Only asmall proportion of SA’s population of almost 58 million can afford private medical aid – just 8.3 million lives are members of medical schemes. For those who are fortunate to hold medical scheme membership, annual premium increases are rising at a faster pace than CPI inflation rates, making it increasingly challenging for medical scheme members and employer groups to keep up with the rising costs, particularly for lower income earners.  Given the current economic trajectory in SA’s post-Covid-19 economy, consumers will be facing greater financial constraints than ever before.

As an alternative to private medical scheme benefits, health insurance solutions are increasingly in demand by consumers who simply cannot afford the high price of medical scheme cover, but simply cannot take the risk of not having any access to quality healthcare at all.  Health Insurance is a valuable alternative solution.  The benefit of health insurance is that it provides a range of options on cover from basic primary care only options, hospital only options as well as more comprehensive options combining both in and out of hospital benefits. 

“Health Insurance helps consumers across many spectrums, including those opting out of medical scheme membership and those who simply have no access to traditional healthcare funding models. Depending on the option taken, a basic health insurance plan would cover you for basic primary medical care, including day-to-day consultations with general practitioners and acute and chronic medication. On more comprehensive plans, there is also cover for defined hospital events within stated annual benefit limits. Healthcare insurance provides consumers with a financial safety net which gives access to quality healthcare services where private medical scheme options are simply not affordable for all,” explains Dion Mhlaba, Chairman of Wesmart.

Wesmart Financial and Administration Solutions (Wesmart) provides a wide range of Health Insurance options and holds an exemption in terms of the Demarcation Regulations from the Council for Medical Schemes (CMS) under exemption number DM1122.Wesmart is underwritten by GENRIC Insurance Company and the focus is on offering options to both private individuals as well as SMME and corporate employer groups.   

“Currently, millions of people make use of an overburdened public healthcare system for their healthcare needs such as GP visits, optometry, dentistry, pathology or radiology – a system which is typically limited and in many instances fails to provide even the most basic of primary health care services.  It is not uncommon to hear that people take an entire day off work simply to queue up among hundreds of patients at a public facility or clinic to see a general practitioner or nurse for a simple ailment or treatment, to fill a chronic medicine prescription, or to be turned away because a healthcare practitioner or medical equipment isn’t available.  In many instances, the only alternative is for people to dig deep into their own pockets to pay for costly medical bills to access some form of quality healthcare. 

“With healthcare insurance, consumers can access a defined network of private healthcare providers, including specialist doctors where referred by a GP, schedule an appointment and get access to the care and quality they need quickly and affordably.  There is tremendous peace of mind for you and your dependents in knowing that there is an affordable safety net in times of a health event,” explains Mhlaba. 

Why is health insurance cheaper?

Health Insurance suppliers manage the costs of cover and keep the premiums affordable by working with a designated network of healthcare providers, providing cover for defined events and conditions, and by ensuring that acute and chronic medication adheres to a set formulary - adrug formulary is a list of prescription drugs used by healthcare practitioners to identify medicines that offer the greatest overall value. More comprehensive options also offer the day-to-day benefits and certain hospital events, including private emergency hospital stabilisation benefits.

“Access to benefits are option-specific and on some basic health insurance plans, cover is provided for GP consultations, a dentist benefit and prescriptions and a significant benefit is that it provides for preventative care which is a big advantage of being covered.  Most people without health insurance postpone going for annual check-ups or health screenings, if at all. Having access to preventative care helps doctors detect an illness early, and early detection can minimise the severity of an illness and possibly even save your life. More comprehensive health insurance options provide extra peace of mind by providing access to 24-hour emergency medical services and ICU benefits.

“Health insurance gives cash-strapped consumers access to quality private healthcare quickly and affordably, ensuring that a health event doesn’t become both a health and financial crisis. Whether you’re an individual looking for a cost-effective solution that understands that you are healthy and don’t need all the “bells and whistles” or a family that needs a comprehensive solution that meets your growing needs, health insurance provides an invaluable solution where medical scheme benefits are simply not affordable,” concludes Mhlaba.

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Wesmart Financial and Administration Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP: 45769) underwritten by GENRIC Insurance Company Limited (FSP: 43638). GENRIC is an authorised Financial Services Provider and registered Short-term insurer.