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Hospital Plan: What You Need to Know

30/10/2012 • • by
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EXACTLY WHAT IS A HOSPITAL PLAN?

A hospital plan is a medical aid option which provides you with HOSPITAL cover ONLY as well as chronic medication benefits for the 26 Prescribed Minimum benefits as per law. PLEASE DO NOT CONFUSE a hospital plan with hospital insurance. Hospital Insurance is a product that pays a Rand value per day spent in hospital or a specified amount per event. A hospital plan under a medical aid IS still a MEDICAL AID, even if you do not have day-to-day medical benefits.

CASE STUDY:

Joe Soap (aged 23) just left university and is starting his career on a monthly income of between R6-R8k. Even though Joe is fit and healthy and does not expect to land in hospital any time soon, he is very aware of the fact that accidents can happen at any time. However, Joe cannot afford to pay more than R1 000 per month for medical aid at this stage.

ADVICE AND SOLUTIONS FOR JOE SOAP:

As Joe is still young and healthy it is very unlikely that he will need the cover available under a comprehensive medical aid. The likelihood of a serious illness occurring is minimal, BUT as already  highlighted above, accidents do happen and can lead to weeks or months in hospital – even ICU (Intensive Care Unit) resulting in extensive hospital bills. I was recently told by a client that a day in ICU can cost you in the region of R10 000-R15 000. As long as Joe chooses a hospital plan that covers most major medical events, he should not be surprised by unforeseen medical bills.

PROS AND CONS OF HOSPITAL PLANS

PROS CONS
If you end up in hospital, you are sure that most (if not all) of the accounts will be paid. You will not be able to claim any out-of-hospital treatment such as dentistry, physiotherapy and the like.
It is more cost effective for the healthy person. Should your health status change during the year, you cannot upgrade to a more comprehensive option. You will need to wait until the end of the year.
 

WHAT OPTIONS TO CHOSE FROM?

All medical aid schemes offer hospital plans as part of their option selection and the premiums for these are all very similar, starting at just under R1 000 per month for the main member (in this case Joe). As the schemes are all so similar, I personally always look at a few important factors, which make it easier to decide which option to choose.
  1. Does the scheme cover take-home medicines after a hospital visit? (I had to pay R800 a year ago for my husband’s take-home meds on a hospital plan.)
  2. How does the scheme cover MRI and CT scans? Must you be hospitalised for these to be covered or will they pay for these out-of-hospital as well?
  3. How much oncology (cancer) cover does the scheme offer? The cost of cancer treatment is very high, and the more the scheme will cover, the less concern you will have in the unfortunate event of diagnosis.
  4. Does the scheme make use of Network hospitals, and if so, are the hospitals convenient to me?
  5. Does the scheme pay at 100% or 200% of medical aid rate? By knowing this, you will be aware of how big possible shortfalls on doctors accounts could be and you can make appropriate plans to re-insure these through GAP cover.
  Some of the major medical schemes’ hospital plans which are all popular (and affordable) are as follows:
  • Bonitas Essential           Ÿ
  • Discovery Core              Ÿ
  • Momentum Custom              Ÿ
  • Medihelp Prime 1
  For more information on the most appropriate Hospital Plan for you feel free to contact Nelda directly on nelda@medicalbenefits.co.za or tel 021 975 8324.

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