For COVID-19 updates, visit official government website

What are the Differences between Health Insurance and Medical Aid?

are you covered

Health Insurance is suited for the individual and specific needs they may have. It can also offer added cover for instances that medical aid may not cover, such as accidental injury or death cover. The term can be simplified as taking out insurance for your health.

Medical Aid and Health Insurance are often confused with one another. Health Insurance is based on the customers’ needs and is dependent on the type of cover you choose. Health Insurance refers to the amount of money that will be covered in hospital, due to emergency, accidents or operations. It also can include pay-outs that cover shortfalls for dental care, GP visits, and other medical needs.

Health Insurance can be particularly beneficial to those that find themselves in hospital more often. It remedies shortfalls that may occur with regular medical aids. Health Insurance can be great for individuals with chronic diseases, as the amount you pay for these premiums is not determined by how sick you are – but rather on the type of cover you choose to take out. Here are some differences:

Health Insurance

  • Health Insurance is risk cover for unforeseen events according to cover limits
  • Health Insurance may be used in conjunction with your medical aid to cover any shortfalls that you may have
  • Health Insurance falls under the Short-term Insurance Act
  • Health Insurance includes Personal Accident risk cover such as disability and loss of limbs cover, inability to work, salary protection.
  • Health Insurance's are allowed to and may include death and / or funeral covers
  • Health cover pays directly to the Insured

Medical Aid:

  • Medical Aids often have shortfalls due to the difference between the Medical Scheme Rate and the provider’s tariff
  • Medical Aid schemes cover medical conditions according to scheme rules and managed health care protocols
  • Medical Aid schemes falls under the Medical Schemes Act
  • Medical Aid schemes have got specified and yearly limits and health events do not need to be specific identifiable
  • Medical Aid schemes is not allowed to include any Personal Accident disability and loss of limbs cover
  • Medical Aid schemes is not allowed to include death and / or funeral covers as part of the Medical Aid Scheme


Health Insurance can have added benefits such as extra cover for pregnant women and chronic patients. Pregnant women may have access to counselling and added services before and after the birth. Chronic patients can benefit from top ups where they may have shortfalls with their medical aid. Such as blood tests, emergency cover or counselling.

Health Insurance is suited to your needs and provides cover based on what you need. It can act as a great way to have that extra protection for when you may need it most! Feel free to fill out your details on our website and we will have South Africa’s top insurer’s call you back to provide more information