African Unity Life underwrites various health insurance benefits. It’s important to note that this is not medical aid, but rather long-term health insurance. We offer this option because most medical aids are too expensive for many employees in the lower- to medium-income segments and we want to ensure that, despite this, they still have access to this essential cover. This is why we offer a solution to make it easy for your workforce to gain access to affordable primary healthcare.
There are various long-term group health cover options available to cover specific needs. Our group health insurance products can be tailored for larger employer groups, brokerages, unions and bargaining councils. We also offer a selection of ready-made options.
Frequently Asked Questions About Health Insurance
What does health insurance cover?
Health insurance provides for hospital cover, day-to-day benefits and medical costs incurred. A set amount is paid out for each day you are in hospital in the form of a daily cash back.
Why do I need health insurance?
Medical aid can be very costly and most lower- to middle-income employees cannot afford the premiums. Medical insurance is the more affordable option and it helps to cover the costs involved with hospital expenses and day-to-day benefits.
What waiting periods can be expected?
African Unity Life will determine the relevant waiting period according to a risk assessment done during the application process.
Will there be any questions with regards to pre-existing conditions when I apply for these benefits?
Yes. During the application stage, we will ask whether you have had any pre-existing conditions in the previous 24 months. There will be a waiting period applicable for these conditions, depending on the benefit plan.
Will the insurer pay my hospital bill directly?
No. In terms of the new Demarcation Regulations, the insurer is to pay the benefit value to the principal member or beneficiary directly.
What is the effect of Demarcation Regulations on my medical insurance?
These regulations came into effect on 1 April 2017 and insurers now have two years to adjust their healthcare product to fall in line with the Demarcation Regulations.
Here is a practical example of how these regulations will affect your Hospital Cash Plan. You have been admitted to hospital after being involved in an accident. You have a Hospital Cash Plan with your insurer and trust that this will cover your medical expenses. The new Demarcation Regulations make it clear that the insurer cannot conduct the business of a medical scheme and therefore all Hospital Cash benefits will be strictly regulated by the Demarcation Regulations in terms of the Long-Term Insurance Act. These Regulations stipulate that this cash benefit can only be paid for non-medical expenses.
In essence, what this means is that once you have been admitted to hospital, the insurer will not be able to pay the hospital directly for all medical expenses. Instead, a daily amount or a lump sum will be paid to the principal member or beneficiary directly. This amount paid will also be limited to R3000 per day (no limitation on the amount of days) or if the benefit is being paid as a lump sum, it is limited to R20 000 per annum. Once the benefit has been paid to the main member or beneficiary, the money may be used for non-medical expenses. Non-medical expenses include paying for childcare while you were in hospital or for groceries or other expenses due to you being in hospital. The money can also be used by the principal member to pay the hospital accounts. It falls within the principal member’s or beneficiary’s discretion to decide what is done with the money paid by the insurer.