Medical aid VS hospital plan – which is better?


We have the pros and cons to both so you can make an informed decision that suits your personal needs.

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Financial Planning Institute of Southern Africa’s Barbara Mundell breaks down what you need to consider when taking either medial aid or a hospital plan.

Pros of Medical Aid

With our state healthcare not being able to provide for majority of our health needs, medical aid is essential. A medical aid will generally provide cover for all your hospital needs.

Medical aid also has an obligation in terms of the Medical Schemes Act to provide benefits under the prescribed minimum benefits. Under these benefits, the medical aid has to provide you with cover for your medicine, doctors’ visits, pathology and other treatment needed to manage your conditions. These benefits are often referred to as PMB’s.

The medical aid usually pays the doctors and the treatment providers directly.

More Medical Aid Benefits

Added to this, you are able to add a savings component to your medical aid that will provide you with you day-to-day benefits, such as doctors’ visits medication.

Majority of the medical aids also provide preventative care benefits such as flu vaccines, cholesterol and blood pressure screenings.

However due to an increase in medical costs, most medical aids don’t settle the provider’s bill in full and sometimes members are required to pay in additional amounts.

To avoid being exposed to this risk, GAP cover can assist. GAP cover is an additional product to your medical aid and depending on your provider, and fill up to 500% of the gap between what doctors charge and what the medial aid pays.

Hospital Plans

Hospital plans, on the other hand, are classified as medical insurance, and generally do not pay the medical providers directly. Majority of the medical insurances only pay you an amount per day that you are in hospital and usually only from day three, onwards or when you are admitted to ICU.

Medical insurance often have a capped amount e.g. R 50 000 per event that they pay out no matter how many days you spend in hospital.

Hospital insurance will only cover you in the event that you have met all the criteria for a claim and you have no certainty that you have enough funds to pay the medical bill.

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