• Your medical scheme membership fees have increased once again. Should you think about taking out a hospital plan instead?
  • This is a question on the minds of many young, healthy individuals who are already battling with bond and car repayments.
  • Many young people start out with a hospital plan and move on to other types of coverage as they grow older and start a family.

What does a hospital plan cover?

If you have a hospital plan, you will generally have to cover most of your day-to-day medical expenses yourself. If you’re healthy and unlikely to have many daily medical expenses, a hospital plan could be a good option for you.

Most hospital plans include cover for all necessary hospital procedures. In many cases, you don’t have to pay in additional fees, but this depends on your plan. Before you sign up, you need to make sure about what’s covered. Don’t just assume you have full cover because you could receive a nasty surprise. You may realise you’re only covered for the time you spend in hospital and not for the treatment you receive.

Hospital Plan Providers

Hospital plans can be offered by insurance companies and medical aids. If the plan is offered by an insurance company, it’s not regulated by the Medical Schemes Act.

The provider can refuse membership to high risk individuals and is not obliged to cover the diagnosis or treatment of prescribed minimum benefits (PMBs), a long list of diseases and conditions that medical aids are required to pay. If a hospital plan is offered by a medical aid, it falls under the Medical Schemes Act. You can’t be refused membership, and the scheme has to pay PMBs.

Hospital Cash-Back Plans

Hospital cash-back plans pay out a lump sum to a policyholder for time spent in the hospital. Healthcare providers may be unwilling to treat you if this is your only source of cover because they have no guarantee you will use the funds to pay their bills. Cash-back plans should not be a primary source of cover but rather a top-up for other health insurance.

Various levels of coverage

Most hospital plans offer a range of cover options, and you can upgrade your plan at any stage. You may start off at a level of cover that’s affordable to you and move up to a higher level of cover at a later stage.

Keeping costs down

Checking with hospital plan administrators before going into hospital can help you to reduce costs. Taking out gap cover, which usually costs about R100 a month, is advisable if you don’t want to make co-payments on your hospital bills.

Some cheaper plans stipulate that you use a specific hospital network or even a state hospital. Here again, you need to check the details. Using designated pharmacies, ambulance services or other services recommended by your hospital plan are likely to be much cheaper.

Some hospital plans pay for procedures, such as pap smears, colonoscopies, and mammograms if they are done in a doctor’s surgery. These are measures that can lead to early diagnosis and prevent major expenses in the future.

Quotes for hospital plans can differ widely, depending on the providers, all of which set their own exemptions and limits when providing cover.


You have to carefully way up your health risks in order to choose the right medical cover. Given the constantly rising price of healthcare, a hospital plan is a better alternative than no cover at all. If you are young and healthy, having a hospital plan may be a good place to start.

It is much less of a financial commitment, and you can increase cover when you can afford it. Remember that accidents happen when you don’t expect them, and you can’t afford to take the risk of not having any cover at all.

  • A hospital plan is ideal if you’re young, only need it for yourself, want hospital cover in the event of an emergency or accident and need affordable cover.
  • Both medical aids and insurance companies can offer hospital plans. Those offered by insurance companies are not regulated by the Medical Schemes Act.
  • On a hospital plan, you cover most of your day-to-day medical expenses, but it covers hospitalisation and hospital procedures.
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