10 hospital plan facts

Cape Town - Full medical cover has become an unaffordable luxury for many South Africans. This is why so many people have opted to go for hospital plans that cover your medical bills if you are hospitalised.

But watch out: there is a big difference between these hospital plans and the ones that pay you a cash amount for every day you spend in hospital. Be careful of these ones, as you could land up having to foot a hospital bill of thousands yourself. Hospital insurance is just that – it pays you for the time you spend in hospital, not for the cost of the treatment you receive.

Hospital plans generally cost less than half of what full medical insurance would cost you. A standard hospital plan for one person will cost you in the region of R1 100 per month, whereas full medical cover can easily set you back R2 500 to R3 500 per month.

The most important thing to remember is to check the small print on your particular hospital plan. The devil is often in the detail. Don’t just assume you have full cover as you could be in for a nasty surprise.

Hospital plans (not hospital insurance) are regulated by the Medical Schemes Act of 1998. They, like medical schemes, have to adhere to strict regulations stipulated by the Council for Medical Schemes, the regulatory body of the industry.

Ten quick facts about hospital plans

• You usually need to be hospitalised for the hospital cover to kick in. This does not include visits to the trauma unit, unless the doctor decides to admit you to the hospital.

• Hospital plans need to cover you for 26 prescribed chronic conditions, such as hypertension. This means that your chronic medication will be paid for by the plan. This is done partly to try and prevent expensive hospitalisation.

• Hospital plans are great for people who are healthy and need minimal day-to-day cover. Visits to doctors and dentists and optometrists will have to be paid by you, but if your costs are low anyway, this won’t be a problem. If your medical needs change, you can opt to change your level of cover (usually in January only) by choosing another option.

• Hospital plans pay for hospitalisation in private hospitals (some cheaper plans specify the use of network or state hospitals, so check the details). Usually schemes have agreed rates with specific hospital groups and your hospital bill and in-hospital medication will most likely be paid in full, depending on the specific plan you have.

• Private doctors/anaesthetists and specialists in private hospitals can and do charge up to three times the rate the hospital plan will pay. Be prepared for this. Even people on full medical schemes are often in this position, where they have to make substantial co-payments.
Check with your hospital plan administrators before going into hospital how you can reduce costs. Always choose a designated service provider/network hospital if there is one – your bill could be covered in full.

• Consider taking out gap cover if you want to prevent making co-payments on your hospital bill yourself. It costs in the region of R100 per month.

• Some hospital plans also pay for certain procedures if done in doctors’ surgeries, such as colonoscopies. Mammograms and Pap smears are also often covered, as these are measures that make early diagnosis possible.

• Use designated pharmacies or services, or ambulance services recommended by your hospital plan. They are likely to be a lot cheaper.

• In a crisis, the hospital will contact your scheme to arrange the admittance.

• Many hospital plans cap the annual maximum hospital bill they will cover per family. Even if cover is supposedly unlimited, cases that exceed specified costs will be closely monitored.

 - Fin24

*Susan Erasmus is a freelance writer. Opinions expressed are her own.

Reference: Council for Medical Schemes; Independent Medical Aid Specialists; Selfmed

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