South African consumers need to be aware that medical cover is not synonymous with medical aid. You may think that you are signing up for cheap medical aid but the cover is not administered by a medical scheme and does not offer the same benefits as medical aid. Instead you may be signing up for hospital insurance (also known as a hospital cash back plan) or medical insurance (similar to a hospital cash back plan with some out of hospital benefits).
Most of us think about the cost of the doctor or medical specialist, surgery and hospital stay when we look for medical cover, but there are other health care expenses you need to keep in mind. There are a range of diagnostic investigations – scans, scopes and tests – that are needed for the treatment and management of your illness. And these investigations are not always cheap. In fact a single MRI scan can cost you more than 2 to 3 days stay in a private hospital. So your medical aid will cover this, won’t it? Not necessarily. Especially if you are only have a hospital plan.
There is no denying that medical aid premiums are pricey in South Africa and not everybody can afford it. Even existing medical aid members question their level of medical aid cover at times, especially during financially difficult periods. If you have decided to downgrade your cover from a full medical aid (comprehensive cover) with day-to-day benefits, then you should consider your decision carefully before you switch to a hospital plan.
One of the most important aspects for first time buyers of hospital plans is to understand the waiting periods thoroughly at the outset. You may be surprised to find that you are caught out without cover by not having properly understood all aspects of waiting periods for hospital plans. The fact of the matter is that there is no immediate cover for any type of hospital plan, be it the hospital cash back plan or a medical aid hospital plan. You will have to wait for a period of time before your cover will payout.
While medical aids and hospital cash back cover offers maternity benefits, it does not apply to women who are already pregnant at the time of joining. Ideally people join a medical aid and sign up for cover before they actually need it. After all these types of cover are a means of financial protection to cover you in different circumstances. Joining a medical aid when you are already pregnant means that you cannot expect to be covered for your pre-existing pregnancy. The same applies to hospital cash back cover policies. You can still join but you will only enjoy maternity benefits and childbirth cover for your next pregnancy.
Having adequate financial cover for pregnancy and childbirth is important if you want to afford quality healthcare for both mother and child. With the host of complications that can arise during pregnancy and childbirth, proper cover can at times make the difference between a viable pregnancy and the birth of a healthy baby or not. Even without pregnancy complications, childbirth in particular can be expensive if you wish to have your baby in a South African private hospital. Most people cannot afford to pay cash and private hospitals do not offer credit facilities. It is either cash upfront or a medical aid hospital plan at the very least.
Although pensioners can rest assured of medical aid benefits, the same does not apply with hospital cash back cover. Medical aids in South Africa cannot discriminate on the basis of age and any person of any age can join a scheme and remain covered throughout life. However, hospital cash policies do not cover a person over the age of 65 years and will fall away once a person becomes a senior citizen. It is not about whether you are retired and receiving pension or still working on your senior years. Age restrictions are part of the hospital cash policy conditions which are essentially insurance policies. Medical aids are covered by a separate piece of legislation and therefore do not have these age restrictions.
Being diagnosed with cancer is shocking to say the least but the thought of the financial implication can add to the stress. Without medical aid, you will have to opt for cancer care in a government facility unless you have the cash to pay for treatment out of your own pocket. Oncologist feess, cancer surgery to remove the tumour, chemotherapy and radiotherapy (radiation treatments) are expensive if you are looking towards the private health sector in South Africa. Medical aid is the only way to afford the care that you need and want with such a life-threatening condition.
The hospital cash back cover is an insurance policy that is often marketed aggressively in South African media. However, it is the cause of much confusion amongst consumers as it is often mistaken for a medical aid hospital plan. These are two different products. Hospital cash back cover is not new. It even precedes medical aids. However, it often took a back seat to medical aid products until a few South African insurance companies decided to revive the product in the market.
The hospital plan medical aid, also referred to as a medical aid hospital plan only, is a popular option among South Africans. It is still a medical aid although it does not have all the benefits. These days the terms are quite confusing because ‘hospital plan’ and ‘hospital cover’ are used interchangeably. However, we focus on hospital plan as being the medical aid option and hospital cover being the insurance product – hospital cash back cover.