health insurance

Ten Facts You Must Know About Hospital Plans


Due to alarming medical expenses, many South Africans have opted to use hospital plans to cover medical bills.

If a person is hospitalized, the idea is that the hospital plan will cover enough expenses to make the stay affordable.

There is a difference between a hospital plan and hospital insurance. Hospital insurance normally pays you a cash amount for each day you are in the hospital. While that may sound desirable when you consider missed wages while being hospitalized, understand that this insurance pays nothing to the hospital. The cost of the stay, treatment, doctors and tests are still to be paid by you. The cost of even a moderate stay could be thousands and the amount you collect will merely pay a portion.

Hospital plans are generally the most cost effective option; costing less than half the price of full medical coverage. Hospital plans (not hospital insurance) must follow stringent regulations specified by the Council for Medical Schemes according to the Medical Schemes Act of 1998.

Here are ten things you need to know about hospital plans.

  1. In order for your hospital plan to begin coverage, you must be admitted into the hospital. Trips to the trauma unit are not covered unless the doctor on duty decides to admit you.
  1. Hospital plans are required to cover you for 26 prescribed chronic conditions. An example would be hypertension. This means if you must take medications to control a covered chronic illness, the hospital plan would pay for that medication.
  1. Hospital plans are ideal for people who are healthy. Since your health requires only check-ups, dental, or optometrist visits; these low expenses are covered out of pocket. If your health changes and you require more extensive help, you may change your plan. The changes are usually allowed in January of each year.
  1. Hospital plans usually have a network of hospitals with which they have a contracted rate for their clients. What this means for you is quality care in a private hospital!
  1. Private Doctors and specialist in private hospitals have more freedom with the prices they charge. There are times when their services are much more than a hospital plan pays. You are always better off to use a doctor or specialist that is a designated service provider. Check with the hospital plan administrator before going in the hospital, in order to keep your cost down.
  1. To prevent paying co-payments consider taking out GAP coverage. It is inexpensive at roughly R100 per month.
  1. Use the pharmacies, and services designated by your hospital plan to get the most affordable options.
  1. In an emergency your hospital will contact your scheme to arrange admittance.
  1. Many doctor surgeries and procedures such as mammograms or colon ostomies are covered by your hospital plan.
  1. Even unlimited plans usually have caps on the maximum hospital bills they will pay per family.

Hospital plans are the way to go to keep your medical expenses down. Just be sure to check the details of your plan to make sure you have the coverage you expect.

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