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A Hospital Plan May Not Provide the Cover You Most Need


Given the current financial climate, many South Africans settle for a hospital plan, but this may not always meet all their private healthcare needs. The concept of offering financial assistance with hospital bills is far from new. It was first introduced by the insurance industry several years before the formation of the medical aid schemes we are familiar with today, and their solution is still available.

The insurance product referred to is the hospital cash plan and was never designed to pay for an inpatient’s treatment and accommodation costs. In practice, its aim was and remains to provide the policyholder with a daily sum to help meet any secondary expenses arising from hospitalisation. These might include lost income and travel costs for relatives. Today, these low-cost insurance products are frequently used to provide gap cover to supplement modern medical aid products.

When medical aid schemes were finally launched, their primary purpose was to fund most, if not all, of the private healthcare expenses incurred due to illness. Medical aids first offered their members cover on a fully comprehensive basis. However, not long after, the industry recognised a growing need for a more affordable option and launched a cheaper but significantly more limited form of cover we now know as a hospital plan.


Understanding the limitations of a hospital plan

Although these products remain the most affordable form of medical aid, it is vital that members understand what they do and do not cover. The contingencies catered for, and the maximum claim entitlements can vary considerably between different schemes and individual products.

The failure of the rapidly deteriorating, underfunded public health service has only increased the need for more affordable medical aid. Many medical aids now offer a choice of plans ranging from entry-level products to others with higher claim limits and varying levels of day-to-day cover, attempting to meet the needs of as many South Africans as possible. That said, even the most comprehensive of these have their limitations. Whichever you may choose, you should take note of the following:

  • Waiting periods: All schemes impose waiting periods for new members to prevent people from enrolling when they require expensive treatment and cancelling their membership once their claims have been paid. Only if you have been a member of another scheme within three months of your application will this rule be waived. Also, anyone with a pre-existing condition may not submit claims for that condition during the first 12 months of their membership.
  • Day-to-day benefits: In its most basic form, the hospital plan is aimed at young, single and generally healthy individuals whose sole worry is the extremely high cost of surgery or some medical emergency requiring a lengthy hospital stay. Those choosing an entry-level option must pay for GP and specialist visits and medication from their own pockets. A hospital plan is unlikely to be your best option if these are usually quite substantial.
  • Chronic illnesses: All medical aids are obligated under the Medical Schemes Act to provide certain prescribed minimum benefits (PMBs). These include the diagnosis, treatment and care of 26 chronic diseases, such as asthma, diabetes and epilepsy. However, the terms governing waiting periods for new members will still apply.


One cannot guarantee continued good health

It is easy for a normally healthy individual to fall into the trap of believing they are invincible. Many who previously believed this, experienced a rude awakening when the COVID-19 pandemic struck the nation in March 2020. By contrast, even those with the most basic cover qualified for a stay in an intensive care unit, an option that was to save thousands of lives worldwide.

This tragic event should remind everyone that the unexpected can change our lives overnight. For many, medical aid is not merely an option but a necessity. As we age, we can no longer expect a life free of illness, and a hospital plan may no longer adequately cover our more extensive healthcare costs. As a general guideline, it is probably time to consider a more comprehensive medical aid option.

Many South Africans choose KeyHealth, one of the nation’s oldest and most trusted schemes, with a choice of six products, each offering three free additional valuable core benefits. Contact us today and ensure you and your family receive the protection they need.