Medical Aid Scheme Vs hospital plan

summary: 

“…There are two main differences between the two insurance schemes. While both Medical Aid and a Hospital Plan help cover you when medical costs rise, they don’t provide the same level of cover. A hospital plan only covers cost in the event of an emergency or accident, during which need to be admitted to the hospital, will a Hospital Plan cover you…”

“…If your finances are tight and you have to choose between either a hospital plan or a medical cover, a hospital plan is undoubtedly more affordable. But if you are in a position to afford full medical scheme membership, one should get one, as it provides not just a peace of mind, but covers many of your day-to-day expenses…”

  • Add Section
  • Edit Section
  • Delete Section
  • Edit
  • Edit

The medical scheme industry is full of jargon and benefit structures that leave most South Africans confused and frustrated when it comes to understanding and accessing their benefits and consequently, end up wondering about their hospital plan options what they cover and what the cheapest ones are.

What are the differences between a hospital plan and a full medical scheme? Is a full medical scheme worth having? Or should you rather think of taking out a hospital scheme?  This is a question many South Africans are asking especially those who are buckling under a large bond, car insurance and debt repayments.

There are two main differences between the two insurance schemes. While both Medical Aid and a Hospital Plan help cover you when medical costs rise, they don’t provide the same level of cover. A hospital plan only covers cost in the event of an emergency or accident, during which need to be admitted to the hospital, will a Hospital Plan cover you.

What are the benefits of a Medical Aid Scheme?

Medical procedures can cost quite a bit of money. A Medical Aid scheme gives you the peace of mind that your healthcare needs will be paid for when you need it. If you belong to a Medical Aid scheme, you can get quick access to healthcare as the funds when and as you need it. It also means that you will have access to private healthcare services that usually offer better quality care.

Comparing Medical Aid quotes online can help determine which scheme suits you best. But, when doing your homework, it’s best to evaluate you and your family’s general health (including past illnesses in your bloodline) as well as the level of cover you can afford. This information will be an indication of whether or not a medical scheme is necessary for you and your loved ones.

The benefits of a Hospital Plan

A hospital Plan gives lower-income individuals access to private healthcare. It can bridge the gap between the coverage that Medical Aid provides and what it does not. Some Hospital Plans allow you to go to a hospital of your choice, dependent on the approval of the provider.

A Hospital Plan may not always be the best option for those South Africans needing the varying degrees of day-to-day benefits a Medical Aid offers. A Hospital Plan will work best for you in the event of an operation or other large procedures; however, it would still be in your interest to have the cash resources available to foot the bill for regular doctor visits and medical expenses, especially if you have dependents.

A Few Things To Keep In Mind…

What are your medical needs?

Considers both yours and your family’s medical needs, If you and your loved ones are above average health and you believe it unlikely that you will have high day-to-day cost then a hospital plan may be right for you.

Why not decide when and if you fall ill?

There are disadvantages to a late sign-up, and one should carefully consider their families medical history and the risk they put themselves and there loved ones in by doing so.

  • You will have to pay more as a result of your older start-up age ( you are now at a greater risk than if you had a signed up years back).
  • You can also be excluded according to the law, for up to 12 months, from treatment for a particular condition.

How much cover does hospital cover give?

Long gone are the days where having a full medical scheme or being on a hospital plan meant that all your hospital expenses are covered. Some policies will pay 100% of the medical fund rate, and others 200%. But surely 100% is, well, 100%? Not necessarily – some private doctors charge much more than the medical fund rate. The most important thing for you to do is to make sure you know to exactly what degree your scheme and benefit options cover you.

If they charge you more 100% you are covered for,  which 90% of them do, you will have to pay in the difference, out of your own pocket. If your specialist charges a 200% rate and you are only covered at 100% (NHRPL rate), you will need to pay the difference and negotiate tariffs with the specialist – especially the anaesthetist.

Many schemes and hospital plans have specific regulations on organ transplants, cancer treatment, ambulance and emergency services, dental surgery, medical appliances, HIV/Aids treatment and artificial limbs, among others.

You could find yourself running out of benefits halfway through a treatment – check the regulations regarding overall limits and treatments that are not covered. It is absolutely essential that you know these things. Speak to your medical broker if you require more information.

Read the Small Print

Size matters and no matter how long or how small the fine print section of your policy document may be – it is essential to read through it. There is a reason the print is small, 99.98% of the time the fine prints the most important information concerning your policy. Read it and understand it thoroughly before signing anything.

Is a Hospital Plan Really Saving you Money?

If your finances are tight and you have to choose between either a hospital plan or a medical cover, a hospital plan is undoubtedly more affordable. But if you are in a position to afford full medical scheme membership, one should get one, as it provides not just a peace of mind, but covers many of your day-to-day expenses.

At SaveMoney, we know that your health is unpredictable and everyone is entitled to the medical and health benefits that can save their lives. But not everyone is able to afford the coverage they need. Finding the best Medical Aid for you and your family, shouldn’t be a complicated process or expensive process. That’s why we’ve made it our mission to help all South Africans find a policy that works for them and their wallets. We instantly get you quotes from SA’s leading providers, fill in your details and find the best and most affordable coverage for you and your family today.

Simply Fill In Your Details And We Will Call You Back.