10 Facts About Hospital Plans in South Africa

    February 16, 2016

    One of the interesting facts about hospital plans are that more and more people all over South Africa are beginning to move over to hospital plan options. The reason for this is that most of them simply cannot afford anything more.

    Having a full-on comprehensive medical aid these days for many South Africans is a sheer luxury. Those who opt for hospital plans usually know that they are at least covered for their medical bills whilst they are being hospitalised.

    Here we deal with important facts about hospital facts to aid you in knowing whether they are for you or note.

    Before deciding to ditch your medical aid scheme, there are important facts about hospital plans to consider first. You need to realise that hospital insurance is different to a hospital plan. Hospital insurance pays out for the time you spend in hospital but not for treatments you might undergo.

    FactsFacts About Hospital Plans About Hospital Plans – They are cheaper than medical aids, but have fewer benefits

    If you opt for a hospital plan, you can count on paying about half of what you would for full medical cover. Hospital plans differ and you can be paying roughly anything between R500 and R1500 each month, depending on your budget. If you were on a full medical aid, you would probably pay anything between R2500 to R3500 a month. It is imperative that you check all the small print applying to your specific hospital plan, understanding that it is not the same as a medical aid plan.

    Hospital plans are not hospital insurance and are regulated by the Medical Schemes Act of 1998. Like the medical aid scheme, the hospital plans also have to adhere to the strict regulations that are outlined by the Council for Medical Schemes. This is the regulatory body of the industry.

    10 Hospital Plan Facts

    1.  In order for your hospital plan to work, you would need to be hospitalised. It won’t include visits to the hospital trauma unit for instance unless your doctor there admits you to hospital.
    2. Hospital plans offered by registered medical aids cover some 26 prescribed chronic conditions which means your chronic medication is covered by the plan. This prevents expensive hospitalisation.
    3. If you are healthy, a hospital plan is great with maybe the odd visit that you will pay yourself such as to the dentist or optometrist.
    4. Hospital plans cover hospitalisation in private hospitals. There are some cheaper plans specifying network hospitals or state hospitals. Generally, schemes have agreed rates with certain hospital groups which means your hospital bill and in-hospital medication is likely to be paid in full. This will depend on the plan you have.
    5. Prepare yourself for the fact that private doctors/anaesthetists/specialists in the private hospitals often charge up to about three times the rate that the hospital plan will pay. Prepare yourself for this as even people on full medical schemes need to pay co-payments.
    6. Enquire from your hospital plan administrators when going to hospital about ways to reduce your costs, choosing always a designated service provider or network hospital – your bill could be fully covered.
    7. Consider getting gap cover if you want to avoid making co-payments on your hospital bills. This can cost you about R100 per month.
    8. There are a few hospital plans which also pay out for certain procedures carried out in your doctors’ surgeries. These could be mammograms, pap smears, etc.
    9. Use the designated pharmacies, services or ambulance services recommended by your hospital plan as they are no doubt cheaper.
    10. In crisis times, the hospital will contact your scheme to arrange your admittance.

    Hospital Plans can be a Powerful Force

    The ultimate in South Africa is to have a comprehensive medical aid plan, but if you, like millions of South Africans, can’t afford it, a good hospital plan can be a powerful force for you when you land up in hospital. Those are the hard facts about hospital plans.

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    All info was correct at time of publishing