Medical Cover and Medical Aid Limitations

Levels of medical cover

The level of medical cover can differ significantly between comprehensive medical aid plans and hospital plans. Although young adults may not have major day-to-day medical aid requirements, they may need to undergo emergency surgery in case of an accident, for example.

It is here where the level of cover of your health insurance plan becomes crucial. For example: A hospital plan may cover 150% of prescribed medical service fees, whereas a comprehensive medical aid plan may cover up to 300% of this standard tariff.

Taking into consideration the fact that specialist medical professionals such as surgeons do charge up to 300% of this medical tariff, it is preferable to have a plan that offers a higher level of medical cover.

What is major medical coverage?

Major medical coverage is applicable to major procedures such as surgical operations or medical procedures requiring anaesthetic for the purpose of medical investigation.

In order for most hospital plans to give you major medical coverage, you will need to be hospitalised, and will probably need to spend the night. Unless you spend the night (as for procedures such as anaesthetised wisdom tooth removal) you usually won’t be covered by most hospital plans.

What are the limits on hospital cover?

Every scheme’s hospital plans and comprehensive medical aid plans will have unique levels of cover – and unique medical hospital cover limits.

Be sure to find out what the limits are on any medical aid plan’s hospital cover before you sign up, as you won’t be able to upgrade your medical aid plan at short notice. Unlimited Benefits Explained

Contact a Selfmed medical aid consultant to find out more about topics such as hospital cover, medical aid benefits as well as the benefits and limitations of their range of medical aid plans.