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Hospital Plan – Affordable Hospital Plans in South Africa


Finding an Affordable Hospital Plan in South Africa

Anyone who has been a member of medical aid scheme for ten years or more will be fully aware of how their monthly premiums have risen and, in many cases, this may well have been accompanied by a reduction in some of their schemes’ benefits. The explanation is simple enough. The combination of inflation and the emergence of expensive new technology has seen the cost of private healthcare spiralling from one year to the next, making higher premiums and/or reduced benefits largely unavoidable.

These same trends have, of course, had a similar effect on the state-funded health services and, together with the increased burden created by the large number of unemployed patients who cannot even afford a nominal contribution, have led to day-long queues, huge waiting lists and many clinics limited to providing primary care. Under these circumstances, the public demand for cheaper private healthcare cover has prompted many schemes in South Africa to offer members affordable hospital plans as an alternative to their more comprehensive and costlier products.

In fact, these products are not really new, but a much improved version of the first healthcare insurance policies developed in the ’50s and, appropriately, marketed by the nation’s long- and short-term insurers. Their products remain available today and are better known as hospital cash plans. Their benefits only apply during periods as an in-patient and do not come close to meeting the actually expenses incurred. They are best seen as a means to compensate for lost income or to cover any co-payments that may arise from claims made upon more comprehensive products.

Where the affordable hospital plans developed by the dedicated medical schemes in South Africa have the edge, lies in the fact that the benefits paid are related directly to the cost of the healthcare services provided. Furthermore, all costs relating to the minimum prescribed benefits are now required by law to be covered, even when not the reason for the admission.

On the downside, almost all such plans provide cover exclusively for those days during which a member remains hospitalised and may not even cover the cost of medication provided upon discharge. All other expenses, such as GP visits and prescription charges throughout the remainder of the year, will be strictly for the account of the member.

Clearly then, despite the fact that they are affordable, hospital plans are not the most suitable option for the average family in South Africa. In practice, they were designed to meet the needs of young, unmarried men and women whose general health is good and whose income was adequate to cover any out-of-pocket other medical expense that might otherwise arise. The product offers them a means to protect themselves against the potentially crippling cost of and accident or some other emergency that requires hospitalisation.

While this may not sound like good news for someone who may be hoping to save money without the need to forfeit too much cover, fortunately, there is a better option. At KeyHealth, we have developed an entry-level product that combines the elements of an affordable hospital plan with a number of additional benefits that apply throughout the year, including dentistry and our unique Easy-ER, Smart Baby and Health Booster services as standard.