Why Join a Medical Aid Hospital Plan
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
Unlike insurance-based hospital plans, medical aid hospital plans are regulated by the Medical Schemes Act and offer:
- Guaranteed cover for 270 life-threatening conditions and 26 chronic conditions (Prescribed Minimum Benefits, or PMBs), including emergencies, diabetes, and asthma.
PMBs will give you (even with only a medical aid hospital plan) guaranteed levels of protection.
- Full cover for hospital expenses, including ward and theatre fees, specialists, medication, and more - from admission to discharge.
- Have lower premiums when compared to comprehensive plans.
Choosing 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.
If you are concerned about the possibility of high day-to-day costs then consider these plans:
The 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 ...
- You can upgrade your plan within 30 days of a major life event, like having a baby or being diagnosed with a serious illness.
So join a lower benefit, cheaper plan, safe in the knowledge if you need higher benefits you can upgrade. - Every plan includes a hospital benefit and a savings fund for day-to-day expenses. You only pay for savings when you spend them. If you never spend the savings, you have a hospital plan at a lower premium.
- Children up to age 27 can be covered at reduced rates.
- Fedhealth covers trauma procedures, post-hospital follow-up care, and specialized radiology.
- 30-day post-hospital follow-up treatment is paid from risk.
- Specialised radiology like MRI/ CT scans is paid for from risk, in or out-of-hospital.
- Unlimited pre-authorised radiology.
- You can get discounts by using listed hospitals and agreeing to certain excess amounts.
The 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.
- Hospital and related accounts (e.g. theatre costs, x-rays, pathology, physiotherapy, blood transfusion, medicines, etc.) are covered at 100% of Scheme Tariff, including day clinic or the recovery room charges of an unattached operating theatre.
- General practitioners and specialists are reimbursed at cost up to 200% of Scheme Tariff. (plan dependent)
- Surgical procedures done in doctors’ rooms.
- Emergency pre-hospital treatment, evacuation and transport
- Freedom of choice, NOT forcing you to use a network provider.
- Very limited procedure co-payments.
- Essential dental treatment is paid for by the plan!
- The lowest annual increase of all medical aids! Surveys prove Genesis offers "exceptional value for money" and are "absolute market leaders" in its respective segments. Private Choice benefit option rated first out of 17 equivalent hospital plans in South Africa!
Discovery 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.
- Guaranteed full cover in hospital for linked specialists.
- Private ward benefit (plan dependent).
- Extensive listed hospitals for plans with reduced premiums.
- Income-related premium plans.
- Comprehensive pre-and postnatal healthcare services for maternity and and treatment for the first two years of your baby’s life
- Cover for relevant healthcare services, as well as a defined basket of care for out-of-hospital healthcare services, related to global World Health Organization (WHO) recognised disease outbreaks such as COVID-19.
- Africa evacuation benefit.
- International second opinion benefit.
- Care at home, including a Home Monitoring Device Benefit
- Vitality wellness rewards programme.
Momentum 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).
- No overall annual limit hospitalisation. Choose any hospital, or get a premium discount when using listed hospitals.
- Cover for certain out-of-hospital procedures that can safely be performed in a doctor’s room, registered day clinic or outpatient facility.
- No co-payment for motor vehicle accidents, maternity confinements and emergency treatment.
- No annual limit on maternity confinement and neonatal intensive care.
- No annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans.
- Choose any doctor/chemist for your chronic medication, or get a premium discount when using listed providers.
- Access to the HealthSaver day-to-day savings product.
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.
Here are some key things to think about when choosing a medical aid, hospital plan:
- Make sure you have unlimited in private hospital cover.
- Doctors' fees should be paid at the scheme rates or up to twice those rates.
- Private providers often charge more, so having a top-up plan is important. You'll need a Gap Plan. to cover any extra costs not paid by your medical aid.
- Consider if MRI and CT scans, day clinic benefits, pregnancy and maternity care, and other procedures are covered.
- Look at the limits on specific procedures, co-payments, and benefits for chronic illnesses.
- Check if you can use certain hospitals to save money without losing benefits.
- See if the plan covers screenings and preventive care.
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.
Private 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 Cura's GAP or top-up insurance plan.
OR Zest 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.
Specialised 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 OR Most Affordable Dental Planin 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!
Talk to me .... I am here to help you - at no charge!
Send me your questions and concerns. I'll answer them for you.
83 655 2164
You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
We will offer you the best help at no cost!
Medical aid pays healthcare costs.
What if a disability stops your income?
YOUR TRUSTED, QUALIFIED ADVISOR:
Peter 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.
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Last update: January 18, 2025