Take Note When Buying Into a Cheap Hospital Plan

    September 8, 2016

    Becoming a member of a medical aid is not cheap. But not everyone can afford the monthly contributions of comprehensive medical aid cover. In these cases, having one of the many cheap hospital plans available is better than no medical aid at all.

    With cheap hospital plans:

    • Your monthly contribution to a hospital plan will cost less than half of what you will pay for comprehensive cover.
    • It is the most basic of all medical aid cover.

    At first glance, this all looks good. But we recommend that you read all the fine print and restrictions before you commit yourself to any cheap hospital plan. There are many restrictions in the benefit schedules that one does not always know.

    Some of the things to take note of when buying into cheap hospital plans:

    Don’t take Risks – Check These Things First

    • Non-PMB admissions.  All medical scheme members are covered in full for PMB conditions. What will happen if you need to go to a hospital for something not related to a Prescribed Minimum Benefit (PMB)condition? So do take out cheap hospital plans with registered medical aids that must abide by the law to cover PMBs.
    • 100% of scheme rate. You may be shocked to discover your actual bill is more than the 100%Cheap Hospital Plansyour medical scheme promised to pay. Your medical aid pays 100% of the Medical Scheme Rates, but doctors and specialists in private practice are not bound by these restrictions, and may charge between 200% and 500% more than medical scheme rates.
    • No overall annual limit. This may sound fantastic, but it is not entirely accurate. Schemes monitor high-cost procedures carefully to protect the interests of the other members. In these cases, they will only pay up to a certain limit for procedures and treatment.
    • Network Hospitals and Designated Service Providers. Many hospital plans, especially the cheaper ones, have special network hospitals, pharmacies and service providers that they expect their members to utilise. If however, you decide to go to a doctor or hospital of your choice, it is possible you will have a hefty co-payment to pay.
    • Co-Payments on Admission. Many hospitals, especially day clinics, will require a co-payment up front on admission. Exceptions to this will be emergencies, accidents, and some maternity admissions.


    More Details of Cheap Hospital Plans

    • Network Day Clinics and Centres. Certain procedures conducted in day clinics. If however, there is a problem and you need an overnight stay for observation, what will happen to you?
    • Formulary medicines. Covers medicine for the 27 chronic conditions. Note that in most cases the medical aid has a formulary for the medication for these conditions, and they usually include generics. Likewise, it is possible that you can use only certain pharmacies, who have delivery or courier service to get your medicine to you.
    • Prosthesis. This feature applies to internal or external prostheses, like in hip, or knee replacements. Some medical aids have maximum limits; others only cover PMB’s.
    • Psychiatric. This amount is usually a lump sum that is allowed per family. If there is more than one member of the family that has a problem, this maximum cover will not be enough.
    • Emergency rooms. Most hospital plans pay if you are in a hospital. If you go to the emergency room, and you do not have to go to a hospital, you will have to pay this account yourself.
    • Take-home medicine. After a stay in a hospital, you are usually discharged with medicine to take home, which you will have to pay yourself.
    • Oncology payments. Most treatment for cancer has an overall annual limit plus a 20% co-payment. Because of this, most people opt for state treatment.

    They always say you get what you pay for, and unfortunately, this is what happens with cheap hospital plans. Be prepared.

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    All info was correct at time of publishing