Medical insurance falls under a different insurance category to medical aids or medical schemes.
With medical insurance, you simply sign a “state benefits contract” – meaning, for example, that if you spend a day in the hospital, your medical insurer will pay out a specified amount, depending on the level of insurance you have. Medical aid plans fall under different legislation in South Africa. They’re regulated through the Medical Schemes Act, as enforced by the South African Council for Medical Schemes.
One of the key components of this legislation is that medical schemes need to cover certain conditions and emergency situations in full, regardless of the particular plan you’re on. These conditions and situations are referred to as prescribed minimum benefits, or PMBs