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Understanding the Essentials of Hospital Plans versus Medical Aid Schemes


In South Africa, both hospital plans and medical aid schemes are crucial components of the healthcare system, but they serve slightly different purposes and cater to different needs. Medical aid usually refers to a medical plan offered by medical scheme providers that covers more than just hospital costs. It’s designed to cover the consumer for both in- and out-of-hospital costs. These schemes help pay medical costs for a broad range of medical procedures, including hospitalisation. The level of healthcare cover provided depends on the type of plan chosen. The more comprehensive the plan is, the more healthcare cover will be available. Generally, the greater the degree of medical cover provided, the more the monthly premiums will be. Medical aid will cover a wide range of medical needs, including those that occur outside of a hospital.

Fundamentally, hospital plans can be viewed as a safety net rather than a comprehensive medical scheme, although some options nowadays offer attractive benefits. They cover the consumer’s medical costs when they need to be admitted to hospital. Typically, events such as heart attacks and motor vehicle accident injuries are covered by hospital plans among other medical emergencies that require hospital admission. The premiums for hospital plans are usually less costly than comprehensive medical aid cover because they provide more limited coverage. It’s worth noting that neither provides unlimited cover – both medical aids and hospital plans provide cover to the extent detailed in the specific policy in question.

Both schemes are medical aid products and by law must provide cover for a defined list of medical conditions.


Medical Aid Schemes

Medical aid schemes are comprehensive healthcare plans that cover a wide range of medical expenses, including hospitalisation, doctors’ visits, medication, optometry, and dentistry, in addition to direct hospital expenses, and several other medical procedures.

Members pay a monthly premium to belong to a medical aid scheme. Medical aid scheme providers typically offer different plan options with varying levels of coverage that offer a range of different premiums, allowing individuals to choose a plan that best suits their needs and that they can afford. Medical aid schemes often include benefits such as chronic medication cover, day-to-day medical expenses, and access to a network of healthcare providers.


Hospital Plans

Hospital plans may be seen as a subset of medical aid schemes that primarily cover expenses related to hospitalisation, surgery, and emergency medical care. The appeal of hospital plans is their relative affordability.

These plans are designed to protect consumers from the high costs associated with hospital stays, surgeries, and other major emergency medical procedures. Many consumers have little to no trust in the public healthcare system in South Africa. Public health services are typically described in the media as failing, crumbling, collapsing or woefully inadequate. Hospital plans provide consumers with the option of getting a quality standard of private medical care in a public healthcare environment that many consumers view as in decline.


Choose a Medical Scheme Provider Focused on Providing True Value

KeyHealth Medical is obsessed with delivering value to its members and nothing else. Everything we do is inspired by a single-minded focus on how we can give our members more without increasing their premiums. Whether it is affordable hospital plans or comprehensive medical aid, our aim is to provide members with the maximum value for every Rand they spend on healthcare.

As one of South Africa’s oldest and most trusted medical schemes, our focus remains to provide members with the essential, core healthcare benefits they need at a cost that they can afford. By directing our members to a network of specified medical professionals, clinics, and pharmacies, we can negotiate better tariffs allowing for more cover at lower cost.

Our drive to provide value to our members has resulted in the creation of innovative additional benefits, such as our Easy-ER benefit – a first-of-its-kind KeyHealth initiative. Easy-ER offers all KeyHealth beneficiaries, except for members in our entry-level hospital plan, direct access to a hospital’s emergency room for medical treatment in emergency situations at no extra charge. Additional innovative benefits include KeyHealth’s Smart Baby Programme which offers valuable maternity benefits, support, and general advice on health and wellness for the expecting mother and our Health Booster preventative care benefit. Health Booster aims to help beneficiaries stay healthy and avoid diseases and hospitalisation. It includes certain vaccinations and medications, early detection testing and support with weight loss.

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