Navigating Eswatini’s healthcare system can be challenging, particularly with rising medical costs and limited resources. For many, understanding the differences between medical aid and medical insurance is crucial for ensuring both health and financial security.
Zanele Dlamini, a 25-year-old professional recently employed by a leading technology firm, exemplifies the importance of making informed choices. Like many young professionals, Zanele is grappling with the complexities of securing reliable healthcare coverage in a country where these decisions can have long-term implications.
Healthcare experts emphasise the advantages of medical aid schemes like Eswatini Medical Aid Fund. Unlike medical insurance, which is profit-driven and often limited to covering specific incidents, medical aid offers comprehensive, inclusive, and predictable healthcare solutions.
“Eswatini Medical Aid Fund ensures equitable access to healthcare by pooling resources to cover members’ needs, regardless of age or health status,” explains Sicelo Mkhonta, the Marketing and Client Relations Manager of Eswatini Med. “This solidarity model allows younger, healthier members to support those who require medical attention, ensuring long-term stability and affordability.”
Eswatini Med also guarantees acceptance within group plans, offering predictable premiums and extensive benefits, including continuous support for chronic conditions such as HIV, diabetes or hypertension. Contributions from employers often further reduce individual costs, making medical aid more accessible for the working population.
Eswatini Med’s coverage extends to over 45, 000 lives, some of whom would be affected by changes in the industry.
In contrast, medical insurance is primarily event-specific, offering financial relief for incidents such as accidents or ICU stays. While flexible, it often excludes pre-existing conditions, and policyholders may face unpredictable premium increases.
“Medical insurance provides financial payouts during critical incidents,” notes health analyst Sibusiso Mkhabela. “However, these payouts may not always cover full treatment costs, leaving policyholders with gaps in coverage.”
As Zanele weighs her options, she is leaning toward medical aid for its comprehensive and stable coverage. Her decision underscores the need for increased health literacy in Eswatini, where many remain unaware of the distinctions between medical aid and insurance.
In a healthcare system with growing challenges, the choice between medical aid and insurance goes beyond individual needs—it represents a commitment to collective well-being and financial security for all.
For Zanele and many others, choosing medical aid is not just a health decision—it’s a step toward a brighter, more secure future.
The law states that all income of Eswatini Med shall be solely used to pay medical expenses for members.
The Eswatini Medical Aid Fund is a not fir profit Section 21 Association and was incorporated in 1980 by the Ministry of Health in terms of the repealed Companies Act of 1912.
A Section 21 company is an association not for gain which is prohibited from paying or transferring directly or indirectly by way of dividend, bonus or otherwise howsoever by way of profit, to the shareholders of the association.
Eswatini Med was established on the following unique principles which form the core of its constitution.
• Open enrolment: this means that anyone is free to join the fund and that if you apply for membership the organisation cannot reject you bas3d on
• age, social and health status. This protects those who are aged, less healthy and low-income earners as the fund cannot reject them.
• Community rating: This means that all members of the medical aid pay the same monthly contribution for the same
• benefit. This prevents price discrimination against older or less healthy members who in an ordinary insurance market would be rejected or
• subjected to higher premiums.
• Prescrib3d minimum benefits: These are medical conditions that that are key to survival of the
• members, such as HIV benefits, cancer, heart problems, kidney problems, and other chronic illnesses.
Eswatini Med operates a form of social security. Monthly contributions are collected into a common risk pool from which benefits are paid out in accordance with the principle of solidarity where the young and healthy cross subsidise the older and sicker members of the same medical aid scheme thereby ensuring the financial health and long term sustainability of the medical aid scheme. The risk pooling is critical in not for profit medical aid funds to achieve social welfare and not only individual welfare.
Since profits are not shared by shareholders but instead are invested back to reserves for future financial sustainability of the scheme, increases in contributions are controlled and service to members is enhanced. The surplus income from contributions and investments cannot be transferred or paid directly or indirectly by way of dividends, bonus or profit to the shareholders of the scheme.
Even in the event the scheme is wound up or dissolved, any debts, liabilities and assets shall be given to institutions with similar objectives or back to the State.
