Hospital Plans & Cover Options

What is a Hospital Plan?

A hospital plan is usually cheaper than a comprehensive Medical Aid plan and provides cover for hospitalisation costs, but not for out-of-hospital treatment. All hospital plans in South Africa also need to cover expenses for the 27 chronic conditions listed in the Medical Schemes Act as Prescribed Minimum Benefits (PMBs).

It’s a form of Medical Aid governed by the Medical Schemes Act and regulated by the Council for Medical Schemes in South Africa. It does not have a savings account or day-to-day benefits like a more comprehensive Medical Aid plan does. It only covers you for the medical costs involved in hospital stays.

Things everyone should know about Hospital Cover options

A hospital plan is an excellent in-case-of-emergency-break-glass type of cover, so you’re not caught unawares and indebted when disaster strikes, like if an accident were to happen or you suddenly fell ill and needed in-hospital medical treatment. It can save you a fortune in medical bills, and make sure you get good private medical cover in South Africa.

But is it the right option for everyone? Probably not, as no two people have the same healthcare needs or bank balance. Let’s take a look at what you need to know about hospital plans so you can make the best decision for yourself.

What does a Hospital Plan cover?

A hospital plan will pay for the bills issued by the hospital itself, like your food, bed and in-hospital medication, as well as specialists’ fees, like anesthesiologists, gynaes and orthopaedic surgeons, but only up to a certain amount.

Most procedures will be approved for private hospital cover on both a full Medical Aid or a hospital plan, as long as they are clinically required, although this does vary depending on your plan. Some hospital plans will cover elective c-sections or joint replacements. Generally speaking though, these types of hospital expenses will have limits and cover shortfalls.

What about specialist fees?

Hospital plans pay for doctors’ fees in-hospital, but usually only up to a certain amount. Depending on the plan you’re on, this could be 100%, 200%, or 300% of the Medical Aid rate or tariff.

Network plans can greatly reduce your costs, but if you already have a healthcare professional at a specific hospital and they’re not on the scheme’s network list, you’ll need to make co-payments if you continue to use them. Either way, you do still get private hospital cover.

What is a Network Plan?

This is when your medical scheme specifies the hospital facilities and doctors you can visit. This means you can’t see just any doctor at any hospital for a planned procedure if you want to avoid a non-network co-payment.

All medical aids must provide cover for emergency treatments at any hospital, like a heart attack or a stroke. Some comprehensive gap products cover one or two penalty co-payments when you go to a hospital out of the network. It’s just as important to understand the benefits offered by your Gap Cover as it is to understand your Medical Aid.

Compare Hospital Plan quotes

Private hospital expenses can be sky high — more than the average Joe or Jane can afford. A hospital plan could be the answer if you’re looking for something affordable that will still give you comprehensive in-hospital cover should you become injured or ill. Compare Medical Aid and Hospital Plan options with Hippo.co.za to find cover that suits your needs and budget.