Detailed Guide on Hospital Plans in South Africa

A Detailed Guide to Hospital Plans in South Africa

In this article you will discover all you need to know when signing up for a hospital plan. Here’s what’s included:

  • The Perks of a Hospital Plan
  • When to Sign Up for a Hospital Plan
  • What Exactly is a Hospital Plan?
  • Hospital Plans in an Emergency
  • Hospital Plans for Maternity
  • Hospital Plans for Pensioners
  • Co-payments and hidden costs
  • Hospital Plans and Gap Cover
  • Hospital Plans and Designated Service Providers (DSPs)

Not all hospital plans are equal

Welcome to our detailed guide on hospital plans where we explore the ins and outs of this essential healthcare cover. In today’s fast-paced world, staying healthy is imperative. A good hospital plan goes a long way to ensuring you are taken care of at times when it matters most.

Most importantly, you need to know that not all hospital plans are equal, and that sometimes the ads for them can be confusing and lead you to choosing cover that is not adequate or incorrectly matched to your needs and budget.

It’s vital to understand what you are signing up for and the extent of the cover you will receive. This blog aims to unpack your various options in an easy-to-understand way, so that you can make educated decisions when choosing a hospital plan for yourself and your family.

Speak to MedXpert at any time. You can request a call back here:

The Perks of a Hospital Plan

Nothing gives you better peace of mind than knowing you and your family are safeguarded from the surprise expenses of a medical crisis. More importantly though, is knowing that should an emergency arise, you have access to top quality private healthcare, ensuring swift treatment and diagnosis. Getting answers quickly and knowing what is wrong relieves an enormous amount of stress. With private hospital cover you won’t have to wait in line for treatment, you will be attended to immediately. It, therefore, goes without saying that signing up for some sort of hospital plan is a critical step towards protecting your health and your wealth.

When to Sign Up for a Hospital Plan

If you’re wondering when to sign up for a hospital plan, you’re likely thinking that it’s okay to postpone it for a while because you’re currently in good health. But you need to consider your future medical needs. As we age, the likelihood of requiring medical care, especially for chronic conditions, increases substantially.

Signing up for cover while you are healthy means: no waiting periods for pre-existing conditions (the standard for this kind of waiting period is 12 months). In other words, signing up for cover while you are healthy means that you can access preferred private healthcare and sidestep the corresponding prohibitive costs.

Waiting until you are sick or in need of hospitalisation is not an option. Being proactive is the solution to securing full cover when you need it most.

What Exactly is a Hospital Plan?

Hospital plans come in different shapes and forms. The idea behind them is to provide cover for hospital stays, surgeries, specialist costs and sometimes diagnostic examinations and procedures. But it’s not a given that, if you sign up for a hospital plan, you are immediately covered for all of this. The truth is that hospital plans vary, leading to potential confusion, disappointment and financial strain during emergencies. Here’s what you need to know:
  • Hospital plans offered by medical schemes cover emergencies, hospitalisation, specialist fees, planned procedures and certain treatments while you are in hospital (in accordance with your medical scheme’s rules).
  • Hospital plans offered as medical insurance policies cover accidents and emergency-related costs at private hospitals. However, if you’re not a medical scheme member, you may be transferred to a public facility once stable.
Understanding these differences is crucial for selecting the right plan.

Hospital Plans in an Emergency

In moments of crisis, having access to immediate medical care can be a literal lifesaver.
Doctors rushing to attend to a patient in an emergency

Hospital plan insurance policies offer a safety net, ensuring swift treatment at your nearest private hospital in emergencies. While they may not cover all medical expenses, they guarantee essential care when it matters most.

If you cannot afford a hospital plan offered by a medical aid, opting for a hospital plan insurance policy still holds immense value. It provides peace of mind knowing that prompt medical attention is readily available in an emergency, potentially making all the difference in critical situations.

Hospital plans offered by a medical scheme have emergency cover built into its make-up. One of the notable differences of a medical scheme’s hospital plan is that, should you need additional care after stabilisation in the emergency room, you can be moved to a ward within the same private hospital for immediate, related treatment.

Hospital Plans for Maternity

When it comes to the birth of your baby, most hospital plans will cover your hospital and delivery costs, including fees for gynaecologists or obstetricians while you are in hospital and caesarean section expenses like theatre fees and anaesthetists’ charges.

