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Hospital Plan vs Medical Aid


Hospital Plan vs Full Medical Aid – How do You Choose?

The cost of providing healthcare in South Africa has been increasing annually in both the state-funded and private sectors, posing an ongoing challenge for the country’s medical schemes, which must endeavour to keep their monthly premium prices affordable. After years of attempting to provide fully-comprehensive cover to all their members, it became necessary to explore more affordable alternatives. The solution proved to be a product that catered solely to the needs of in-patients. However, how should one choose when evaluating a hospital plan vs full medical aid cover?

While the answer may appear simplistic, it is necessary first to understand what each has to offer and then to determine which will best meet your known and anticipated needs. Let’s begin by exploring the main differences between these two options.


The Differences Between the Hospital Plan vs Full Medical Aid

Firstly, there is a good reason why the newer product is significantly more affordable. Simply put, you will be getting less for your money. However, don’t be deterred. These products now offer peace of mind regarding their private healthcare expenses for many South Africans. In practice, in the hospital plan vs medical aid contest, the former has much to offer those with limited finances.

In its original “bare bones” format, the product was aimed at young, single individuals with good general health no longer eligible as dependent members in a parent’s scheme. It offered cover during periods of enforced hospitalisation due to an accident or medical emergency. Thus members were protected from the crippling costs of such treatment, but all benefits ceased once they were discharged. Any bills for occasional GP visits or medication were for the member’s account. In practice, hospital plan vs medical aid comparisons have gradually become less clear-cut.


Prescribed Minimum Benefits (PMBs)

The first significant change occurred in 1998 when regulations enacted under the Medical Schemes Act mandated that all schemes include certain prescribed minimum benefits (PMBs) in each of their products. Immediately those with chronic illnesses who would previously have needed to purchase fully comprehensive cover were presented with a significantly cheaper alternative. In essence, the act partially levelled the playing field for the hospital plan vs medical aid match, allowing people with asthma, diabetics, epileptic patients and those with any of 23 other named chronic illnesses to benefit from the former and cheaper option in many cases.


Day-to-Day Benefits

Despite this significant extension of benefits, many people still require more comprehensive cover. For example, although dentistry does not usually require hospitalisation, a prolonged course of specialised dental treatment can be expensive and not easy to settle from one’s monthly salary. In their efforts to solve this problem, scheme managers have sought ways to narrow the traditional hospital plan vs medical aid gap, providing additional day-to-day benefits with the cheaper option. Matching people’s private healthcare requirements to their available income can be challenging. However, at KeyHealth, we are confident we have developed the best possible solution. Rather than maintaining such clearly defined differences between in-patient and more comprehensive cover, we now offer several plans that include different levels of day-to-day support to meet a broad range of budgets.


KeyHealth’s 6 Cover Options

The selection of six KeyHealth products begins with our entry-level offering known as Essence. This option is intended to rectify some of the hospital plan vs medical aid disparity by combining unlimited private in-patient benefits with medication for 26 chronic diseases and supplementary cover for psychiatric treatment, prostheses, medical appliances, endoscopy and emergency ambulance transport.

For those who can afford a little extra but cannot pay for a more comprehensive product, Origin combines all the benefits of Essence with additional out-patient cover for GP visits, X-rays, physiotherapy, dentistry, pathology and ophthalmic services. Naturally, there must be a limit to the total value of these out-of-hospital benefits, but this is an ideal option for a family where one individual experiences most of the health issues.

Next in the hospital plan vs medical aid contest is the KeyHealth Equilibrium option. This product aims to extend the total value of out-of-hospital benefits beyond that offered with Origin. The additional monthly premium contributes to an integrated savings account that allows members to draw from as and when required. In addition, this product provides cover for three more chronic medical conditions. Those who need and can afford fully-comprehensive cover can choose from our Silver, Gold and Platinum offerings.

Before you become embroiled in a hospital plan vs medical aid debate, consider Keyhealth’s products – all of which include three valuable additional core benefits at no extra charge. Get a quote today.