Chronic Medication and Your Hospital Plan
January 11, 2017
There is a difference between a medical aid and a hospital plan. They may seem to provide similar cover, but they are very different from one another. Your hospital plan should have added benefits, for example, they should cover for your chronic medication.
Medical aid is a more comprehensive plan. It covers you for day-to-day medical expenses. They usually do also include some hospital cover too.
A hospital plan is exactly that – simply for expenses incurred in the hospital.
There is, of course, a big difference in price. Hospital plans are a lot easier on the pocket. If you are a healthy person who seldom sees the doctor, this may be a better bet.
If on the other hand, you are in and out of the doctor’s office, the medical aid is the better bet.
Most hospital plans offer similar benefits. Let’s go through them.
Benefits While In-Hospital
This helps when you need it. It will cover you should you need to go to the hospital. The medical scheme will attach conditions, however.
A lot of plans will cover you in full if you choose a network hospital. If you choose a different hospital, you might have to pay in money.
According to law, hospital plans are required to cover certain conditions, whether treatment is in the hospital or not. The prescribed minimum benefits relate to 27 chronic conditions.
If you have one of these, the hospital plan will usually cover treatment and your chronic medication.
If you are prescribed medication to take home after your hospital stay, the plan might pay for it. The idea is that it cuts down on the amount of time spent in the hospital.
Check your plan – some do not have this benefit. Some will offer treatments for a few weeks after they discharge you from the hospital. If the chronic medication you require for a chronic condition, the plan will usually cover it.
In this case, the medical aid covers follow-up visits or treatment that continues at home. This could include home care to aid recovery. It could include visits to the doctor to check progress. Some hospital plans do cover this treatment. They will mostly not, though.
FedHealth EntryZone and Core plans include up to 30 days of treatment on discharge from the hospital.
Day to Day Benefit
It is not the primary purpose of a hospital plan to cover day-to-day medical expenses. For the most part, they exclude these.
In some instances, such as KeyCare Core offered by Discovery, they provide limited coverage. In this case, they may cover visits to a specialist if the member has a referral from their GP.
The primary benefit that a hospital plan offers is that it covers you should you need to be admitted to hospital. Whether it is in an emergency or for a chronic health problem.
The cost of even spending a few days in the hospital can be astronomical. Then you need to add in the cost of the surgeon, anaesthetist, etc. and it climbs higher. You also need to add in that you also need medication and supplies in the hospital. (And they charge for every cotton ball used.)
Having a hospital plan simply makes good sense.
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All info was correct at time of publishing