Hospital Plans: Still the best for covering hospitalisation expenses

The cost implications of hospitalisation at a private hospital, as opposed to a state-subsidised public hospital, are considerable. When one considers the fact that overnight hospitalisation – for any number of days – can result in costs amounting to tens of thousands of Rands, the issue of hospital bill payment becomes a lot more pressing to consider.

Selfmed explores the various methods of making provision towards hospitalisation expenses, and also takes a look at why having a hospital plan still beats most other methods of paying for hospitalisation.

Private hospitals, unlike public hospitals, are not run on taxpayers’ money. As such, operational costs are recovered by charging patients for medical services rendered or treatments administered. Where patients are hospitalised for a number of days and undergo major surgery or receive treatment for injuries sustained during an accident, the costs of treatment can be financially debilitating.

As an adult, it is critical to make provisions for such eventualities. There are a couple of ways to do this:

Do medical insurance policies provide sufficient cover?

There are many medical insurance type policies that pay out a lump sum if the policyholder is involved in an accident, or is diagnosed with certain specified dread or chronic diseases. The problem with such insurance policies is that the benefit is often a fixed amount. Although a payout of R20 000, for example, may seem like a lot of money, it is critical to be aware of the fact that medical procedures like open heart surgery may amount to more than R100 000, depending on complications.

Even if such policies extend to family members of the policyholder, these may not be sufficient if the entire family were to be involved in a serious car accident. Apart from this, many medical insurance policies may only cover hospitalisation for specific treatments, conditions or accidents. As such, these may not be suitable for families.

Savings funds – but no medical aid

The same problem applies for slush funds or personal “nest egg” savings. Even if you were to have enough savings to sustain your family for several months, these funds will be depleted very quickly if your entire family were to require treatment for serious injuries. Especially over weekends, you may also experience difficulties in accessing these funds. If you are unconscious at the time, you won’t be able to produce the cash required for private hospital admittance – which could prove to be disastrous if your injuries are serious.

Road Accidents Fund Claims

Under certain circumstances, claims for medical costs and personal suffering may be submitted to the South African Road Accidents Fund. There are many requirements for these to be approved and paid out, such as that the claimant was not reckless or drinking and driving. The problem with using this type of payment for hospital costs is that the RAF can take up to 18 months to process a claim – and success is not guaranteed. As such, private hospitals may refuse you access to hospitalisation, unless you are able to pay in cash up-front.

Apart from the fact that you may not be conscious at the time when hospitalisation is required, carrying that amount of cash is not feasible. And, with the exception of certain medical aid affiliated credit cards, credit cards are generally not accepted as a guarantee of payment either.

The benefits of a hospital plan

The major benefit of hospital plans is that these give the policyholder and beneficiaries guaranteed admittance into a private hospital, subject to the limitations of the particular hospital plan. Apart from these being particularly cost-effective, most of these products also offer 100% of hospitalisation cover for a prolonged or even unlimited period of time. As such, a hospital plan such as Selfmed’s MEDXXI Option is particularly well-suited for the potential hospitalisation needs of young adults and families alike.

What about injuries sustained in the workplace?

There are specific circumstances under which other entities may be liable to pay a person’s hospitalisation bills. If an employee is injured on the job, or as a direct result of performing his or her job, a piece of South African legislation known as the COID Act (Compensation for Occupational Injuries and Disease Act) determines that the Compensation Commissioner must cover the costs of hospitalisation and treatment. This piece of legislation has implications for the employee, such as that the company needs to report on their earnings, business activities and the number of staff members employed.

The Compensation Commissioner’s office issues the employer with an annual assessment and insurance billing. This is especially critical in businesses or industrial sectors (construction, heavy industry, etc.) where the risk for sustaining injuries is relatively high.

All things considered, it makes sense to utilise a hospital plan for settling hospitalisation costs. Private hospitals are geared for verifying and accepting hospital plan members for treatment, and beneficiaries are guaranteed to be granted access to private medical treatment when they need it most.

    More on choosing a hospital plan
    Hospital plans and emergency hospital admittance
    Pre-Authorised admissions on hospital plans