South Africa has about 160 medical schemes totaling around 7 million beneficiaries. The total annual contribution to medical schemes is around R35-billion (according to the Council for Medical Schemes – 2006). Take into account that South Africa has a population of more than 47 million people! Less than 15% of SA citizens belong to a medical scheme or have a hospital plan.
Not all medical schemes or hospital plans are open to the public. In fact, of the 160 medical schemes, only about 30 are open to the public. This number might decrease over the years as the larger schemes take over the smaller ones.
So how do you choose a medical scheme or hospital plan, a specific option of the scheme, which benefits to include or exclude? In this ever-changing environment, you need the services and advice of an independent intermediary. Someone who doesn’t only have the interests of a specific hospital plan at heart, but one who can guide you to ensure your needs are met.
Our Hospital Plan Experts will assist you with:
choosing the most suitable hospital plan in the market
investigating more than 30 plans and options
providing pro-active advice on your present medical aid
assist you with claims and query resolution
Some Hospital Plans Used When Analysing Your Needs:
Discovery Health Hospital Plan
Fedhealth Hospital Plan
Resolution Health Hospital Plan
Momentum Health Hospital Plan
Genesis Hospital Plan
Medihelp Hospital Plan
Oxygen Hospital Plan
Profmed Hospital Plan
Bonitas Hospital Plan
Liberty Hospital Plan
The Difference Between A Hospital Plan, Full Medical Aid And Health Insurance
Hospital Plans usually provides cover only when you are submitted to a hospital and the associated costs, including certain medication. Day-to-day benefits are excluded in most cases (plan dependent).
For this reason, hospital plans are a lot cheaper than a full medical scheme option (where both hospital cover and day-to-day benefits are included). A hospital plan is a great option if you are young, healthy and don’t need cover for day-to-day medical expenses (e.g. optometry, dentistry, medication, doctor visits etc.)
Some hospital plans includes cover for basic dentistry and a few other out-of-hospital treatments. All medical aid and hospital plans must, by law, cover 27 chronic conditions, referred to as Prescribed Minimum Benefits.
Health Insurance plans are not medical schemes or hospital plans. It provides cash benefits depending on the number of days you have been hospitalized due to an accident or illness. Payments are made directly to the policyholder and he/she can use the payout to cover hospital or other daily expenses.
Health Insurance is mostly taken up by low income earners (who cannot afford a medical aid or hospital plan) or in conjunction with medical aid/hospital plan as an income replacement due to hospitalization.
What Is Gap Cover?
If the hospital and/or doctor charges more than the medical scheme tariff, you will be liable for these costs. Cover for the shortfall between what the medical aid or hospital plan pays and what the hospital and/or specialist charges, is referred to as Gap Cover.