Why Join a Medical Aid Hospital Plan

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Join a Hospital Plan or a Comprehensive Medical Aid?

Frequently Asked Questions: Why Join a Medical Aid Hospital Plan

1. How do I decide between a hospital and comprehensive medical aid?
Your choice will depend upon your needs and budget. Comprehensive plans offer greater cover because as they include day-to-day benefits. However, they cost more. Your greatest medical financial risk lies with private hospitalisation, so hospital plan is the foundation of your healthcare insurance.

2. What benefits do hospital-only medical aid plans offer?
A hospital plan takes care of your hospital bills from admission to discharge and covers everything from your ward and theatre fees, surgeon, anaesthetist, doctor, specialist, physio, pathology, radiology, emergency treatment and so on. All hospital plans provide cover for the 270 life-threatening conditions and 26 chronic PMB conditions.

3. How do savings funds in comprehensive plans work?
Comprehensive plans have savings funds from which you pay out of hospital costs. Some plans give you a portion of a shared pool of funds, while others require you to contribute extra to a savings account as part of your monthly premium. Some plans offer a safety net should you savings be spent.

4. Can I upgrade my plan during the year?
Only one scheme will allow a interim plan upgrade - Fedhealth. If you suffer a major life-changing event, like having a baby or being diagnosed with a serious illness, you can upgrade your plan within 30 days of that diagnosis. You can now join a lower-cost, lower benefit plan, safe in the knowledge that if you need to upgrade – you can.

What key considerations are there when choosing a medical aid?
Make sure you get unlimited private hospital cover, cover for doctors' fees at scheme rates or higher and MRI/CT scan benefits. Look at the limits on specific procedures, maternity care, chronic illnesses, and co-payments. Does the plan offer screenings and preventive care. Join a Top up/ Gap Plan to help with in-hospital claim shortfalls and procedure co-payments.

Do you wonder how you can afford private healthcare?
It can be confusing when comparing different medical aid plans in South Africa.
Comprehensive plans offer extensive benefits, however high premiums can be a significant problem for many people.
This is where an in-hospital only medical aid plan has great potential.

Hospital-only Medical Aid Plans

hospital plan

Unlike insurance-based hospital plans, medical aid hospital plans are regulated by the Medical Schemes Act and offer:

But are they right for everyone?


private hospitalChoosing Between Hospital-Only and Comprehensive Plans

Deciding if a hospital plan or comprehensive plan is best to join depends on your individual needs and budget.

Out-of-hospital expenses: If you frequently require doctor visits, medication, or other non-hospital care, a comprehensive plan covering these costs might be more cost-effective in the long run, even with a higher premium.

Your budget: Can you comfortably manage out-of-hospital expenses yourself?
If so, a hospital-only plan could offer significant savings while providing essential hospital benefits.

Don't just look at the premium: While hospital plans might seem cheaper, if you often need treatments outside of the hospital, a comprehensive plan could actually save you money in the long run.

Go here to request more information.


About medical aid savings funds - Comprehensive plans often come with savings funds from which you pay out of hospital costs.
Some plans give you a portion of a shared pool of funds, while others require you to contribute extra to a savings account as part of your monthly premium.

An excellent Idea if you can self-fund day-to-day costs - Instead of being tied to a comprehensive plan with a savings fund (and higher premium), look to joining a hospital-only benefit plan.
By self-paying your day-to-day costs, you can enjoy the benefits of hospital cover without the added expense of a savings fund.

Remember, a comprehensive plan or a plan with a medical savings, does not give you a better bed in hospital!

A hospital plan takes care of your hospital bills from admission to discharge and covers everything from your ward and theatre fees, surgeon, anaesthetist, doctor, specialist, physio, pathology, radiology, emergency treatment and so on.

Read more here ...

If you are concerned about the possibility of high day-to-day costs then consider these plans:

hospital planThe Fedhealth flexiFED - offer unlimited hospital cover combined with a day-to-day savings fund that you only repay once you spend it!

Your premium remains that of a hospital plan until you spend from your savings.
What you spend is then repaid monthly - interest free over the following year - as an addition to your premium, until it is paid back whereupon your premium drops back down to that of a hospital plan.

(Other medical aid plans force you to repay a portion of the savings from the start of your plan, whether you have spent them or not That is money you cannot use as you wish. A forced loan!)

Fedhealth gives you a safety net of funds for high out of hospital costs, but only paying for that benefit when you use it!

How the savings work ...

Fedhealth Medical Aid.

Now you can have one of the finest hospital plans and the resources to pay high, unforeseen day-to-day costs. You can address you healthcare risks in one plan where you control what it costs you!


special premium hospital planThe Genesis hospital plan pays unlimited private hospitalisation as well as essential dental costs!

It addresses your threats of high private hospital and dental costs, all in one plan.

And they have the lowest annual medical aid increases, therefore the lowest premium of all medical aids.


discovery health hospital planDiscovery Health Medical Aid offers up to 23 plans and all have no overall limit for hospital cover and a wide range of benefits that will meet your personal needs and budget.


momentum health hospital planMomentum Health Medical Aid presents a range of plans designed to meet your needs and budget, while potentially saving you more than R 1,000 per month in premiums (when you use listed providers).

Key Considerations when Choosing a Hospital Plan are to ensure there's no limit on cover for private hospital admissions and comprehensive benefits for all related expenses.

Additionally, look for options covering MRI/CT scans, day clinic benefits, maternity care, and chronic illnesses without restrictive limits or co-payments.


medical aid hospital planHere are some key things to think about when choosing a medical aid, hospital plan:

Some of these concerns may impact your decision, depending on your individual circumstances and medical history.
If you also join a top-up, it will greatly enhance your benefits.

It goes without saying that you need at least a hospital benefit medical aid.
A plan that will guarantee you admission to a private hospital with no up-front deposits to pay and unlimited cover.

top-upPrivate healthcare providers can charge up to 500% of medical scheme rates.
Medical aids add procedure co-payments as well.
These are significant concerns for medical aid members.

Protect yourself against these potential threats, by joining a GAP or top-up insurance plan.

This separate insurance will cover most in-hospital claim shortfalls and any co-payments. It is a vital safety net, ensuring you have adequate benefits for medical treatments without bearing the full burden of unexpected costs.

Protect yourself from soaring medical expenses by bridging the gap between medical scheme rates and the charges imposed by private providers.

dentalSpecialised Dental treatments can be extremely expensive!
The costs of braces, root canal, implants and so on, can run into thousands of rand. Most treatments are done out of hospital, so are funded from your savings. That can result in less money available for other medical needs and family limits being used on one member only!

Dental treatment is something we all need and it is vital you consider the Best Dental Insurance Plan in South Africa.

No Medical Aid or have a Hospital Plan only? This plan will help you meet the high costs of both normal and specialised dentistry!

medical aid quote What is the cost?

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You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.

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peter pyburn brokerpeter pyburnPeter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate Planning. More...

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Last update: April 12, 2024