Medical Aid Hospital Plan
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.
What is a medical aid hospital plan only?
A hospital plan medical aid is simply just the hospital cover of a medical aid. This means that you are covered for expenses incurred while you are in hospital. Most medical aids also include the chronic benefit in the hospital plan. Out-of-hospital or day-to-day medical services are not covered and you will have to pay cash to the doctor, specialist, pharmacist, laboratory or other healthcare professional.
How much does the medical aid hospital plan cost?
The monthly contribution for a medical aid hospital plan only varies on the plan itself. It can start from about R500 per month and be in excess of R3,500 monthly. Apart from the greater benefits in the more expensive hospital plans, there is also the issue of the number of people on the medical aid. Adult members pay a higher rate, usually with the main member paying the most. Child dependents pay less and many schemes now cover additional kids for free if you are paying for the first two or three.
Does the hospital plan benefit offer chronic medication?
Yes. Most medical aid hospital plans offer a chronic benefit where the medication and sometimes a few necessary services and products are covered. The chronic benefit is not unlimited. However, there are certain diseases as defined under the Prescribed Minimum Benefits (PMBs) clause that will be covered throughout the year. This means that even if your chronic benefit for the year is exhausted, you will continue receiving the medication for the management of the PMB conditions.
What are the benefits on a medical aid hospital plan only?
The benefits vary depending on the hospital plan that you opt for. You get what you pay for so cheaper plans have less benefits and expensive plans have more benefits. Some hospitals plans will restrict you to only going to certain network hospitals that are approved by the medical aid. Other hospital plans will allow you to go to any private hospital of your choice. There are even hospital plans that only allow you access to hospital plans located in coastal cities of South Africa.
Which is the best medical aid hospital plan?
There is no best hospital plan. More expensive plans on different medical aid schemes are essentially the same. No scheme offers a significantly better hospital plan for a cheaper price than other medical aids in the country. The best medical aid hospital plan or you is one that suits your budget, meets your healthcare needs and if you so desire, gives you additional perks like a gym membership. However, there are few extras that you should look at in a hospital plan, which may be paid from the in-hospital or chronic disease benefit. This includes :
- Cancer treatment cover (outpatient basis)
- Cochlear implants and other prosthetics
- C-PAP machine and other home medical equipment
- Mental disease hospitalisation
- Addiction and rehabilitation
- Overall annual limit for hospitalisation
- Private rates for doctors and specialists above and beyond the medical aid rates as defined by the National Health Reference Price List (NHRPL)
Last updated on 25 June 2012