A non-DSP benefit of R9 300 is limited to one claim per year on the Universal plan. Liberty Health offers full cover for copayments relating to hospital admissions, scans and certain procedures on the Essential and Universal gap cover options. Cover escalates to R50 000 on the Co-Evolution and Elite options, and there’s a non-network copay benefit of R8 500. In South Africa, there are several gap cover providers that include copay cover in their benefit structures.Īt Stratum Benefits, the entry level Compact 200 plan provides R15 000 copayment cover per policy per year. Providers of copayment cover in South Africa Where do you get cover for medical copayments? Here are a few of the top providers in SA. Now that you know the ‘copay’ from the ‘deductible’, it’s time to consider copay cover as an integral part of your financial planning. This type of cost sharing is seldom imposed in South Africa. Once the deductible has been paid, the scheme steps in to cover its share of the medical costs accrued for the remainder of that year. It is similar to the excess payable in motor vehicle insurance. In other parts of the world, a deductible is the annual amount a medical scheme member has to personally pay towards health care before medical aid kicks in. Similarly, the term ‘copayment’ and ‘deductible’ is used interchangeably in South Africa. ‘Coinsurance’, on the other hand, is the correct term for the percentage-based system imposed on medical aid scheme members. In South Africa, a copayment is either levied as a fixed fee or as a percentage of the total cost of a particular health care service or procedure.Īlthough ‘copayment’ is a generic term used in South Africa, it actually applies to the fixed fee model of cost sharing. The only other alternative is to rely on the dysfunctional public healthcare service, instead. If you don’t have copay cover, and your budget doesn’t extend that far, you’ll have to do without the treatment or surgery. In South Africa, an out of pocket expense levied on medical aid scheme members is known as a copay or copayment.ĭepending on the level of cover, a copay can apply to a wide range of services - hospital admissions, MRI and CT scans, specialist consultations, lab work, prescribed medication, the voluntary use of non-network service providers, and so on.Īs a member of a low- to mid-cost medical aid plan, you’ll be expected to pre-pay for specified health care services, conducted in and out of hospital. The soaring cost of health care in South Africa has forced medical aid schemes to introduce cost sharing mechanisms.Īlong with monthly contributions, scheme members of more affordable plans are now expected to cover a portion of the costs of certain medical treatments and procedures - up front, and from their own pocket.
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