There’s no disputing the fact that being a member of a medical aid in South Africa is expensive. When you decide to join a medical aid, you are in effect paying for a service which, in many other countries, you get for free. True, you can make use of government hospitals and doctors, and it will cost you nothing or very little, but the service levels at these government hospitals are notoriously lacking – but that’s a subject for another day! Let’s discuss your options, when you do decide to opt for ‘private cover’.
The Choices
Because of the high cost of medical aid cover in South Africa, many families are these days only interested in obtaining cover for the major medical expenses that can have a long-lasting effect on their lifestyle, such as an extended hospital stay. When they start investigating the costs of these ‘hospital plans’, a huge discrepancy seems to exist.
The differences
While there definitely is a place in the market for both products, consumers need to be aware of the differences between the two, in order to make an informed decision:
A hospital plan covers you for any medical procedures that are performed in a private hospital, such as if you’re in an accident and need an emergency operation. If you need cover for medical attention given outside of a hospital, like seeing your GP, visiting the dentist or getting new glasses at the optometrist, a hospital plan would not cover these costs – however a medical aid plan would.
Hospital plans
A hospital plan requires you to pay a monthly premium that would then cover you for treatments and procedures as an in-patient in a private hospital. Any medication or doctor visits out of hospital would be for your own account. If you need to go into hospital for a planned procedure, you would need to get authorisation from your hospital plan provider beforehand, except in an emergency, when your provider would arrange your admission directly with the hospital.
Medical aids
Many medical aid plans provide both in-hospital and out-of-hospital cover, depending on which option you choose. So you’ll be covered for all the things a hospital plan covers you for, plus day-to-day medical care, such as going to the doctor and dentist. Depending on your plan though, your day-to-day savings (called your Medical Savings Account or MSA) are limited up to a certain point. So, make sure you do your research before signing up to a medical aid plan, to ensure the limits will be enough for you and your family.