Essential Med is fully exempt to offer South Africans low-cost healthcare options. Picture: SUPPLIED/ESSENTIAL MED
Essential Med is fully exempt to offer South Africans low-cost healthcare options. Picture: SUPPLIED/ESSENTIAL MED

As living expenses rise, more South Africans are struggling to keep up with the mounting costs of medical aid. Medical aid rates have been in the media spotlight recently, yet there seems to be little or no alternative for consumers who want to affordably and reliably protect their families’ health with private healthcare.

Low-cost options in limbo

In recent years, many employers have opted for primary healthcare options to provide large groups with affordable healthcare cover. From less than R200 per month compared with the average medical aid contribution of R2,436 per month, these options provide access to general practitioners, certain tests, medicines and even some dentistry or optometry benefits, as well as limited hospital cover for emergencies.

These options now cover hundreds of thousands of lives, but recent developments have left both employers and individuals in limbo due to the Council of Medical Schemes’ (CMS) demarcation of health insurance and medical schemes potentially rendering these products illegal.

Demarcation regulations came into effect in April 2017, offering an exemption to insurers from the Medical Schemes Act by allowing them to offer their plans while the CMS developed a standardised low-cost benefit option. From 36 applicants, only 18 received an exemption.

It was recently announced that this standardised low-cost option would not be ready by March 2019 as initially expected. Now the repercussions are starting to become a reality for medical aid schemes.

What are the repercussions?

Earlier this year, one of the biggest players in the medical aid field was denied the exemption to run its primary healthcare plans on the grounds that as a medical aid scheme rather than a registered insurer, it could not apply for exemptions.

This clearly reinforces the CMS’s stance that primary healthcare benefits are in essence operating in medical aid scheme territory, rather than insurance, and that enforcement of the Medical Schemes Act against providers without the necessary exemptions will now begin in earnest.

This leaves both employers and individuals in no-man’s-land as far as basic medical cover goes. Those who already have some of these options in place might soon discover that their benefits are in fact deemed illegal, which will affect many individuals, while the increased uncertainty will make potential new members or employee groups wary to sign up.

Who got it right?

Essential Med, one of SA’s most prolific medical-insurance providers and part of the AfroCentric Group, is ready, willing and able to provide legitimate, low-cost, private-care cover that checks all the legal requirements.

According to Paul Cox, CEO of Essential Med, its product is highly configurable and has been granted exemption in totality.

This means employers and individuals can enjoy personalised cover that fits both their needs and pockets without any uncertainty around the demarcation regulations.

“Going forward, every time a provider wants to enter a new product into the market, they would need to approach the council for exemption of that product, a process that may or may not succeed. Our product, on the other hand, is exempted as a whole, allowing us to configure it in a variety of ways without introducing a new product,” says Cox.

What is medical insurance?

Cox explains why Essential Med medical insurance has become an affordable alternative to medical aid without compromising on quality.

“Medical aids are regulated by the CMS. They are required to provide certain minimum benefits and cover structures to all their members. The upside is that medical aid members enjoy a minimum level of cover. The downside, however, is that in order to provide this, it costs the scheme more and that cost is eventually carried by the member. That’s why medical scheme members have seen this steady increase in rates over the past few years, while the minimum benefits might not even be personalised to what they need.

“Medical insurance, however, is exactly what the name suggests. Similar to the way you would insure your car or home for a set amount against certain risks, you insure your health and that of your family for a set amount.

“This means you don’t have to pay for minimum benefits you don’t need. Instead, you get to select the benefits that you really need – be it day-to-day or hospital benefits – and select the level of cover you want. Because you don’t have to pay for unwanted minimum benefits, the monthly rate is significantly lower when compared to medical aid.”

Simply put: it is personalised private-care cover, at a fraction of the price of medical aid.

Isn’t medical insurance inferior to medical aid?

“The answer to that question is a resounding no,” says Cox. “That perception has been around forever, but the reality is that medical insurance from a reputable provider is definitely a viable alternative to medical aid – especially for younger and healthier individuals or families.

“To be honest, medical insurance isn’t necessarily for everyone. A cancer patient, for example, might need lifelong treatment and numerous hospital visits. For someone like that, medical aid is definitely the better choice, as medical insurance will only cover their treatment up to a certain amount.

“Yet, for the vast majority of South Africans, the need for day-to-day cover for doctor and specialist visits, glasses and dentists – coupled with a great hospitalisation benefit should they need to be admitted – is very real. And this is what Essential Med offers at a fraction of the cost of medical aid.”

Essential Med goes the extra mile

Having been in operation since 2009, Essential Med has a longstanding track record of reliability and trust among its policyholders. With personalised cover at affordable rates, Essential Med allows its customers to create their own cover, which includes all from just R169 per month:

Day-to-day cover

  • GP visits
  • Acute & chronic medication
  • Pathology & radiology
  • Dentistry
  • Specialist visits
  • Optometry

Hospitalisation cover

  • Accident hospitalisation
  • Illness hospitalisation
  • Maternity
  • Emergency casualty visits
  • Dread disease
  • Permanent disability
  • ICU care

When compared with traditional medical aid schemes, it’s clear that Essential Med offers a viable alternative without compromising on quality.

If you’re ready to change your thinking about medical insurance and start saving, visit www.essentialmed.co.za for a personalised quote today.


This article was paid for by Essential Med.