As I wrote in a previous article, full medical cover has become an expensive purchase that few South Africans can afford. As we see a significant increase in the purchase of hospital plans, we are also seeing a decrease in how much our clients fully understand the big differences between an old-school medical aid and the intuitive products of today’s marketplace.

Having come from a generation that largely understood medical cover as a ‘covers all’ policy, I’ve highlighted five more facts about hospital plans that are overlooked until they are needed! Some are comforting to know that they’re in place, others require being armed with the correct information.

  1. If you find yourself in a crisis, the hospital will contact your scheme to arrange admittance.
  1. Hospital plans can pay for hospitalisation in private hospitals, although some specify the use of network or state hospitals. 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 specifics of the plan you have chosen.
  1. Private doctors and specialists in private hospitals can charge up to three times the rate that the hospital plan will pay, be prepared to make co-payments (even people on full medical schemes can find themselves in this position). You can always check with your hospital plan administrators for available avenues to reduce costs. Always go with the designated service provider/network hospital if there is one, your bill could be completely covered!
  1. Consider taking out gap cover if you want to prevent making co-payments on your hospital bill yourself. It consists of a small monthly payment that could reduce some unnecessary pressure in the future.
  1. Hospital plans usually cap the annual maximum hospital bill they will cover per family. Cases that exceed the specified costs will be closely monitored.

Hospital plans generally cost less than half of what full medical insurance would cost you and they are strictly regulated. Always read the small print so that you know exactly what you are covered for. I’d be happy to run through these with you and answer any questions you might have!

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