Hospital Plans, Medical Insurance and Comprehensive Medical plans

If you are a young, active and healthy individual, or have just started a small family, you may benefit from choosing a hospital plan. Selfmed’s MEDXXI plan offers a complete hospital plan.

In choosing medical aid cover, people nowadays increasingly tend to opt for hospital plans or health insurance products instead of full comprehensive medical plans. The reason for this trend is that hospital plans are seen to be more affordable than the traditional medical aid plans, which in recent years have become a luxury for many families. People are also increasingly willing to manage their day-to-day primary healthcare expense themselves by using facilities such as Medical Savings Accounts (MSAs) or medical credit/debit cards. Hospital plans allow you more direct control over your medical spending and the management of your budget, but be aware that they differ significantly from medical insurance and comprehensive medical plans in terms of their levels of medical cover…

Comparing medical insurance, hospital plans and comprehensive
medical aid

There are some key differences between these three types of products. Hospital plans occupy a middle ground of sorts between medical insurance and comprehensive medical plans, not only in terms of the levels of cover they give, but also in terms of the pricing. Hospital plan is the ideal option if you are looking for complete health cover in terms of major medical expenses at a reasonable fixed monthly price. Review Selfmed’s hospital plan and its benefits to get an idea of the features and medical benefits involved.

Difference between medical insurance and hospital plans offered by medical schemes

Medical insurance is a simple insurance policy that is taken out from insurance companies and covers you for a set amount per day for your hospitalisation needs (typical payouts might start at R300 per night spent in hospital). Alternatively, such policies may pay out a set fee for specific procedures. Many insurance companies - and even banks that have insurance companies underwrite policies - are offering these and referring to them as “hospital plans” or "cash back hospital plans". Always beware of the small print and make sure that you understand the meaning of all the exclusion and limitations.

So why not opt for a hospital plan offered by an insurance company?

Quite simply said, a medical aid offering you a hospital plan will offer you significantly higher levels of cover – and peace of mind - despite the fact that it might cost slightly more than the insurance policy.

With most medical insurance cover plans, you can also choose where you want the operation to take place. Additionally, any surplus that the insurance pays out in the lump – over and above the price you pay for the procedure – you even get to keep. Some of them also offer you cash-back incentives and no-claims bonuses. This is also very different to a true hospital plan offered by a medical aid, which is a product negotiated by the medical aid schemes with hospital chains, where 100% of the agreed tariffs are covered if a preferred provider is used.

Very often a good hospital plan will even allow for unlimited in-hospital procedures and usually pays standard medical aid tariffs or BHF rates. If you are involved in a serious vehicle accident, for example, your hospital bills could easily be upwards of R100 000 for a single person; and much more for an entire family to be hospitalised, especially if you need to be in the emergency ward or intensive care unit of a private hospital.

Also, if there are complications with an operation, costs can soar even higher. This is where a hospital plan is indispensable: It allows you to have the peace of mind that you are covered more fully, and won’t just receive a once-off payout on diagnosis of a condition, or for a type of operation where the benefits payable to you will be capped and limited.

Plans from medical schemes are typically healthcare products where you manage day-to-day medical expenses yourself, so paying standard medical consultation bills and over-the-counter medicines remains your responsibility. Actual payouts are done by your medical scheme to the service provider, in this case the hospital, so you are also not left with all the hassles and paperwork associated with being hospitalised.

Difference between hospital plans and comprehensive plans

The key difference between hospital plans and more comprehensive options is that a comprehensive medical aid plan will make provision for out-of-hospital expenditure such as regular doctor visits and medicines. Hospital plans usually do not cover these services, so out-of-hospital expenses such as optometrists, dentists and alternative health services will need to be settled by the member.

Which plan should I choose – basic or comprehensive?

In determining your medical cover needs and benefits, always make sure you make an informed decision by speaking to a consultant to find more about the available medical aid options.

    More on choosing a hospital plan
    Paying for hospitalisation
    Hospital plans and emergency hospital admittance
    Pre-Authorised admissions on hospital plans
    Overview of hospital plans