It is not difficult to understand why Hospital Plans are becoming increasingly popular among people seeking medical cover. Here are some important facts you need to know.
They cost far less than the comprehensive medical cover.
Individuals can expect to pay in the region of R1 400 a month for a good Hospital Plan, whereas comprehensive medical aid would cost more than R4 500.
The monthly savings in premium payments is, therefore, substantial and far more appealing to people working on budgets.
Beware the pitfalls
But beware the pitfalls.
A Hospital Plan covers the cost of hospitalisation procedures.
Hospital Cash-Back Plans pay a stipulated cash amount for the number of days spent in a hospital.
While that lump sum may sound appealing, it would probably leave policyholders owing vast sums of money.
Even comprehensive medical aid cannot always cover the cost of in-hospital treatments.
Nowadays it is not uncommon for specialists, surgeons, anaesthetists and other members of the medical profession to charge up to five times more that the stipulated tariffs paid by medical schemes.
Medical schemes, including Hospital Plans, regulates by the Council for Medical Schemes and have to abide by the restrictions imposed by the governing body.
Ten important facts
- Hospital Plans only pay for in-hospital treatments
- Also, hospital Plans offer cover for chronic conditions – up to 26 are prescribed
Hospital Plans are appealing to healthy people – they do not cover routine medical needs such as visits to doctors, dentists and optometrists, or for medication - Hospital Plans only pay for in-hospital procedures in private hospitals or, in the case of cheaper plans, at specified network hospitals or even State hospitals
- Prepare to pay substantially more when undergoing procedures in private hospitals where members of the medical profession do not have to adhere to the health care tariffs stipulated by the Hospital Plan – always choose service providers and network hospitals designated by the Hospital Plan to ensure that the final bill will be fully covered
- Depending on the Hospital Plan chosen, some do cover procedures at doctor’s surgeries, including Pap smears, mammograms and colonoscopies
- Use medical services designated by the Hospital Plan such as pharmacies and ambulances
- Hospital Admissions can be a nightmare, but in emergencies, hospitals will arrange admission directly with the patient’s medical scheme
- Do not exceed annual Hospital Plan limits for hospitalisation
Conclusion about the Important Facts.
Always read the fine print of the Hospital Plan before putting pen to paper.
It will help avoid nasty and often crippling financial shocks.
Always use the network of hospitals, emergency services and members of the medical profession designated by the Hospital Plan.
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