What Hospital Plans Do Not Cover
While medical hospital plans may be an affordable option for healthier medical scheme members who don’t require comprehensive day-to-day or chronic cover, it is worth knowing what hospital plans do not cover so that you can make an informed decision when choosing your medical scheme plan.
Basic hospital plan
Sometimes a hospital plan does not work out to be the most practical or useful form of medical cover and in fact there are numerous things that a basic hospital plan will not cover that other medical aid plans will.
For example, while there are some hospital plans that will cover dentistry work, most will not and if you have children who need regular dentists consultations you will end up paying a great deal of money out of your own pocket.
Essentially, hospital plans are designed to cover members in the event of a hospital stay and will not necessarily cover all GP or specialist visits.
If you want to take out a hospital plan to save money you need to carefully think about how much money you may need to pay out of your own pocket should a medical emergency arise.
And not just an emergency but instances such as doctor’s consultations or optometrist appointments.
When considering what hospital plans do not cover be mindful that a number of hospital plans require members to make use of certain hospitals, doctors and specialists within a specific network and should members choose to seek health care outside of the network, the medical aid provider will not pay anything towards your medical bill.
Planning your future
If you’re planning a family or would like to do so sometime in the future then be aware that a hospital plan may only cover you for the actual delivery of the baby as that would form part of a hospital stay. Things like gynecology and GP visits as well as scans would have to be paid for by you.
If you do want to start a family, rather look into comprehensive medical aid cover that will include your spouse and children and give you peace of mind for medical bills. The comprehensive cover may be more costly but the benefits are worth it.
People who require chronic medical treatment and medication would also do better to consider comprehensive or premium plans. This includes members and families with high day-to-day medical expenses who will find that a simple hospital plan will result in an escalation in the cost of their medical expenses.
Medical aid scheme
Hospital plans provide cover for medical bills accrued from service providers during hospital stays. The percentage that is covered by a medical aid scheme varies depending on the hospital plan.
In fact the rates can vary from the National Health Reference Price List – the minimum rate that medical schemes must pay – up to a whopping 400% that certain hospital plans afford their members.
The main deciding factor when choosing a health care plan would be affordability followed by yours and you dependents health care needs. Age also plays a factor. Try to calculate your average yearly day-to-day medical costs and realize that such expenses are your responsibility when choosing a hospital plan.
You may just discover that although you will be saving on monthly premiums, the day-to-day expenses may become a burden.
Ultimately, selecting medical cover is a personal choice as long as you research and are clear as to what is and isn’t included in the plans.