What do hospital plans in fact cover?

Medical aid can be costly, so many people opt to purchase only a hospital plan instead in order to save some cash, while still keeping some cover for emergencies.

Hospital plans are exactly that: insurance that covers anything that is done in hospital, on condition that you are admitted. Certain hospital plans also cover emergency room visits, but this is scheme dependent.

This is a great option for people who hardly ever see the doctor. If you are generally able to afford the occasional doctor’s visit out of pocket, you will save loads of money by opting for a hospital plan.

Is it the same as hospital insurance?

Be wary, there is a difference between a hospital plan and hospital insurance. A medical aid hospital plan will pay the hospital directly and will most likely cover the full costs of any in hospital procedures. Hospital insurance will pay you a set lump sum, or daily fee into your own bank account to assist you with the cost of the hospital visit while you are admitted. Hospital insurance is usually much cheaper than a hospital plan – in the same way that hospital plans are usually half the price of full medical insurance cover.

With hospital insurance you may find that you still have to foot some of the bills yourself.

Hospital plans (not hospital insurance) are regulated by the Medical Schemes Act of 1998, explains Finance 24. Like medical schemes, hospital plans have to adhere to strict regulations stipulated by the Council for Medical Schemes, the regulatory body of the industry.

What else do hospital plans cover?

Mammograms, Pap smears, colonoscopies and other preventative procedures are usually covered, even if they are performed in the doctor’s surgery. This could prevent a large hospital bill, so there is grey area when it comes to this.

Also, by law the hospital plan needs to cover chronic medication for 26 prescribed chronic conditions.

Hospital plans also cover specialists in hospital. However, your particular plan may only cover admission to hospital on its particular network. This is a very common practice, even when you have a full medical aid package.

And yes, this means that you will be able to go to a private hospital for your care.

Hospital plan cover usually costs around R900-R1500 per person per month.