8 Reasons Why Your Hospital Plan Might Not be Enough Cover

Lots of South Africans take out a hospital plan. They think it will be sufficient cover if they ever land in hospital due to illness or accident.

They are almost certainly wrong. Here are 8 reasons why your hospital plan is probably lacking.

Problems with a hospital plan


  1. If you show up at a private hospital, you would have to pay a huge upfront cash amount for admission. Your hospital plan would pay up only after discharge. PROBLEM: You would be out of pocket. Or you would run up a huge amount on your credit card, if you had the credit available at all.
  2. Hospital plans that promise to pay out cash if you land in hospital might indeed pay you. But it is unlikely that they will cover you from Day 1 in hospital. Some plans count hospitalisation from the third or fourth day. PROBLEM: you would have to pay cash for the balance plus all other expenses.
  3. Hospital Plan in South AfricaThe daily amount paid out by some hospital plans do not relate to actual hospital costs. R1000 a day might sound like a lot. However, your bill could easily be in the region of R5000 to R50 000 a day. Especially if you ended up in a trauma unit or intensive care. PROBLEM: you would be personally liable for the outstanding balance.
  4. While the hospital bill is a large part of the cost of hospitalisation, there are many other expenses involved. These include specialists, x-rays, scans, medication and a hundred other costs. PROBLEM: you would have to pay cash for all the other bills. And don’t for a minute believe that a private hospital will let you lie there running up a huge bill. If you couldn’t pay after a day or two you would be transferred to a state hospital pronto.
  5.  If you have a hospital plan from an insurance firm and not a registered medical aid, the insurance company would not be obliged to pay for anything other than the basis daily hospital fee as promised in the policy. PROBLEM: there is no obligation for insurance companies to take care of your health, whereas medical aids are obliged by law to cover the treatment of over 300 conditions, no matter what plan or scheme you join. That’s not to say they like doing it or always follow the letter of the law. But at least the law is on your side.
  6. In the scheme of things hospital costs are a small part of a person’s health care requirements. PROBLEM: What about GP bills and dental checkups and all the medical care that people require as they get older, from hip replacements to chronic medication. Do you want to rely on the creaky public health system for that?
  7. Hospital plans do not relate their payouts to the actual cost of being in hospital. They actually say they would pay out money for other expenses such as helping your family while you are in hospital. PROBLEM: the policies are not necessarily related to the actual expense of being in hospital.
  8. There is always a ceiling to a hospital plan. PROBLEM: the ceiling is almost always way below what your hospital costs will be so you would almost inevitably have to pay out a huge cash amount to settle hospital bills. People have lost their homes trying pay hospital bills.

The SOLUTION is to join a registered medical scheme such as Discovery Health, Selfmed, Fedhealth or one of many others. Buy into the best plan you can afford and if you can only afford a hospital plan make sure you get one from a medical scheme. Discovery, Bestmed and Momentum have excellent hospital plans available.

Although hospital plans from medical schemes won’t pay for everything, at least with hospital cover from a medical scheme you have the regulations of the Medical Schemes Act to help you get the most out of your health cover.

All info was correct at time of publishing