What Do Hospital Plans Cover?

It’s reality in South Africa that some medical aid schemes are just too expensive. Which is why many South Africans consider hospital plans. So what do hospital plans cover?

There’s a huge difference between medical aid and hospital plans. So it’s important to know what you’re in for. Because you might have to foot a bill of thousands yourself if you don’t familiarise yourself with what your plan covers.

Don’t assume you have the full cover on a hospital plan or insurance because your fine print could state otherwise.

A hospital plan pays you for the time you spend in hospital. In most cases, you won’t have to pay any extra fees for procedures. But this will depend on the plan you have.

Generally speaking, it costs less than half of what full medical aid would cost you. A standard hospital plan per person will cost in the region of R1 100 per month, while medical aid can easily cost double that and more.

What Do Hospital Plans Cover

Hospital Plans CoverSome hospital plan packages do not cover day-to-day benefits such as doctor’s visits and medication. While others give you the option, at a higher price, to include some benefits.

Because it’s a type of insurance, a hospital plan can be structured based on your personal risk profile, which is determined by the insurer after asking certain questions.

Hospital plans don;t have full coverage, but they must still provide for Prescribed Minimum Benefits (PMBs).

There are also chronic medical conditions that fall under the umbrella of PMBs, which means that medications for treating these conditions come from a hospital plan as well.

Cover for take-home medications is often in hospital plans too, but the extent to which your medications have cover differs from one hospital plan to another.

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