Medical Aid Hospital Plans

A hospital plan is medical aid cover that provides benefits for in-hospital (inpatient) visits and procedures. Most medical aid hospital plans also provide chronic medication cover. Private health care is expensive and hospital costs are staggering should you not have medical aid cover. A hospital plan is not a complete medical aid with day-to-day cover and out-of-hospital benefits but it is a cost-effective option for medical care should you require hospitalisation.

What is a Medical Aid Hospital Plan?

A hospital plan is a form of medical aid cover that provides benefits in the event that you are hospitalised. Medical aid hospital plans will pay for the doctor’s consultation fees, procedure costs, investigations and tests, medicines and your hospital stay.

Most hospital plans also provide chronic cover which pays for medicines for chronic conditions. This chronic cover has an annual limit but for PMB (prescribed minimum benefit) conditions, the cover may be unlimited for certain medicines as decided upon by individual medical aids.

Affordable Hospital Plans

A medical aid hospital plan is a cheaper option if you cannot afford comprehensive medical aid cover. While many of us may be able to cope with the out-of-hospital expenses like doctor’s fees and medicines on a day to day basis, hospital care is very expensive and usually not affordable.

A typical example is a coronary artery bypass that may be required in the event of a heart attack – this can reach as much as R150,000. Without medical aid cover, a private hospital will refuse to admit you without an upfront cash deposit (anywhere from R5,000 or more for certain procedures). If you are unable to afford this, you will then have to opt for a government hospital or cheaper semi-private facility.

With a medical aid hospital plan, you can have the security of hospital cover at a lower price than a comprehensive medical aid. This can be anywhere between 30% to 50% cheaper than a medical aid with out-of-hospital benefits.

Different Types of Hospital Plans

Based on your budget constraints, there are different types of hospital cover. Some will allow you to go to any private hospital while others will restrict you only to certain group(s) of private hospitals. The latter type of hospital plan is usually cheaper. Individual benefits vary and it is therefore important to compare medical aids before making a final decision.

Many medical schemes now offer small but significant benefits for certain outpatient treatments like chemotherapy for cancer as part of the hospital plan. Another aspect to consider is whether your medical aid hospital plan will cover the cost of certain prosthetics and the degree of cover. This can vary among medical aid providers.

Medical Aid Hospital Plan vs Cash Back Hospital Plan

Medical aid hospital plans should not be confused with cash back hospital plans. These are two different financial products. A cash back hospital plan offers you cash for each day that you are in hospital, depending on certain criteria. This is not a medical aid and your doctor or the hospital will not recognise these cash back plans as a form of medical aid. Cash back plans will also not offer you cover for chronic medication.

Hospital cash back plans are handy financial tools for paying for your living expenses should you be hospitalised and cannot work. It can also be used to pay for your medical expenses if you so wish but this is up to the individual and will not be accepted by the doctor or hospital without making prior arrangements and paying a cash deposit upfront. A medical aid on the other hand is accepted by many doctors and all hospitals as a form of insurance that will cover medical procedures, hospitals stays and medicines without requiring a patient to pay a cash deposit fee upfront.

While a cash back hospital plan is helpful, it should not be used as means to replace a medical aid. Some cash back hospital plans offer large amounts of cash for each day that you are in hospital . However if you compare the amount that you will be paid out by a cash back hospital plan to the medical bills that you may accrue while in hospital, you may find that the benefit from the hospital cash back plan is insufficient. You will then be held personally liable for the medical costs.

For example, even if your hospital cash back plan is paying you R3,000 per day, it would not cover a 7 to 10 day hospital stay which may be necessary in the event of a heart attack and coronary artery bypass surgery. In this instance the hospital stay, specialist’s fees, operating theatre time, medicines, equipment and so on can vary between R100,000 to R150,000. However your hospital cash back plan may only pay you R30,000 if you stayed in hospital for those 10 days. You would still have to find other means to cover the remaining costs.