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What to Consider When Comparing Hospital Plans

What to Look at When Comparing Hospital Plans

Insurance is not compulsory in South Africa. It’s great for capitalism and for competition, but makes it more difficult to compare products. Even comparing options in the health insurance market can get tricky.

Most medical schemes offer hospital plans and medical aid that is more comprehensive. It’s important to know what to look for so you can choose the best policy. Here’s what to consider when comparing hospital plans.

Hospital plans do not cover day to day illnesses or medical conditions. These are excluded from the comparison. They also don’t include over-the-counter medication and visits to a GP. They only cover hospitalization and surgical procedures in hospital. While medical schemes offer different products, they do feature similar benefits.

 Hospital Plan In-Hospital Benefits

When comparing hospital plans, check the hospital procedures covered on the plan. Hospital plans may not include elective procedures. Check which procedures the medical aid you are looking at considers elective.

Some procedures are also not fully covered. The insured will have to make co-payments for these. Other procedures are only covered up to a certain amount, such as cochlea implants, transplants, and prostheses. Some hospital plans have an annual limit as well. This restricts the number of procedures allowed per year (in terms of finances).

Under the in-hospital benefits, your medical scheme will also list the hospital networks and clinics you can have procedures at. This includes mental health and drug and alcohol rehabilitation facilities.

Hospital Plan Chronic Medication Benefits

All medical aids are required to cover Prescribed Minimum Benefits. These are a list of 27 PMB chronic disease conditions they must cover according to law. These include Addison’s disease, asthma, bipolar mood disorder, bronchiectasis, diabetes, epilepsy, hypertension, schizophrenia, and others. Hospital plans will include medication for these conditions. Chronic conditions that aren’t on the PMB list won’t be covered by a hospital plan in most cases.

Hospital Plan contributions

Yes, yes, the extent of the hospital plan is more important than the cost. Unless you’re healthy. Medical schemes have different rates for different individuals to make it more appealing for whole families to join one plan. Principal members pay a certain amount and dependents usually pay a smaller price. (Spouses and children will cost less hen they are included on a main member’s plan.

Get a quote for a hospital plan before they become nationalized. Fill in our form for health insurance and an insurance representative will contact you.

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