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Interesting articles about the Medical Aid industry and Medshield position in it
Posted in Articles   |   July 24th, 2018
The public healthcare sector is overburdened. The majority of South Africans do not belong to medical schemesand do not have hospital plans. As a result, most people in South Africa rely on the public healthcare system. With limited funds, however, the public healthcare system cannot sustain the burden. It is not uncommon to see long queues at public healthcare clinics and at hospitals where patients are waiting for treatment. Many of the public hospitals have already closed during the past twenty years and as such, more pressure is placed on those still in operation
Add to the crisis, an increase in vehicle accidents and the number of people diagnosed with life-threatening conditions, such as cancer, tuberculosis, and AIDS, in addition to stress-related disorders, and one can understand the need for a viable solution.
Numerous private healthcare facilities have been developed over the same period, specifically to provide high-quality medical care to patients able to afford such or those that are members of medical schemes in South Africa. However, to cater to the needs of lower- and middle-income earners, many medical aids now offer hospital plans, making it possible for members to use private hospitals instead of relying on the public healthcare system.
These hospital plans are not the same as the hospital cash back plans where people pay monthly premiums and receive cash back in their accounts upon hospitalisation. The medical aid hospital plans form part of medical scheme benefit plans, enabling members to receive cover for in-hospital treatments according to the benefit limitations of their particular medical scheme and benefits plans.
With the hospital plans in South Africa, a wider section of the population can now afford private healthcare. All the hospital plans cover the conditions forming part of the prescribed minimum benefits (PMBs) list, including 27 chronic conditions and 270 life-threatening medical conditions. As such, hospital plans have made essential medical cover more affordable in South Africa.
Medshield is one of the medical schemes in South Africa that offer benefits plans that include hospital plans. This Scheme puts the member in control of their own expenses and has an offering for everyone – whether the member wants an all-inclusive and comprehensive benefit plan that includes extensive day-to-day cover and in-hospital cover, or only wants a hospital plan with superb coverage and no day-to-day benefits.
An example is the MediCore benefits plan, which includes unlimited in-hospital cover through the Medshield Hospital Network, while certain procedures are paid at the Medshield Private Tariff of 200% instead of the normal Medshield Tariff of 100%. It is the perfect hospital plan for young people who do not require extensive day-to-day coverage.
Subject to pre-authorisation, unlimited in-hospital specialist treatments are included in the cover according to the limits and terms & conditions of the MediCore benefit plan. Medicine on discharge from the hospital is also covered if the medicine is obtained from a network pharmacy on the day of discharge.
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