Definitions of the Various Kinds of Hospital Plans

    August 2, 2020

    A hospital plan is a form of insurance cover designed to cater to you and your family’s healthcare needs. Like any other kind of insurance policy, you will be required to make a regular contribution, mostly monthly. You will then be eligible for certain benefits, which you can claim whenever you seek medical treatment. Here are definitions of the various types of hospital plans.

    Definitions of Hospital Plan Vs. Medical Aid

    At this point, it is important to make the distinction between a hospital plan and comprehensive medical aid. As the name suggests, hospital plans are designed to cater for treatment that happens in the Definitions of Hospital Plans, Medical Aid and Health Insurancehospital, or when you have been hospitalised. If you go for a consultation session with a GP, a hospital plan will not cover the costs involved. It won’t even pay for whatever drugs the doctor prescribes. Should you undergo treatment for a medical emergency that did not require your admission, you will have to meet the cost from your pocket.That is if the only form of cover you have is a hospital plan.

    Medical aid covers both in-hospital medical expenses as well as outpatient treatment, or what is referred to as day-to-day treatment. In addition to this, medical aid will cater for some wellness programs as well as dental and ENT treatment, depending on the policy.

    Definitions of Hospital Plans and Medical Schemes

     Here are some more points to note about hospital plans:

    • Both insurance companies and medical aid schemes offer hospital plans.
    • When the plan is offered by an insurance company, it is regarded as a financial product and is therefore not under the Medical Schemes Act.
    • Providers of hospital plans are not required by law to cover Prescribed Minimum Benefits (PMB) conditions.
    • If the hospital plan is offered by a medical scheme, it is subject to the provisions of the Medical Schemes Act. Members of the plan therefore have the right to be treated for PMB conditions under the cover.


    Additional benefits of hospital plans

    We mentioned that hospital plans do not offer day-to-day benefits as standard, but some of them do, although within some restrictions. One of these is that you will have to seek treatment from a doctor, specialist or healthcare facility that is listed among the provider’s designated service providers (DSPs). If you choose to visit a facility outside this network of providers, you will be liable to pay for the treatment yourself.

    Some hospital plans will let you seek treatment from non-DSP facilities, but will require you to make a co-payment when you go for treatment there.  This will work to your disadvantage if you don’t reside or work close to healthcare facilities within the hospital plan provider’s network. You may therefore want to take up an additional cover (gap cover) or opt for a medical aid plan altogether.

    Hospital Cash-Back Plans

    There is a category of hospital plans that, instead of settling with the healthcare provider after your stay in hospital, give you a lump sum payout. Ideally you will use this cash to settle your hospital bills, but the provider has no guarantee of this. For this reason some are reluctant to treat patients under this form of cover.


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    All info was correct at time of publishing