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What to Consider when Choosing a Hospital Plan


In South Africa, healthcare is a critical consideration for individuals and families who wish to have access to quality medical services. With the rising cost of medical treatment and the increasing demand for healthcare services, the hospital plan can be an ideal entry point to accessing medical cover.

As the name suggests, hospital plans are specifically aimed at covering the consumer’s medical expenses during hospitalisation. They cover heart attacks and injuries from motor vehicle accidents, for example, as well as any other medical emergency which would require hospital admission. The premiums for these plans tend to be lower than the premiums for complete medical aid cover as they provide less comprehensive cover.

A medical aid scheme covers more than just hospital expenses. It is usually structured to provide coverage for both inpatient and outpatient medical costs. Medical schemes assist in covering expenses for a wide array of medical procedures, including hospitalisation. To make an informed decision, it’s essential to understand exactly what cover is provided and at what monthly cost.


Key Considerations when Choosing a Hospital Plan

The first step in choosing a hospital plan is to look carefully at the coverage and benefits offered. Does the plan include hospitalisation, surgery, consultations, medication, and chronic illness management? Are maternity benefits, emergency services, and specialist consultations covered? Ensure that the plan aligns with your specific healthcare needs and offers the level of coverage you and your family require.

Is the use of a specific network of hospitals and healthcare providers stipulated? If so, are your preferred hospitals and doctors included in the network and are they close to your residence or workplace? Opting for a plan with a broad network of facilities and healthcare providers ensures convenient access to healthcare services when needed.


Assessing the Costs

Cost is always a significant factor when choosing a hospital plan. Compare the premiums of different plans and assess whether you can afford them. Check whether there are any additional costs, such as co-payments, deductibles, and out-of-pocket expenses over and above the monthly premium. While a lower premium may seem attractive, check that essential coverage isn’t compromised or that you won’t incur high out-of-pocket costs during a medical emergency.


Considerations Outside of the Direct Benefits

Look at factors that demonstrate the quality of customer service and support you can expect from the medical aid scheme that you are looking at using. Test how easy it is to reach customer service representatives and their responsiveness to inquiries. Research what their reputation is with claims processing. Look for reviews and testimonials from existing policyholders to gauge their satisfaction with the services provided. A reputable, reliable medical scheme with excellent customer service will provide peace of mind that you can rely on timely assistance during medical emergencies.

Check their accreditation with the relevant regulatory bodies such as the Council for Medical Schemes (CMS) in South Africa. Accreditation ensures compliance with industry standards and adherence to ethical practices.

It goes without saying that the medical scheme offering the hospital plan should be financially stable and solvent. Financially sound schemes are best equipped to fulfil their obligations and provide continuous cover. A medical aid provider’s financial rating may be established through independent rating agencies or the industry’s regulatory authorities.


Additional Benefits and Wellness Programmes

Consider any additional benefits and wellness programmes offered with the hospital plan. Some plans provide access to wellness initiatives such as health screenings, preventative care services, and lifestyle management programmes at no extra cost. These additional benefits can contribute to your overall well-being and help prevent future health issues.


Choose a Healthcare Cover Provider Focused on Your Health

KeyHealth Medical is obsessed with delivering value to its members and is one of South Africa’s oldest and most trusted hospital plan and medical aid providers. Members of our hospital plans, except for the entry-level Essence plan, qualify for Easy-ER which allows for direct access to a hospital’s emergency room for medical treatment in emergency situations at no extra charge. Additional innovative free benefits include KeyHealth’s Smart Baby Programme for valuable maternity benefits, and KeyHealth’s Health Booster wellness and preventative care benefit.


Get the best value-for-money hospital plan without compromising on the quality of your healthcare. Contact KeyHealth today for more information or visit our website.