Admission into a private hospital is not by choice. A medical doctor has to admit a patient and the medical aid has to approve payment before the hospital will allow you admission. These days you will have to wait for an available bed at times in the hospital of your choice as the demand on private health facilities in South Africa continue to grow. Before you show up at a hospital, it is important that you understand how the hospital admission procedure works or you may be refused admission or even held liable for the hospital bills.
Chronic Cover on Hospital Plans
Most medical aid hospital plans include chronic cover which ensures that you can access medicines and some medical services for the treatment and management of your chronic condition. This is is an essential cover as most chronic conditions have serious and even life-threatening complications if it is not managed properly.
It is important to understand how the chronic cover works on medical aid and the way in which it takes care of you in the long run. Second to the hospital cover on medical aid, chronic care can be extremely expensive and often unaffordable in the private health sector without proper chronic cover. While hospital cash back plans also cover hospitalisation for chronic diseases, these insurance policies do not pay for the medication for chronic conditions. (more…)
Combination Medical Aid and Hospital Cash Back Cover
Medical aid, be it a hospital plan or comprehensive cover, and a hospital cash back plan are two different financial products. As a medical aid member you are allowed to also have a hospital cash plan and vice versa. However, the purpose and benefits of each should not be confused. Neither product can replace the other and ideally you should have both forms of cover for maximum benefit. These two specific products are not combined into one and you will have to sign up for each separately. Medical aid cover can be purchased from a medical scheme while hospital cash back plans are available from insurance companies.
Hospital Cover for Midwife Delivery and Home Births
Although most women living in urban areas may opt for a hospital setting with a gynecologist and obstetrician overlooking the delivery, there is a growing trend among mothers to give birth at home or opt for a water birth and use the services of a midwife. It was a common practice in the past and is once again favoured by some mothers who wish to be in familiar surroundings, with the support of family and friends at hand. However, one has to consider the financial implications of having a home birth or delivery by a midwife. It really depends on what type of hospital cover you are looking at – medical aids pay for a midwife and homebirth but a hospital cash back plan does not cover home births.
Top Up Hospital Cover (Gap Cover) for Medical Aid
Medical aid is the lifeline that allows most people in South Africa to access private health care services. Probably the most expensive of these services is in-hospital expenses and at the very least a medical aid hospital plan only is seen as a necessity if a person does not want to opt for a government facility. However, medical aids do not guarantee unlimited payment at exorbitant rates. Instead medical aids pay according to the National Health Reference Price List (NHRPL) rates and up to a predetermined benefit limit. So what happens if you medical aid payout falls short of rates that your doctor is demanding? Previously you would have to pay the difference from your own pocket but these days there is a top up cover which will settle the bill.
Age Limits (Minimum and Maximum) on Hospital Plans
Age limits are an important consideration for hospital plans because depending on what you may be looking at for cover, you may be too young or too old. It ultimately depends on the type of hospital plan you are looking at. In South Africa, the term hospital plan is used so frequently but very few people understand that it is an umbrella term which refers to different financial products, namely medical aid and a hospital cash back plan. Similarly the minimum and maximum age criteria and limits for cover varies according to each type of hospital plan. Here is a quick overview :
- Any person of any age can join a medical aid.
- A hospital cash back plan is only open to people under the age of 65 years.
Hospital Plans for Pensioners
Growing old has major implications for your healthcare cover. Whether it is a medical aid or hospital cash plan, there are certain implications associated with becoming a pensioner that you need to take into account. The fact of the matter is that a medical aid will accept a person of any age but once you factor in the late joiner fee, you will be paying extra for hospital cover. Unfortunately hospital cash plans are insurance policies that do not accept people over the age of 65 years so you cannot sign up for this cover. Nevertheless, it is important to consider your healthcare options carefully as the senior years are the time when you need this protection the most.
Best Hospital Plan is a Medical Aid
If you have been searching for the best hospital plan in South Africa, you need to realise that there is no cover better than a medical aid. The term hospital plan can refer to either a medical aid without the day-to-day benefits or an insurance policy that pays you cash when you are hospitalised. Although these are two different products, many consumers are confused as to which is the best option. Medical aid cannot be replaced. Even private medical insurance in most countries in the world do not have the offerings of medical aid. South Africans need to realise that if they want protection for the exorbitant private healthcare costs then medical aid is the best way to go.
Hospital Cash Back Plan
A popular type of insurance among South Africans, that is often confused with the medical aid hospital plan only, is the cash back plan. It protects a person against the financial implications of being in hospital by paying out cash for each day in hospital. These cash back plans are not medical aids. It was not intended to replace a medical aid and there should be no choice between either a medical aid or cash back plan. Both financial products are different and the hospital cash back plan is essentially the predecessor of the medical aid cover that we know of today. However, this should not detract from the fact that the hospital cash back plan is a helpful form of cover when you need it most – lying incapacitated in a hospital with the personal bills piling up.
How to Choose the Best Hospital Plan
Everybody wants the best product or service that they can get for the cheapest possible price and it is no different with a hospital plan. However, South African consumers have to be aware of a few points – the medical aid and insurance industry is heavily regulated and there is no best hospital plan that is significantly superior than others yet is less expensive. In other words you pay for what you get. Ultimately what is best for one person may not be so for another – it is a matter of individual needs and affordability. Therefore the term ‘best hospital plan’ is individualistic and any advertisement claiming to have the best product is misleading.