In order to compare the various hospital plans offered in South Africa, it is first necessary to understand how they differ from other medical aid products. Once this is clearly understood, the next step is to become familiar with the alternative ways in which such plans may actually operate. Armed with these insights, it should then prove far easier to make an informed choice that will best serve your needs and those of any dependents.
The most obvious difference between hospital plans and cover offered by other products within a given medical scheme is implicit in the descriptive title. All benefits only apply only during periods of hospitalisation. This means that if you suffer from a chronic illness that requires you to pay regular visits to your GP, the cost will not be covered by your hospital plan and so, in this respect alone hospital plans do not compare fully with other more comprehensive, though correspondingly more expensive, products that are offered by most medical aid schemes.
In practice then, this abridged form of cover is really best suited to members whose general state of health is remarkably and consistently good, thus their need for the services of a general practitioner is sufficiently minimal and he or she is able to cope comfortably with the related expenses on an out-of-pocket basis. Following new legislation, members suffering from certain defined chronic conditions are now assured that expenses arising from such conditions will be met if they are hospitalised, this cover extends to any necessary medication as well. This means that, for anyone who has the means to meet his or her routine expenses, cover for emergency admissions could be all that is required.
To compare hospital plans effectively requires some understanding of the three main types of product. Each differs from the other in terms of cost, the extent of cover and freedom of choice in selecting healthcare providers. The Health Maintenance Organisation (HMO) type of product is the most common option and is a prepaid plan designed to extend comprehensive cover when hospitalised. It covers emergency care, radiology, laboratory tests, surgery and accommodation while providing a choice of specialists and facilities from which members may select. Should a member elect, instead, to use an unlisted provider, additional fees and co-payments will normally apply.
The main alternative to an HMO product is the PPO or Preferred Provider Organisation model – both offer benefits that will need to be weighed when you set out to compare hospital plans. The biggest advantage of the latter is that this type of product will meet most of your major expenses in full while you are hospitalised and it also provide support from a variety of preventative treatments, such a primary doctor visits, immunisation and mammography. These plans, however, restrict the choice of service providers to those nominated as part of the relevant scheme’s network.
Though much less common than the either of the types described so far, the third type of plan, known as the POS or Point of Service model, combines features from both the HMO and PPO types of cover. However, it differs from each in offering members far greater freedom of choice when selecting their primary service providers.
Ultimately, however, once you decide that it is time to compare the available hospital plans, you will need to bear in mind that all forms of insurance must be based upon perceived risk and the need for an insurer to maintain the level of solvency required to ensure the payment of claims. For this reason, fund managers are faced with no choice but to pursue an ongoing balancing act between benefits and premiums.
At this point, your personal needs should be examined very closely. Will the product you select, for instance, include cover for the possible maternity and paediatric needs of your wife? Will it cover the costs of medication that may be prescribed post hospitalisation? You need satisfactory answers to these and other similar questions before making any commitment.
Equally important is to determine just how dependable the company behind the product may be. In the case of Medshield, more than 50 years in this business is a reassuring testimonial and our reputation for innovation, fairness and value means you need look no further when you compare hospital plans.
