Health insurance in South Africa

Healthcare is a hot topic in South Africa right now, with the government attempting to push through radical reforms to fix the ailing state system. With many questions surrounding the future of the healthcare system, it’s important that expats consider taking out a private insurance plan to ensure they are covered against any issues.

This helpful guide provides information on the following:

The healthcare system and health insurance in South Africa

The South African healthcare system has two tiers, public and private, with around eight in 10 residents relying on the public system. Unfortunately, the quality of public healthcare in South Africa is relatively poor; this is due to too few doctors, outdated facilities, and long waiting times.

A recent report by the Office of Health Standards Compliance found that only five of 696 public facilities hit targets for drug availability and controlling infections. This problem is exacerbated by the rising cost of private insurance; this is well out of reach of many South African residents.

The vast majority of expats moving to South Africa take out private cover. This ensures they receive a standard of care on par with what they are accustomed to in their home country.

The National Health Insurance fund

In the last few years, the South African government has been pushing forward plans to set up a new state healthcare system, called National Health Insurance (NHI). The government says the new system would create a higher healthcare budget and offer better standards of care for residents.

The NHI would involve combining public and private healthcare systems into one organization. Critics say that introducing a new system would be highly complicated and would mean raising taxes; at this stage, a full rollout seems years away.

In August 2019, a report by The South African found that the cost of bringing in NHI could be anything from R165bn to R259bn. This means that individual taxpayers would need to contribute from between R7,850 and R12,300.

Who needs health insurance in South Africa?

State healthcare in South Africa is primarily designed to help the poorest citizens, for whom primary services such as emergency treatment, clinic visits, and consultations with doctors are provided free of charge.

Workers in South Africa need to be pay a contribution towards the cost of treatment from doctors and in South African hospitals. The specific amount depends on how much they earn.

The South African healthcare system boasts both public and private hospitals. Expats and higher earners generally take out private health insurance to benefit from better conditions and shorter waiting times.

Public health insurance in South Africa

Everyone is theoretically covered by public healthcare in South Africa, regardless of their nationality or immigrant status. As mentioned earlier, however, this doesn’t necessarily mean you will be able to obtain care for free.

As well as low earners and the unemployed, elderly residents and new mothers can also obtain primary care without paying. If you are a foreign student applying to study at a university in South Africa, you will need to show that you have adequate health insurance before you will be granted your study visa.

There are various companies that offer specialist student health insurance plans, with a range of different care options available. These work similarly to normal health insurance plans. They are usually locked to one set of clinics and will cover your hospital bills. In some cases, they’ll cover medicine bills after you are released.

Private health insurance in South Africa

Who should get private health insurance in South Africa?

More than half of the healthcare budget in South Africa goes towards private services. With this in mind, some of the best doctors and specialists who train in Western countries use their expertise solely in the private sector; thereby increasing the service gap between state and private healthcare.

Opting for private healthcare means you will be able to attend specialised clinics with a better standard of care and shorter waiting times.

The advantages of getting private health insurance coverage in South Africa

If you have a private healthcare insurance policy in your home country, it might not work in South Africa unless it is specifically designed for expats.

In this instance, you can speak to your insurer about switching to an international cover policy for when you move to South Africa. Alternatively, you can start up a new local policy once you move.

Ideally, a private policy should cover you for medical costs in South Africa, your home country, and any medical evacuation costs; as these can be very expensive if you have to pay for them yourself.

If your trip to South Africa is only a temporary one, you may be better taking out travel insurance; make sure this provides a sufficient level of coverage for your stay.

How does private health insurance work?

Private health insurance providers in South Africa are regulated by the Medical Schemes Act, and healthcare packages are available for individuals and families.

In some industries, health insurance is offered as an employee benefit, with the costs shared between the employer and employee.

Some insurers prefer their customers to give notice before getting treatment, and your provider might offer rewards if you lower their likely liability by exercising or having regular medical check-ups.

With so many different options available, it is important that you take your time to find the right provider; some have a better reputation when it comes to paying out than others. Once you have signed up for a plan you should get a healthcare card; you will need to show this when applying to see doctors or specialists.

How to choose a health insurance provider

When choosing a company, it is important to make sure that you have long-term coverage; one-year contracts can be troublesome because your insurer could refuse to renew the contract if you become unwell.

Also, make sure to steer clear of companies that reserve the right to cancel policies if you have a serious illness; instead, choose one with a longer period under which you can’t be excluded.

Healthcare plans in South Africa will cover care up to a certain cost each year. These vary significantly in their terms, however, from those covering emergency issues through to comprehensive plans which, in some cases, include dentistry in South Africa. You may find that some healthcare plans include more coverage than you are likely to need; therefore, shop around for the best health insurance quotes to meet your individual needs.

In addition to checking your coverage, get your head around how premium scales work and what excess charges you will have to pay if you become unwell. While premiums can often paid either monthly, quarterly or annually, some companies will ask for a year’s payment upfront.

If you are in good health, it may be worth getting a scheme where only specialist and hospital treatment is covered, meaning you pay the small charges to see your South African doctor and get prescriptions yourself. Before you take out a plan, you will need to fill out forms and provide details of your medical history; this includes information about any pre-existing conditions.

Private health insurance companies in South Africa

Some of the largest private health insurance companies in South Africa include:

• Allianz Care
• Cigna Global

Health insurance costs and reimbursements

As an expat living in South Africa, you are likely to have to pay towards public healthcare. Fees are payable for working residents, and the co-payment you will make for treatment depends on how much you earn.

When you receive treatment in South Africa, you will usually need to pay on the day by cash or card; then recoup the payments from your health insurer afterwards. The maximum payment you can make (assuming you are a top earner) for a consultation with a doctor is R55; however, you will also need to pay for any tests and treatment on top.

These fees might seem low, but for a hospital stay this rises to a maximum of R485 a day, plus any treatment or operating costs. With this in mind, it is helpful to arrange health insurance before you move to South Africa.

Useful resources

• South African Department of Health