Mother in hospital after childbirth

However, they won’t cover day-to-day pregnancy-related expenses such as antenatal checkups, scans, and gynaecologist consultation fees.

Most Medical Aid hospital plans do cover antenatal checkups, scans, and gynaecologist consultation fees as part of their maternity programme. To gain access these benefits, you have to register with the maternity programme offered by your hospital plan.

If you’re already pregnant and without medical aid, you won’t be eligible for maternity benefits now. However, you can still join a medical scheme to ensure immediate cover for your baby from birth.

For guidance and assistance in maximising your maternity benefits, consult a MedXpert consultant. You can request a call back here:

Hospital Plans for Pensioners

Hospital plans are just as important for pensioners and seniors as they are for younger individuals. Perhaps even more so. However, seniors should be aware of specific considerations related to cover.

Pensioners enjoying a heathy lunch

While medical aids cannot turn down membership based on age or health status, there may be waiting periods and cost-related implications, depending on medical aid history.

It’s important for seniors to speak to a MedXpert consultant, to assist them when selecting a hospital plan suited to their retirement budget and health needs.

Co-payments and Unexpected costs

Although hospital plans provide invaluable protection, it’s crucial to acknowledge the presence of co-payments and hidden costs that may take you by surprise. Co-payments, which vary depending on your medical scheme and plan, require you to pay a predetermined

Additionally, there are also hidden costs in the form of deductibles, services not covered, and out-of-network charges that can considerably impact your finances.

This is why those who are on a hospital plan with a registered medical scheme should seriously consider adding gap cover to their plan.

Hospital Plans and Gap Cover

There’s a lot of confusion out there about different financial products related to hospital plans and gap cover. Here are three facts you need to know:

  1. Gap Cover is not the same as a hospital plan.
  2. Gap Cover is additional insurance that members of a medical aid can take out as a safeguard against payment shortfalls and co-payments relating to in-hospital expenses.
  3. Only members of a registered medical scheme can take out gap cover.

Depending on the Gap Cover policy you sign up for, you could also protect yourself from the hidden costs of co-payments and out-of-network charges.

Learn how Mr. Kruger faced hefty additional charges from surgeons and anaesthetists after both his wife and daughter had to undergo spinal surgery at the same time. Despite having medical aid, he was in for a significant payment shortfall.

Fortunately, he had followed the recommendation from MedXpert some time back and took out a GAP cover policy. This decision proved invaluable as it covered almost all the extra costs, including follow-up CT and MRI scans.

Watch the testimonial video here:

It’s a good idea to have gap cover in addition to your medical aid plan. Speak to a MedXpert consultant if you need some more information.

Hospital Plans and Designated Services Providers (DSPs)

Most medical schemes have lists of specified GPs, specialists, pharmacies and hospitals. These are healthcare providers that the scheme has an agreement with and, as part of their scheme rules, you may be required to make use of these providers or face a penalty co-payment.

If you are unsure which hospitals you can make use of, contact MedXpert for assistance. Knowing which hospitals you can access can influence your decision around which hospital plan to choose. It’s pointless selecting a plan with a hospital network that is situated far from where you live for example.

Downgrading to a Hospital Plan

People with ongoing health issues might consider switching from a comprehensive medical plan to a hospital plan. They can still have peace of mind knowing that if they have one of the 27 listed chronic conditions, it will still be covered. It’s smarter to downgrade to a more affordable medical plan than to cancel it because of money problems. But it’s best not to wait too long to make the switch. The earlier you do it in the year, the better.

A MedXpert consultant can work with you to explore your options. Request a call back to compare plans here:

In summary

Understanding the wide range of medical cover products available can sometimes be confusing. From medical aid to hospital plans to health insurance and gap cover, each product offers unique benefits. While there may be some similarities, it’s important to recognise that they cater to different needs and situations.

Remember, not all products labelled as hospital plans are equal, so when comparing options, it’s essential to get independent advice from a qualified expert.

MedXpert can assist you to make an informed decision about which plan is the
right fit for you.

We are the medical cover expert on your side

MedXpert will support you every step of the way. Visit our website and find out how we can help you. Alternatively, you can call us on 0860 860 860 or email