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What Does a Hospital Plan Cover?


As the cost of private healthcare rises, so too does the cost of providing medical aid, forcing funds to adopt measures to limit premium prices in order to retain sufficient membership to sustain their operations. One such measure has been the introduction of the hospital plan. However, it is important to be sure what it does and does not cover before committing yourself and your dependents to this option.

Although the most affordable option, the lower premiums are only possible because the benefits they secure are limited compared with costlier options. Furthermore, those which are offered may differ significantly between medical aids, so it is necessary to make careful comparisons to ensure that your most important needs will be met.

In fact, the name given to this type of product is a clear indication of its most obvious limitation. What a hospital plan does cover will apply only whilst the member is undergoing treatment as an in-patient. All other services, such as visits to a general practitioner or specialist physician, as well as any related medication will need to be paid for by the member.

In general, this is an option that will be best suited to younger members, who have no dependents and have good general health, but who need to insure themselves from the unexpected, such as the potentially crippling cost of treatment for extensive injuries incurred in a motor accident. By contrast, for anyone who is affected by a chronic illness and is in need of year-round consultation and treatment, such limited benefits would be totally impractical.

The most comprehensive offering in the category is undoubtedly “Essence” from KeyHealth. So, what does this hospital plan cover that makes it so different? Not only does it include unlimited payment of all in-patient costs, including those arising from accidental injury, but it also provides some uniquely valuable core benefits with its Easy-ER, Health Booster, and Smart Baby Programme.

A word of caution; do not confuse these products with the hospital cash plans sold by insurance companies. They pay a fixed daily sum that is far less than the treatment costs.