Hospital plans are basic medical aid products designed to provide cover for in-hospital procedures, treatments and diagnostic tests when part of an admission. They also include chronic medication cover and may include limited out-of-hospital treatment, restricted to prescribed minimum benefits (PMBs).
Hospital plans are the ideal choice for young healthy families in a position to pay for day-to-day expenses out of their own pockets.
Monthly contributions vary according to the scope of cover that’s offered. The general rule of thumb is the higher the premium, the more attractive the benefit structure.
Network Options
To keep costs as low as possible, many medical aid schemes negotiate set fees with networks of hospital and clinics. These network options are typically more affordable but do require that you use only the approved or network-linked providers.
If you use non-network providers, punitive co-payments may apply or you could end up paying the full account!
Unique Benefits
To sweeten the deal, medical aid service providers may offer various unique benefits as part of hospital plan packages. For example, these may include child illness benefits, free annual flu vaccinations, free preventative screening and even benefits for basic dentistry. Note that this is with certain options and not all schemes offer it!
Exclusions
Hospital plans provide limited medical cover, with various exclusions where applicable and based on your underwriting criteria. Typically certain conditions, treatments and procedures may not be covered at all. It’s essential that you familiarise yourself with any exclusions before signing up or you could be in for a nasty surprise.
Co-payments
Co-payments are payments that plan members are required to make to cover certain procedures in or out of hospital and even on certain types of medication/consultations which may also have these co-payments. You should determine what payments you’ll be liable for whenever using healthcare services.
Choosing a Plan
Before selecting a hospital plan, it’s important to determine how much you can contribute each month and what your healthcare requirements are. Once you have a monetary amount in mind, you can begin looking for a hospital plan that offers the requisite cover.
Medical Aid Comparison
Our medical aid comparison tool allows you to compare the benefit structure and monthly contributions for a wide variety of hospital plans from top medical aid schemes in the country. You can also request medical aid quotes online or get useful advice from our helpful consultants.
Consult the table for an overview of the hospital plans offered by some of the leading medical aid schemes in South Africa.
| Hospital Plan | Major Medical Benefits | Unique Benefits | Contribution |
|
Major medical expenses at 100% of the scheme rate Chronic medication for 26 PMBs at designated service providers (DSPs) |
Antenatal and postnatal maternity benefits Childhood illness benefit Infant paediatric benefit HIV test and flu vaccine Mental health benefits |
R1877 for the main member R1436 per adult dependent R550 per child dependent
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Unlimited private network hospitalisation Post-hospital treatment up to 30 days after discharge Seven days take-home meds Trauma treatment at casualty ward Chronic medication of 25 PMBs |
Free annual flu vaccinations for the family One free GP visit per annum per beneficiary Immunisation benefit Screening benefit Emergency medical transport
|
R1424 for the main member R1088 per adult dependent R482 per child dependent
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Unlimited cover in private hospitals Lower contributions for stat or associated hospitals Associated specialists covered in full, all others at 100% of scheme rate Chronic cover for 26 PMBs |
Preventative screening benefits Maternity programme Cover for specified check-ups Health Saver for day to day expenses |
Associated hospital, chronic at state R1642 main member Associated providers R2106 main member Any providers R2767 |
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Unlimited hospital cover at a hospital of your choice covered at scale of benefits Limited in-hospital cover for certain major medical illnesses Cover for 25 chronic conditions |
Emergency medical evacuation Basic dentistry benefits of R25,000 per beneficiary per annum
|
R1255 per adult R410 per child |
Contact us now if you would like one of professional consultants to help you find the right hospital plan for you.
