Is Hospital Insurance Enough Health Cover?

There are many Medical Aid Schemes which offer many different levels of Health Coverage. One of these is hospital insurance. In addition, there is also at present Health Insurance available which one can buy directly from insurers which cover only a specific condition. And will only payout if a member has this condition and lands in hospital. This can be very limiting and leave the member with large amounts to settle after they recover. Medical Insurance does not cover PMB’s.

What do they cover with hospital insurance

They will cover all or most of the cost when a member is in the hospital. This is often as a result of an emergency.

Pros and Cons of hospital insurance


Hospital Insurance

They are cheap. People who are young and fit often do not understand the need for a more comprehensive cover.  Also people working with a restricted budget find the Hospital Plan attractive. At least they have some cover!! In terms of South African law even a Medical Aid Hospital only option must cover the list of Prescribed Minimum Benefits. (PMB’s) This includes chronic medicines as per the list.


Hospital plans which only cover hospitalisation may seem like a cheap option providing you have the funds set aside in your bank account for day to day visits to doctors and dentists. Hospital plans do not pay for annual health checkups. These are essential to ensure that there is no risk to health from an undiagnosed problem. Some people may feel that they can pay for this out of their own pockets but there are always additional expenses for examples blood laboratory testing fees and even follow up appointments. Most people avoid making these annual appointments.

Most Hospital only plans do just that. They cover members only when they are hospitalized.This cost can be quite significant.

Hospital plan with Day to Day Benefits

Many schemes offer an option by which hospitalisation is covered but in addition a number of Day to Day benefits are covered. A limited number of Out of Hospital procedures can also be likewise covered. This usually involves a slight increase in premium.

It is clear that whilst a Hospital Plan is indeed better than no cover it does leave large gaps which the member will have to meet financially. Therefore it is certainly worth the consideration and for peace of mind to pay the additional amount and have the more extensive coverage.


All info was correct at time of publishing