Medical Aid Hospital Plan Only

Medical aids have different plans to suit the range of needs and affordability of its membership. The plans can be broadly divided into full medical aid which has both out-of-hospital and in-hospital benefits, or a hospital plan only. The latter is often cheaper and has become a preferred option among South Africans. With hospitalisation costs being exorbitant in South Africa, a medical aid hospital plan only provides cover for the more expensive medical bills. These hospital plans also have a chronic medicine benefit which covers the cost of treatment for chronic diseases. However, the day-to-day benefits are not available on a medical aid hospital plan only and patients will have to settle these bills in cash.

Costs

Medical aid hospital plans vary in price. It can start from as little as R600 per month and will allow you access to any private hospital in South Africa. There are even cheaper options which will only allow you to cover the network hospitals – this means that you can only go to certain hospitals within a group as an arrangement has been reached between the medical aid and hospital for members of these hospital plans. However, the difference in cost is minor and most people prefer a medical aid hospital plan that is open and allows them to go to a private hospital of their choice.

The cost of a medical aid hospital plan does not differ based on pre-existing diseases. Apart from a waiting period the monthly contributions stay constant for all members on the same plan. However, people who join a scheme after 35 years of age are subject to a late joiner fee for life which is added to the monthly premium. Unlike an insurance policy, a hospital plan for HIV positive people does not have any loading charges are higher monthly contributions. HIV positive patients are subject to the one year waiting period for a pre-existing disease after which they will enjoy the same benefits at no additional cost.

Benefits

A medical aid hospital plan only has both in-hospital and chronic medication benefit.

In-Hospital

This part of the benefit covers in-hospital costs such as :

• stay in hospital, such as the hospital bed, meals and other consumables.
• fees for doctors and other health care practitioners who consult with you in hospital.
• blood tests, scans and other investigations while in hospital.
• operating theatre times, professional fees for surgery, anaesthesia and consumables used during the procedure as well as post-operative observation.
• prosthetics and implants up to a certain limit.
• medication and other consumables such as IV needles, syringes, cotton wool, bandages and gloves.
• cancer treatment on an out-patient basis.

Chronic Medication

The chronic medication benefit as part of a medical aid hospital plan only pays for :

• medicines for treating and managing various chronic diseases, subject to the annual limit.
• unlimited medication for serious and life-threatening illnesses as part of the prescribed minimum benefits (PMBs) cover.
• equipment and consumables for monitoring certain chronic diseases at home, such as glucose metre and sticks for diabetes mellitus (sugar diabetes).

It is important to discuss the benefits and carefully examine the schedule provided by the medical aid. The benefits can vary among schemes.

Exclusions

Medical aids pay for the diagnosis, treatment and management of all diseases. The hospital plan only pays for care within the hospital environment. Radical and experimental treatments that have not been prove to be clinically effective are usually not covered. In addition, medical aids do not cover :

• Cosmetic surgery
• Fertility treatments
• Non-essential medical services such as coloured contact lenses
• Alternative medicine, although homeopathy and chiropractic are some of the therapies that are covered

Waiting Periods

All medical aid plans, whether hospital only or comprehensive cover, have a 3 month general waiting period. This means that you do not qualify for cover for any medical services and products in the first 3 months of joining the scheme although you will still be paying the monthly premium. However, in the event of an emergency like with a car accident, the medical aid will cover the bills in most cases even though you are still within your 3 month waiting period. This policy may vary among schemes.

Pre-Existing Conditions

A pre-existing condition is any ailment or state that exists prior to joining the medical aid. There is a one year waiting period for pre-existing conditions. This includes all diseases including HIV/AIDS, hypertension (high blood pressure) and diabetes to name but a few. It also includes pregnancy. There is no hospital plan for already pregnant women but future pregnancies will be covered. After a one year period, the member can then enjoy full cover for their pre-existing condition.