Radiology

Basic radiology according to the 1Doctor Health formulary via a 1Doctor Health Network GP. Black and white diagnostic x-rays only. A 1 month waiting period applies.

Pathology

Diagnostic blood tests on referral by a 1Doctor Health Network GP and subject to a list of basic pathology tests approved by Day1 Health. A 1 month waiting period applies.

Basic Dentistry

Basic treatment includes preventative cleaning, pain control, fillings, one emergency root canal treatment and extractions via 1Doctor Health Network Dentist. A 3 month waiting period applies.

Optometry (Iso Leso Optics)

One eye test and one set of glasses every 24 months per the specific Iso Leso Optics agreed protocol range. A 12 month waiting period applies.

Out-of-Area Visits

In the event that you cannot see your Network GP, the Plan will allow 3 “out of area” visits per family per annum to an alternative Network GP or GP of your choice, subject to pre-authorisation. A 1 month waiting period applies.

Day To Day Benefits Via 1Doctor Health Provider Network

Medical Aid Pensioners — Senior Plan (55+)