Health or Medical Insurance and Hospital Plans

See Health, Medical or Hospital Plan News:

• 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.