Medical insurance in South Africa

Medical insurance in South Africa

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It is advisable for expats set up suitable medical insurance in South Africa to ensure that they can gain access to the best medical aid available.

Discover why it’s important to take out private medical insurance in South Africa, how to choose a healthcare provider and what to do if you’re studying in South Africa.

While four in five South African citizens don’t have private health insurance, the vast majority of expats moving to the country take out cover to ensure they get a standard of care on par with what they’re accustomed to in their home country.

The main reason for this is that South Africa suffers from a significant healthcare imbalance. Its public hospitals are understaffed and underfunded, leading to long waiting times for patients.

Medical insurance in South Africa for foreigners

If you have a private healthcare insurance policy in your home country, it might not work in South Africa, unless it’s been specifically designed for expats.

In this instance, you can speak to your insurer about switching to an international cover policy for when you move to South Africa, or you can instead start up a new local policy once you move.

Ideally, your policy should cover you for medical costs in South Africa, your home country and any medical evacuation costs, as these can be very expensive if you have to pay for them yourself.

If your trip to South Africa is only a temporary one, you may be better taking out travel insurance with a sufficient level of coverage for your stay.

Top 5 medical aid schemes in South Africa

State medical aid in South Africa

While state healthcare coverage in South Africa has improved over the last couple of decades, it remains significantly underfunded, and there is a big gap between the quality of care you can expect between state and private institutions.

State healthcare in South Africa is subsidised for citizens and permanent residents, with how much you’ll need to pay depending on your earnings. The maximum co-payment you can receive from the government towards your medical costs is 40%.

The cost of different treatments is regulated across South Africa through the Uniform Patient Fee Schedule.

National Health Insurance

The South African government plans to set up a National Health Insurance fund (NHI), with the first signs of progress set to be seen in 2017. The proposals involve significantly increasing the healthcare budget - improving maternity, psychiatric and elderly care in particular. The reforms are set to take over a decade to fully come to fruition, with refining work still underway from a White Paper released by the Health Minister in 2015.

Who can choose private medical insurance in South Africa?

To get healthcare of similar standard as you’re used to in your home country, you’ll need to take out a health insurance plan. Opting for private healthcare means you will be able to attend specialised clinics with a better standard of care and shorter waiting times, especially when it comes to getting appointments with specialists.

More than half of the healthcare budget in South Africa is put towards private services. With this in mind, some of the best doctors and specialists who train in Western countries use their expertise solely in the private sector – thereby increasing the service gap between state and private healthcare.

Private health insurance providers in South Africa are regulated by the Medical Schemes Act, and healthcare packages are available for individuals and families. In some industries, health insurance is offered as an employee benefit, with the costs shared by the employer and employee.

Healthcare plans in South Africa will cover care up to a certain cost each year, but they vary significantly in their terms, from those covering emergency issues through to comprehensive plans which in some cases include dentistry.

You may find that some healthcare plans include more coverage than you are likely to need – so shop around for the best deal for your circumstances.

Best medical aid in South Africa

Choosing a healthcare provider in South Africa

South African and international companies both offer medical insurance policies.

When choosing a company, it’s important to make sure you’re covered for the long term - one-year contracts can be troublesome, as if you become unwell your insurer could refuse to renew the contract. Steer clear of companies who reserve the right to cancel policies if you have a serious illness and choose one with a longer period under which you can’t be excluded.

In addition to checking your coverage, get your head around how premium scales work and what excess charges you’ll have to pay if you become unwell. While premiums can often paid either monthly, quarterly or annually, some companies will ask for a year’s payment upfront.

If you are in good health, it may be worth getting a scheme where only specialist and hospital treatment is covered, meaning you pay the small charges to see your doctor and get prescriptions yourself.

Before you take out a plan, you’ll need to fill out forms and provide details of your medical history, including information about any pre-existing conditions.

What happens if you get ill in South Africa?

When you have treatment in a South African hospital (or visit a specialist), you’ll usually need to pay on the day either by cash, credit or debit card, and you can then recoup these payments from your insurer afterwards.

Some insurers prefer their customers to give notice before getting treatment, and your provider might offer rewards if you lower their likely liability by exercising or having regular medical check-ups. With so many different options available, make sure you take your time to find the right provider, as some have a considerably better reputation when it comes to paying out than others.

Once you’ve signed up for a plan you should be given a healthcare card, which you will need to show when applying to see doctors or specialists.

Sick pay in South Africa

Sick pay in South Africa is calculated over a three-year period. Across this period, workers are entitled to the number of days they’d usually work in six-week period (so 30 days for those working 5 days a week).

If you take sick leave, your employer must pay you in full during this period - although sick pay can be reduced in some cases if you take a longer period off.

If you’re off for more than two days, or more than once during an 8 week period, your employer can request a medical certificate from your doctor to prove your are ill, and if you fail to provide this they can refuse to pay you.

Cheapest medical aid in South Africa

Health insurance for students in South Africa

If you’re applying to study at a University in South Africa as an international student, you’ll need to show you have adequate health insurance before you’ll be granted your study visa.

There are various companies that offer specialist student health insurance plans, with a range of different care options available. These work similarly to normal health insurance plans - they are usually locked to one set of clinics and will cover your hospital bills, and in some cases medicine bills after you’re released.

Learn more about the health insurance in other countries


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