Health or Medical Insurance and Hospital Plans in South Africa

In the event of hospitalisation (due to an accident or medical emergency), Hospital Plans or Health and Medical Insurance, will help to take care of you and your family – should your life be disrupted by the unforeseen costs of medical expenses.

 Is hospital accommodation covered in Hospital Plan or Health/ Medical Insurance
Is hospital accommodation covered in your Hospital
Plan / Health or Medical Insurance?
 Need Hospital Plan or Health & Medical Insurance Assistance
 Broker Directory News

See Health, Medical or Hospital Plan News:

•  Your Guide to Medical Aid and Insurance Costs (November 15, 2018)
•  Comparing and Understanding Medical Aids in 2018 (January 20, 2018)
•  Choosing a medical scheme for your parents (November 24, 2017)
•  Medical Aid Review Questions (October 19, 2017)
•  Taking on the High Cost of Healthcare (October 06, 2017)
•  What you should know when changing Medical Schemes (September 23, 2017)
•  Medical Gap Cover in SA (March 01, 2017)
•  How to Select the Right Medical Plan (February 17, 2017)

Your health is your most important financial asset, but even the healthiest of us could fall victim to disease & illness.

Hospital Plans and/or Health and Medical Insurance, provide benefits to ease the burden of unexpected expenses.

Health Insurance and medical aid only came about in South Africa in the 1980’s. Since then, vast improvements have been made on cover options – services and competition is fierce amongst the medical schemes and insurers, in offering private hospital plans. There are however, plans from government to make drastic changes within this space.

There are various Hospital Plans or Health Insurance schemes, where a host of insurers offering health insurance, medical cover and hospital plan options. Clients should take the time to peruse all options before making a final product selection.

Note also that there are many restrictions and conditions that may apply to the various products – so study and understand your product options well.

As with most Hospital Plans or Health Insurance products, your benefits and medical cover options will largely be dictated by what you can afford to pay, your medical condition, age and some other factors.

Do a proper need analyses and consider your available budget, as many cover options are available.

In fact, the smartest thing you can do is -- Get a specialist broker to do it for you!
Also, note the following guidelines, tips and considerations with regards to Hospital Plans or Health & Medical Insurance:
  • Most private medical insurances would offer Hospital Plans and Day-to-Day benefits:
    • The Hospital Plan would cover all, or some of the costs of hospital treatment, such as doctor’s charges and hospital accommodation.
    • Day-to-Day Plans on the other hand, help you pay for the 'everyday' costs of staying healthy – such as going to the dentist, getting prescription glasses, or even acute or chronic medication.
    • You may also combine the cover with certain products.
  • Health Insurance group schemes may also offer a solution for employer groups wanting to offer private medical aid to their employees.
  • Some age restrictions may apply to qualify for certain Hospital Plans or Health Insurance products.
  • All Hospital Plans have to pay for medication for 27 Prescribed Minimum Benefits (PMB) Chronic Disease Conditions. However, some may limit your rand value, or opt for generic medicine.
  • Daily cash limits for hospitalisation may be included, along with hospitalisation due to illness or accident and maternity. Certain products also provide cover for accidental death, disability and dreaded disease.
  • Some Hospital Plans may cover you for emergencies when travelling.
  • Certain Hospital Plans may extend cover to include access to advanced medical care, both in South Africa and abroad.
  • Check if your Hospital plan caters for a savings element for either day-to-day expenses, or for those unlimited and above your cover threshold. Check the rates on offer for general treatment, versus the average service fees charged. You may end up having to pay in, if the service provider of your choice charges more than your allowed rate.
  • See if your Hospital Plan covers you in full for medicine listed on the chronic list and additional, or only chronic. There are many restrictions and conditions that may apply – so study your product options well. “Take-home medicine”: Once released from hospital, you may be responsible for all costs associated with medicine. Some Hospital Plans will pay for a fixed number of days of take-home medicine, others may restrict you to a rand amount – and others may pay nothing. You need to know these details.
  • If you are on Day-to-Day cover, then check the specifications, because some procedures may require you to sleep over in the hospital – this will be for your own account.
  • Oncology Cover: Cancer treatment can amount to thousands of rand. Make sure you select a plan that provides decent cover – even if you have to make a substantial contribution or co-payment.
  • Payment for Prostheses: The various schemes have a variety of different rules – be sure to check and understand the differences here.
  • Pharmacies: Does your plan restrict you to certain pharmacies? If so, are they available in your area?
  • MRI and CT Scans: Check if your Hospital Plan include, or exclude this.
  • Check for the different co-payment requirements. In other words, some Hospital Plans require a payment from the client on certain procedures. This may also apply on admission to a hospital. Be sure to save and set aside some money to cater for this eventuality.
  • Psychiatric Treatment: Check your Hospital Plan as there is normally a rand value limit, or a number of days per annum limit.
  • “Step-down”: How many days or rand value, does your plan provide for?
  • Check if follow-up visits, once released from hospital, are covered or not. Some plans only cover your medicine for a certain number of days.
  • Health Insurance plans may offer free tests on a preventative care basis.
  • Make sure you select a Hospital Plan and insurer or service provider, that grants access to a large network of leading medical practitioners and hospitals on a national basis. If you end up using a non-member network hospital, you may be accountable to pay a substantial amount on a co-payment basis.
 Check Pharmacies & Medication in Health Medical Insurance for Chronic Medication
Check the conditions with regards to Doctor visits, Pharmacies & Medication
 Check whether MRI & CT Scans are covered in Health/Medical Insurance
Check upfront whether MRI and CT Scans are covered - these are
expensive procedures, should you have to pay for it yourself
 Prosthesis: Different Health/Medical Insurance schemes have different rules
Prosthesis: Different schemes have different rules
Understand the differences beforehand
Broker DirectorySmart insurance advice brought to you by professional insurance brokers!