Medical scheme membership doesn’t come cheap and consequently many consumers are wondering about hospital plans, what they cover and what the cheapest ones are.
The medical scheme industry is full of jargon and benefit structures that often leave the man on the street confused and frustrated when it comes to understanding and accessing their benefits.
A hospital plan is offered by a registered medical scheme and should not be confused with hospital insurance or hospital cash-back plans. Medical schemes are regulated by the Medical Schemes Act, while the others fall under the umbrella of insurance products. A hospital plan has to pay for 270 Prescribed Minimum Benefits when treated in a hospital and for the treatment of 26 chronic conditions.
Where the difference comes in is that a hospital plan will pay up to a certain limit for the procedures and treatment that you receive in a hospital, whereas hospital cash-back plans tend to pay for the time you spend in hospital.
Things to keep in mind
- Many hospital plans specify that there is no annual limit to the hospital care you may receive, but all high-cost cases are nevertheless carefully monitored by schemes in order to protect the interests of other members.
- Closed schemes are usually just for employees of a particular company, whereas anyone can join an open scheme. The schemes listed below are all open schemes, not listed in any particular order. For more on benefit information, click on the links of the various websites.
- Do remember that if a scheme says it will pay up to 100% of the medical aid rate, that might be lower than your actual hospital bill and you could face a co-payment. A hospital bill is also made up of different components, such as the doctor’s account, the anaesthetist’s account, medication, ward fees and so forth. Check to see what percentage of the medical aid rate the individual hospital plans will cover. Private doctors in out-of-network hospitals do not have to charge medical aid rates.
- Also remember that some plans require you to use network hospitals or designated service providers (DSPs) for non-emergency treatment. Failure to make use of these could result in large co-payments. It is advised to use network hospitals/doctors at all times when possible.
- It is also important to remember if you have not been a medical scheme member in South Africa for a certain number of years after a particular age, you can be made to pay a late joiner penalty of up to 75% in the case of someone who has had no cover at all for the preceding 25 years after a certain age. Read more about it here.
- Some hospital plans also come with a day-to-day savings portion for out-of-hospital expenses, but they obviously tend to be pricier.
- Most hospital plans will pay only if you are admitted to a hospital. If you go to the emergency unit and you are not admitted to the hospital for treatment, you will have to pay for the emergency room visit yourself.
- Most hospital plans charge a flat rate for monthly contributions regardless of your income, with Discovery’s Keycare Core being an exception. Other plans with differentiated rates based on income are Bonitas’ BonCap Plan, Momentum’s Ingwe Option and Sizwe’s Gonomo Care.
- Some schemes differentiate contributions on whether you have chosen the network or the non-network option. Your choice depends on your financial situation, but it is much better to have cover on a network option than no cover at all.
Read more about some of these plans on IHS. Details about the other plans can be found in links contained in the table below.
Benefits and contributions change every year, but here are some of the cheaper hospital plans you might consider for 2016, and a link to the respective websites. (This list is not comprehensive and in no particular order):