Hospitalisation

Patients who require surgery or treatment generally spend time in hospital. These days, even an overnight stay in a private hospital can be enormously costly.

Medical Aid Schemes and insurance companies in South Africa offer a range of products that provide cover for in-hospital expenses including medical insurance plans, comprehensive medical plans and dedicated hospital plans.

Many of these plans, however, do not provide full or unlimited cover for hospitalization. This is where additional Gap Cover is highly recommended.

Medical Insurance

Medical insurance is one of a raft of insurance policies offered by insurance companies. It generally covers you or a family member, in a hospital of your choice:

  • For a prescribed amount per day, starting from approximately R300 or
  • Pays out a set lump sum for a specific treatment, operation or procedure, enabling you to keep any excess after you have settled the cost of the procedure.

Although medical insurance will cover some of the in-hospital costs, it’s highly likely there will be a significant financial shortfall at the end of the day which you will have to fund yourself.

Medical Aid Cover for Hospitalization

All medical aid schemes in South Africa offer a variety of hospital plans and comprehensive medical aid plans, both of which provide in-hospital benefits:

Hospital Plans: are amongst the most affordable medical aid options on the market today and offer you and your family high levels of in-hospital cover.

Although hospital plans are traditionally more expensive than medical insurance options, hospital plans from reputable service providers routinely offer unlimited in-hospital benefits and generally pay standard medical aid rates. It is very important to note that Insurance products should not replace medical aid but should rather be used as a "top-up".

Comprehensive Plans: provide the most extensive and expensive medical aid cover which includes both in and out-of-hospital benefits.

It is important to remember, however, that many comprehensive plans only offer limited or restricted in-hospital benefits at 100%, 150%, 200% or 300% of the scheme's rate.

It is not uncommon for medical professionals and service providers to charge anything up to 400% of the rate, leaving you to pick up the tab of the outstanding amount, known in the industry as a shortfall.