Medical Scheme Hospital Plan Selection in South Africa
When browsing for a medical scheme also consider the inclusion of a hospital plan for South Africa. No doubt, the biggest concern is that of serious injury, trauma or disease. In such an instance, you will want a medical scheme that covers the Prescribed Minimum Benefits for emergency care, allowing you peace of mind that you or your loved ones will receive the medical attention needed.
Cost Considerations
It is essential to consider the maximum payment of benefits when reviewing a hospital plan. As such, we recommend that you review all our plans and consider not only your monthly budget, but also the maximum benefit payable. For most conditions 100% payment of benefits applies, but note that pre-authorisation will be required for hospitalisation and specific treatments.
The most basic package is that of Essence. It is exceptionally affordable and the ideal package for someone that wants medical cover and a hospital plan without having to break the bank in the process. If, however, you want higher payment limits and more benefits, we recommend the Equilibrium and Silver packages. For the person that wants complete coverage the Gold and Platinum packages can be recommended.
Monthly Payments
Another consideration when shopping for a medical scheme in South Africa that includes a basic to comprehensive hospital plan range is that of the monthly payments needed. Note that it is often better to go with a package that offers fewer benefits and for some conditions payment limits than it is to opt for a package that you cannot afford. You need medical cover in South Africa to ensure that essential medical care can be paid for and if you miss monthly payments you risk not being covered in the specific period when you need it most.
Why is Pre-Authorisation Needed for Hospitalisation?
The member’s benefit package may not cover specific treatments or cover such according to terms and conditions. It is essential that the hospital administration knows which treatments are covered as to ensure correct billing. With pre-authorisation, we make provision for the treatments and hospitalisation. As such we also require information regarding planned procedures and the details of the doctors. This of course, is also for your protection since we will only approve treatment by a qualified doctor.
What Happens in Case of an Emergency?
In case of an emergency requiring immediate medical care and hospitalisation, and where the member is unable to obtain pre-authorisation, it is essential that a family member, friend or the hospital contact us to inform of the hospitalisation and treatments. This is to prevent fraud and to plan for payments that we must do.
An emergency can be described as a medical condition that is sudden or unexpected requiring immediate surgery, hospitalisation or medical care. If such treatment is not provided, the patient can suffer serious and lasting injury, loss of functioning or death.
Prescribed Minimum Benefits
It is also known in short as PMB, such are the minimum benefits payable as stated in the Medical Schemes Act No. 31 of 1998. The Council for Medical Schemes has a list of such conditions and emergency care covered. This simply means that the conditions listed must be included in benefits provided by a medical scheme.
DSP Hospitals
We have appointed the New National Hospital Network and state facilities falling within the PMB. DSP stands for Designated Service Provider and such a service provider is one that is approved by the Scheme and must be used by members to qualify for specific benefits. The service provider renders the services according to agreed tariffs.
Select an option that includes the preferred hospital plan for treatment in South Africa. View our full range of benefits and price structures.
