At Myclinic, we see many patients who arrive with very different expectations about what their healthcare cover includes. Some believe their plan covers everything, while others are caught off guard by out-of-pocket expenses for GP visits or basic tests.The reality? Many patients don’t fully understand how medical aid differs from health insurance, or how either one works in a general practice setting. Let’s break it down in simple terms—because when it comes to your health, informed decisions matter.
First, what’s the difference?
Medical aid (e.g. Discovery, Bonitas, GEMS, Fedhealth):
Works like a credit card for healthcare, your plan gives access to a set amount of funds for day-to-day benefits or hospital cover.
Regulated by the Medical Schemes Act.
Must cover Prescribed Minimum Benefits (PMBs).
Includes managed care plans like GEMS Beryl and Discovery KeyCare which require the use of network providers and strict referral protocols.
Health Insurance (e.g. Prime Cure, Affinity, Dis-Chem Health, Unity Health):
Covers specific events like accidents or hospital stays.
May offer a limited number of GP visits or telemedicine consults.
Often requires upfront payment with claims submitted afterward.
May not cover chronic conditions or routine care.
So How Does This Work at Myclinic?
We accept all major South African medical aids and work with most recognised medical insurance providers. Here’s how it plays out in a real-world GP setting:
With Medical Aid: We check if your plan allows us to claim directly. If funds are available, you may only need to pay a small co-payment—or nothing at all. If funds are depleted or you’re not covered, you’ll need to pay in full. You remain responsible for confirming your benefits before your appointment.
With Managed Care Medical Aid: You must be registered with Myclinic as your nominated provider. Referrals and tests must follow strict networks and authorisation processes to be covered.
With Medical Insurance: You usually pay up front and claim back from your insurer. Some plans allow us to claim directly, but only for specific services. Not all tests or referrals may be covered—so pre-authorisation and plan review are critical.
Final Thoughts
Medical aid and medical insurance serve different needs. If you have chronic health conditions and want full access to primary and specialist care, medical aid may be better. If you want to keep monthly costs low and mainly need emergency or limited care, insurance might suit you best.
Whatever you choose, the key is understanding how your cover works—and how it works with your GP. If you're ever unsure, our team at Myclinic is here to help guide you through it.
Empowered patients are healthier patients. Ask questions, know your benefits, and let’s navigate your care together.