South Africa: Health Insurance

Overview

If you’re visiting or living or working in South Africa, it’s extremely risky not to have health insurance for your family; if you’re uninsured or under-insured, you could be faced with some high medical bills. When deciding on the type and extent of health insurance, make sure that it covers all your family’s present and future health requirements in South Africa before you receive a large bill. A health insurance policy should cover you for all essential health care, whatever the reason, including accidents (e.g. sports accidents) and injuries, whether they occur in your home, at your place of work or while travelling. Don’t take anything for granted, but check in advance. When travelling in South Africa, you should carry proof of your health insurance with you at all times.

You should avoid a company that reserves the right to cancel a policy unilaterally when you have a serious illness or when you reach a certain age (maximum insurable age), as it will prove difficult or impossible to find alternative cover. You should also steer clear of a one-year contract, which a company can refuse to renew. Policies often have a period (e.g. five years) during which the insurance company cannot exclude you from cover, even if you have a serious illness costing the insurance company a lot of money.

Visitors

Visitors spending short periods in South Africa (up to a month or so) should have a travel health insurance policy (see below), particularly if they aren’t covered by an international health policy. If you plan to spend up to six months in South Africa, you should either take out a long-stay policy or an international health policy. There are no reciprocal health agreements between South Africa and Australia, European countries or the US.

Residents

If you’re planning to take up residence in South Africa, your family will be entitled to subsidised or free medical treatment under the national health service. In theory, this provides hospital accommodation and treatment (including tests, surgery and medication during hospitalisation), visits to family doctors (GPs), specialist medical assistance provided by paediatricians, obstetricians and other specialists, discounted medicines, laboratory services, appliances, ambulance services and free or subsidised services at a local health unit.

In practice, the South African public health system is badly underfunded, overstretched and often inefficient, meaning that receiving proper treatment can be a difficult, time-consuming procedure. For this reason, almost everybody in South Africa who can afford it has some form of private medical insurance, covering at least major treatment, and you’re strongly recommended to do the same.

Private Health Insurance

When buying private health insurance, you should consider South African as well as international companies. When comparing policies, carefully check the extent of cover and exactly what’s included and excluded from a policy (often indicated only in the very small print), in addition to premiums and excess charges. In some countries, premium increases are limited by law, although this may apply only to residents in the country where a company is registered.

Although there may be significant differences in premiums, generally you get what you pay for and can tailor premiums to your requirements. The most important questions to ask yourself are: does the policy provide the cover required and is it good value? If you’re in good health and are able to pay for your own outpatient treatment, such as visits to your family doctor and prescriptions, the best value is usually a policy covering only specialist and hospital treatment.

South African Companies

The South African healthcare sector has been facing challenges in the early 21st century: sharply rising medical costs and legislation to enforce 25 per cent solvency reserves on providers have led to some collapses and many mergers in this constantly evolving sector. In order to survive, South African healthcare providers have had to be innovative and devise schemes that people can actually afford; the choice is bewildering and includes clever, managed healthcare schemes and savings plans offering comprehensive, partial and limited cover.

Younger, fitter people often buy limited coverage, for serious conditions (a list of over 50 chronic conditions is specified in some policies), and pay for minor treatment themselves. In other schemes, your insurance covers only a percentage (e.g. 80 per cent) of claims and you must pay the balance yourself (in effect an excess or deductible), for which you pay a lower premium than for 100 per cent coverage.

Private policies vary considerably in price, depending on their scope and the percentage coverage, but generally cost from R1,000 (£85) to R2,000 (£175) per month for a family of four, although costs are higher for comprehensive cover and the elderly. Many companies, retirement groups and other organisations offer lower rates and some South African employers pay 50 per cent of key employees’ health insurance costs.

The largest medical insurer in South Africa is Discovery Health (www.discoveryworld.co.za), with over 1.5 million members – at least twice as many as any of its competitors. Its website tells potential customers that its claim-paying record has received an AA rating, the highest in the industry. However, the website also states that Discovery Health’s annual price increases ‘have consistently been contained to 12 per cent to 15 per cent over the past seven years’, which indicates how much private healthcare costs have been rising in South Africa.

