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Hospital Plans – Limitations When Opting for Hospital Plans


Be Aware of the Limitations When Opting for Hospital Plans

It is often said that for every lock there is a key and it was a very specific lock that the underwriters of the medical aid products known as hospital plans had in mind when they fashioned their key. As the title of these products implies, they are intended to cover the needs of a member in the event that they should become hospitalised. Typically, the requirement for in-patient treatment would be as a result of some medical or surgical emergency or perhaps an accident.

At all other times, however, any other healthcare expenses that may be incurred, such as the cost of visits to a GP, dentist, or optometrist, and any prescription charges that may arise from such visits, are strictly for the account of the individual and will receive no benefits under the terms of most hospital plans. It is therefore clear, in this case, that these products were not designed for everyone, but with a particular type of member in mind. In this case, the product was intended for the young, unmarried man or woman with good general health, but with a limited disposable income, sufficient only to handle any out-of-pocket medical expenses in the relatively unlikely event that this should prove necessary.

Despite this limitation, many of those who choose this type of product do not match the intended member profile but choose it because it is the cheapest available option and the only one that they feel they can afford. In practice, there is actually a cheaper option that was first introduced by insurance companies back in the ‘60s and is still offered today. Known as hospital cash plans, they are, unfortunately, even more limited than the products offered by medical aid schemes.

The word “cash” says it all. While the medical aid products cover most, if not all, of the actual private healthcare costs incurred as an in-patient, the insurance product simply pays a fixed daily sum of cash to the insured. Based upon the premium amount paid, these cash payments fall well short of the actual costs of treatment, medication, and hospitalisation. Furthermore, unlike the medical aid equivalent, they generally do not guarantee cover for all the expenses arising from chronic illnesses and other prescribed minimum benefits (PMBs) as mandated by the Medical Schemes Act. If you consider this option, it should be seen only as a means to meet any incidental expenses, to compensate for loss of income, or to meet any co-payments required under a comprehensive medical aid scheme.

In contrast to the more limited benefits provided under the hospital plans offered by many schemes, KeyHealth has striven to deliver cover that more comprehensively meets the needs of a member and their dependents, whilst also ensuring that the premiums are as affordable as possible. It would be near impossible to beat the range of additional core benefits included in our entry-level product. KeyHealth Essence combines the benefits of a quality hospital plan, including emergency ambulance services, with a number of those normally only provided by comprehensive medical aid products, such as unlimited chronic medication and treatment for PMBs. It also includes some unique and valuable core extras at no charge.