Switching to a Hospital Plan from Full Medical Aid

    January 21, 2016

    If you live in South Africa and have the privilege of belonging to a medical aid, you will have to admit that they can be pretty pricey. There are thousands of South Africans who rely on the shockingly inadequate state hospital for some form of medical assistance because they can’t afford to belong to a medical aid. Switching to hospital plan cover from medical aid or no cover is becoming vital.

    Sometimes the members of medical aids question the level of cover they get against what they pay each month. Many contemplate downgrading to lower options in their medical aid range.

    There are others too, who investigate what it means to switch to a hospital plan from a full medical aid with its comprehensive cover and day to day benefits. With a hospital plan, you are going to have to cover almost all your day-to-day out-of-hospital costs yourself. If you are Switching to Hospital Planplanning on switching, consider your options carefully before you take the plunge.

    Switching to Hospital Plan – The Differences

    Hospital plans and medical schemes fall under the authority of the Medical Schemes Council. What are the benefits of a hospital plan provided by a medical aid? You first need to remember that the hospital plan as provided by the medical aid will offer less cover. This does not mean it is inferior cover, it is just less. In fact there are some hospital plans that offer you far more than some of the lower medical aid options. This will however only be noticed with the in-hospital benefits and any chronic cover.

    When it comes down to the nitty-gritty, a full-on medical aid will offer you benefits that a hospital plan will not, and that is limited cover for medical expenses when you are out of hospital. These will include things like medication, consultations, testings and scans that need to be done as an outpatient. The thing to remember is, you pay for what you get.

    If you are in a tight spot financially, don’t give up on all medical help. It is far better having some form of cover than having no cover at all. With private hospital care so expensive in South Africa, and the horrible prospects waiting for you at a state hospital, a hospital plan is something you should never rule out.

    Switching to Hospital Plan – When to Make the Switch

    Most of the medical aid schemes won’t allow you to make changes in the middle of a year. You need to wait until the end of the year to make the change. You can still resign though from your existing medical aid and join another scheme but be careful because you don’t want to break the cover and lose the valued protection of medical aid.

    Switching to Hospital Plan – Understand what the Hospital Plan Offers

    If you do need to change over from one medical aid to another, you will probably bypass the normal waiting periods. This will only be if your cover from the one plan to the other is not interrupted. Remember to understand all the pricing structures of your new medical aid scheme or hospital plan and the implications of your changing over.

    Your new medical aid needs to know about your existing membership of your current medical aid. Even though it might not always be an easy and smooth transition, the most important factor is to ensure continuity of cover with no interruptions at all. Don’t try and keep the cover of both medical aids; this is illegal.

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    All info was correct at time of publishing