Smaller healthcare providers include Multimed (www.multimed.co.za) and Selfmed (www.selfmed.co.za). The latter claims that ‘whilst small enough to ensure that members receive the personalised, individual attention they deserve, Selfmed is still big enough to ensure members have peace of mind about all their healthcare needs.’ A full list of costs for various schemes can be found on www.discoveryworld.co.za/dhealth/rate_tables_2004.jhtml.

Shop around and compare policies, which vary considerably: some have particularly murky small print that entitles the insurer to avoid paying almost any claim! It’s well worth seeking out and speaking to people who have used various medical insurance schemes, to discover which ones actually live up to the promises made on their websites and in their promotional literature.

As in many countries, South African insurance companies are loath to pay claims (one of the reasons they don’t insist on a medical examination is so that they can refuse to pay a claim because you omitted to tell them you’d had a heavy cold three years previously!). So, when completing the questionnaire, be sure to list all previous illnesses, hospitalisation, current ailments and treatment. However, South African companies are usually no worse (or better) in this respect than those in other countries.

Foreign Companies

There are a number of foreign health insurance companies with agents or offices in South Africa or offering cover for people living in South Africa, including AXA PPP Healthcare (www.axappphealthcare.com), BUPA International (www.bupa-intl.com), the Exeter Friendly Society (www.exeterfriendly.co.uk) and HealthCare International (www.healthcareinternational.com). These companies offer special policies for expatriates, and most international health policies include repatriation or evacuation (although it may be optional), sometimes including shipment (by air) of the body of a person who dies abroad to his home country for burial. An international policy may also allow you to choose (within limits) the country in which you have non-urgent medical treatment.

Most international insurance companies offer health policies for different areas, e.g. Africa, Europe, worldwide excluding the US, and worldwide including the US. Most companies also offer different levels of cover, e.g. basic, standard, comprehensive and ‘prestige’. Each level has a different limit on the total annual medical costs, the minimum usually being R2 million/£175,000 (although you’re recommended to have much more cover and many companies provide cover of up to R7.5 million/£650,000) and some companies limit the charges for specific treatment or care such as specialists’ fees, operations and hospital accommodation.

A medical examination isn’t usually required for international health policies, although ‘pre-existing’ health problems are excluded for a period, e.g. two years.

Claims are usually settled in major currencies and large claims are usually settled directly with the hospital or doctor by insurance companies. Always check whether an insurance company will settle large medical bills directly; if you’re required to pay bills and claim reimbursement from an insurance company, it can take several months before you receive your money (some companies are slow to pay).

It isn’t usually necessary to translate bills into English or another language, although you should check a company’s policy. Most international health insurance companies provide emergency telephone assistance.

The cost of international health insurance varies considerably with your age and the extent of cover. With most international policies, you must enrol before you reach a certain age (usually between 60 and 80) to be guaranteed continuous cover in your old age. Premiums can sometimes be paid monthly, quarterly or annually, although some companies insist on payment annually in advance.

If you already have private health insurance in country other than South Africa, you may be able to extend it to include South Africa rather than taking out a new policy.

Changing Employers Or Insurance Companies

When changing employers or leaving South Africa, you should ensure that you have continuous health insurance. If your family is covered by a company health scheme, your insurance will probably cease after your last official day of employment. If you’re planning to change your health insurance company, however, you should ensure that important benefits aren’t lost; for example, existing medical conditions won’t usually be covered by a new insurer for a period. When changing health insurance companies, it’s wise to inform your old company if you have any outstanding bills for which they’re liable.

© Survival Books Limited 2005

“Buying a Home in South Africa” 1st Edition, Graeme Chesters.

Reproduced with the permission of Survival Books Limited.

Further information on this topic can be found in “Buying a Home in South Africa” 1st edition, by Graeme Chesters.

For extensive information about buying a property in South Africa, you can purchase this book at www.survivalbooks.net