Will a Hospital Plan Meet Your Private Healthcare Needs?

  • June 3rd, 2024

While the Covid-19 pandemic has taken many lives and caused widespread disruption, it has also taught us a valuable lesson. We should never take our health for granted. Most of us can generally cope with the odd cold or a bout of flu by dosing ourselves with affordable over-the-counter medications from a pharmacy or supermarket. However, how many could meet the cost of a major illness that might require a prolonged period of hospitalisation without help? For many, the only viable option will be a hospital plan.

Help with private healthcare expenses has been available to South Africans since the first Medical Schemes Act in 1967, since the state-funded service could not adequately meet the nation’s demands. Private medicine was unaffordable to most. Previously, the earliest form of assistance was offered by insurers who offered a policy that paid the holder a fixed sum of cash for each day spent as an in-patient. The payments failed to cover the total cost of hospitalisation, as it was more a means to cover incidental expenses and lost income. By contrast, today’s hospital plan is the product of a recognised medical scheme and is structured to meet most, and often all, of the in-patient costs incurred by its members. 

Alternatively, one could enrol in one of a medical scheme’s more expensive comprehensive products. However, the premium price alone should not determine your choice. Before reaching a decision, you need to understand how each option works and how effectively it will meet your anticipated healthcare needs. 

Who Benefits From a Hospital Plan

When first released, South Africa’s medical aid schemes intended the hospital plan as a more affordable alternative to fully comprehensive cover. It was aimed at younger, single members with good general health. They reasoned that such individuals could cope with the relatively modest costs of an occasional GP visit and prescription charge but could never cover the expense of hospitalisation and surgery in the event of a motor accident or other medical emergency. However, while this premise remains true, affordability has since become a more widespread issue that now affects many who were previously able to purchase more comprehensive products. Consequently, many who had chosen to invest in a hospital plan discovered that it did not meet their overall annual healthcare requirements.

The Inclusion of Prescribed Minimum Benefits

In its most basic form, the hospital plan product covers only those costs incurred whilst the member is under treatment as an in-patient. At all other times, the member must pay for any healthcare-related services. If a main member or dependent should have a chronic illness, those out-of-hospital expenses could be considerable and hard to handle. Fortunately, amendments to the Medical Schemes Act, introduced in 1998, compelled schemes to include certain prescribed minimum benefits in all their products. As a result, even a hospital plan must now include cover for twenty-five chronic illnesses, including asthma, diabetes, epilepsy and hypertension. 

While this was a significant bonus, some medical aid schemes have gone the extra mile, seeking ways to maximise the benefits included in this most affordable form of private healthcare cover. Medshield is the nation’s oldest scheme and one of the most innovative. It now offers members a choice of several highly-affordable hospital plans that incorporate numerous additional, unique and valuable core benefits as standard.

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