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What to Know When Considering Hospital Plans


The pandemic has been a wake-up call for many South Africans. It taught us that even those who enjoy excellent general health could fall victim to the virus, leaving them fighting for their lives in an intensive care unit. However, the outbreak of Covid-19 also had other consequences. It severely damaged critical sectors of our economy and left many people out of work and struggling to keep up with their bills. One result of the economic downturn has been an increased interest in hospital plans. However, while this is the most affordable private healthcare cover available, it might not be suitable for everyone. Before committing to membership, there are a few points you may need to consider.


Coverage of In-patient Treatments

Firstly, in most cases, this cover will only assist with your medical expenses while receiving treatment as an in-patient. For the remainder of the membership year, you will generally be personally responsible for all other healthcare costs, such as GP visits and prescription charges. Typically, hospital plans do not even cover the cost of a visit to an emergency unit unless you are admitted. If you have diabetes, suffer from asthma or have another ongoing illness, you might believe this is not a suitable option for you. However, you would be wrong.


PMBs are Fully Covered

After the Council for Medical Schemes (CMS) was formed, the statutory body mandated that its members include cover for certain prescribed minimum benefits (PMBs) in every product. These include full cover for the diagnosis, treatment and care of twenty-six chronic illnesses. Consequently, a scheme’s hospital plans must help meet the costs of the member’s treatment while hospitalised plus any expenses arising due to PMBs during the remainder of the membership year. Other chronic conditions also named by the terms of the Medical Schemes Act include ulcerative colitis, rheumatoid arthritis, multiple sclerosis, hypertension and epilepsy. The remaining qualifying chronic illnesses and more details of the relevant mandatory support are available on the CMS website.


It’s a More Affordable Cover Option

This type of product is undoubtedly the most affordable and appropriate option for someone with one of these conditions and a limited income. More importantly, could a hospital plan meet your needs and those of your family? When these products were first launched, they were aimed at young, single individuals with sound general health. Young people starting a new job often find it difficult to afford more comprehensive cover. Furthermore, they could never meet the crippling cost of hospitalisation and treatment following a motor accident or a sudden medical emergency. Medical aid companies introduced this limited but more affordable option to cater for those in this position. It is not only young people struggling to afford more comprehensive products today. Thus hospital plans have had to undergo some changes to accommodate the needs of older members and their families.

Scheme managers have had to find ways to extend their cover while attempting to keep premium prices to a minimum. One effective way to achieve this is to appoint a network of preferred service providers. While the ministry of health provides guidelines regarding the fees for all procedures and medicines, doctors and clinics in South Africa are not legally obliged to observe them. Instead, some may charge as much as three or even five times the recommended rate. However, when compiling hospital plans, some medical schemes have negotiated more favourable terms with preferred service providers. As a result, they have been able to meet most if not all of their members’ private healthcare expenses while minimising the need to hike the monthly premiums.


Choose KeyHealth’s Essence Option

You should not be influenced by the premium price alone. Some schemes have chosen to limit the benefits included in their products to reduce costs and maintain more affordable payments. Others attempt to justify the higher prices with attractive “free” incentives. Given the fundamental restrictions of hospital plans, you need to focus on getting the most for your money.

For many South Africans, the solution is an innovative yet highly-affordable product from KeyHealth, one of the nation’s oldest and most trusted medical schemes. Our Essence option offers unlimited cover for most major medical expenses incurred as an in-patient and for any chronic medication used continuously for three months or more. In addition to unlimited PMBs and emergency road or air ambulance transportation, Essence also includes three unique core benefits at no extra cost. We invite you to view more details of this exceptionally comprehensive hospital plan.