Over the years there have been several financial products that have become popular in South Africa as a means to fund a person’s healthcare needs. Occupational health insurance has become increasingly popular but it is important to realise that this product is not a medical aid. Nevertheless, it does offer a host of benefits for members who cannot afford medical aid cover. So what exactly is occupational health insurance and how does it work?
What is occupational health insurance?
Occupational health insurance is a type of cover that pays for outpatient medical services at selected doctors and other health service providers. It is a type of insurance policy for low income workers. Occupational health insurance is not a new concept. Many businesses like factories provide a similar cover for its employees which is popularly known as a sick benefit. Occupational health insurance allows even smaller businesses or the independent employer of domestic workers the opportunity to give their employees access to private health care. What is important to note is that an occupational health insurance plan is NOT a medical aid.
However, this should not detract from the fact that occupational health insurance is a great financial product that takes care of some of the health needs of your workers. It has grown in popularity as an alternative to medical aid for domestic workers where private individuals can offer health care cover to the staff within their homes, such as to their gardeners and maids.
Doctors Visits and Acute Medication
Two of the most necessary out-of-hospital benefits that a person will require probably several times in a year is primary health care services like at a GP. With occupational health insurance, the member is able to visit certain doctors and have unlimited consultations for the year. Acute medication is also covered within the plan but it may be restricted to only certain drugs that have been deemed necessary for acute conditions. Occupational health insurance plans are constantly evolving and some plans have now included diagnostic investigations (blood tests and X-rays) and even dentistry and optometry benefits within their plan.
Can you visit any doctor for any medication?
A person with an occupational health insurance benefit cannot visit any private GP. Only those general practitioners who are on the list of network providers will see patients with occupational health insurance cover. Similarly only acute medicines approved for cover by the occupational health insurance plan will be accessible to members. Chronic medication and medical specialists are not covered. Neither is care within a private hospital.
Costs and Benefits of Occupational Health Insurance
Occupational health insurance plans in South Africa cost around R200 per month. This is for a single person although employers with many workers may be able to get cheaper rates for their entire workforce. The plan covers the worker only and does not usually include children and spouses. However, these details should be discussed with an occupational health insurance provider as newer products may be in the offering that can have a wider coverage.
The benefits of occupational health insurance are obvious. Workers can now access private healthcare services in South Africa without having to wait in long queues and returning for multiple visits at public health facilities. All these plans cover GP (general practitioner) visits and acute medication but some plans now include diagnostic tests, dentistry and optometry. Occupational health insurance covers the member for these primary health care services but specialist medical care, chronic medication and hospitalisation are not covered.
Occupational Health Insurance vs Medical Aid
Occupational health insurance and medical aid are two different products. Medical schemes are regulated by the Council of Medical Schemes as per the Medical Schemes Act. Since occupational health insurance was developed with low income workers in mind, it is important to compare it with similar low income medical aid plans. At face value, the out-of-hospital benefits of occupational health insurance and medical aid are largely the same. Where occupational health insurance does fall shorts though compared to a medical aid is that it does not provider cover for private hospital care or chronic medication.
It is mandatory for medical aids to provide in-hospital care and chronic cover is usually included even with medical aid hospital plans. Occupational health insurance does not cover hospitalisation nor does it pay for chronic medication.The other major difference is the pricing structure. Occupational health insurance is significantly cheaper but then it is important to look at the benefits included for the price. For example, occupational health insurance costs around R200 per month for unlimited GP visits and acute medicines. Low income medical aid plans provide unlimited GP visits and acute medicines PLUS access to specialist medical care, chronic cover and hospital cover starting from as little as R450 per month.
While a medical aid for low income workers may be twice the price of an occupational health insurance plan, it is important to compare the benefit. Remember that the most expensive part of private health services is the care within private hospitals and chronic medication.