How to Join Hospital Plans

Sadly, millions of South Africans simply cannot afford private medical care and the vast majority cannot even afford a medical aid plan. Many of these people realize that calamity can strike at any time and that it is definitely preferable to be admitted to a private hospital if such a drastic step becomes necessary. It is for people like these, and also for fit, young healthy people, that hospital plans have been developed.

What are hospital plans?

Clientele Hospital PlansThe term “hospital plan” says it all. These plans are designed to cover the cost of hospitalization. Some plans offer limited cover for out-of-hospital medical expenses but they are really not designed to provide comprehensive medical cover.

Factors to consider when evaluating hospital plans

  • Some hospital plans also offer cover for chronic conditions and even some other day-to-day medical expenses. For many people, this may seem like an unexpected bonus, but it is important to consider the cost implications. Nothing is for free and out-of-hospital benefits will either increase the price of the cover or it will decrease the in-hospital benefits and cover.
  • Many people try to save money by opting for hospital plans, citing cost as their reason for not choosing comprehensive cover. In many cases, such decisions are not based upon the reality. Too many people simply do not have their priorities straight. If you are able to afford yearly holidays or a regular trade-in on your car, you should ask yourself if you are not falling for false economy. Health is the most important asset any person can possibly possess, and it would be better to sacrifice luxuries in order to obtain more comprehensive cover.
  • Most hospital plans offer full cover for in-hospital treatment. However, they do not always alert members to the fact that they will only pay according to the approved medical aid rates. In some cases, they are even willing to pay double the approved medical aid rates. The reality can be harsh: most specialists and hospitals charge far above the approved medical aid rate. In fact, four times this rate is normal practice. Members can, therefore, easily land up with the responsibility to pay massive medical bills themselves.
  • Some plans will not pay for the hospital treatment of pre-existing conditions.
  • Many plans will not pay for the treatment of certain conditions within the first twelve months.
  • Some plans include emergency medical transport, and others do not. This is an important point to keep in mind when selecting a specific plan.
  • Many plans will only pay the cost of treatment if the member makes use of a pre-approved network of service providers. In such cases, members have little or no choice regarding the medical specialist or hospital he or she wants to use.

When comparing the benefits of various hospital plans, it is extremely important to study the terms and conditions carefully. If there are any doubts, the scheme should be asked for clarification, preferably in writing. It is generally thought to be best to choose a plan that allows the member to upgrade the cover when circumstances change. © Medical Aid Plan


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