While paying for medical aid can feel like a grudge spend, it is crucial to have some form of medical cover. Deciding between a hospital plan or a full medical aid scheme can be daunting, but it your choice, depending on your needs, budget and current state of health.
The basic difference, of course, lies in the amount for which you are covered, and the amount you pay every month. A full medical aid scheme usually entails “comprehensive” cover – this is a relative term depending on your medical aid provider, but basic medical and emergency care is usually covered at a minimum. The major benefit here is peace of mind, knowing that should you have a car accident or require emergency life-saving surgery, you will be covered. A slight drawback with most of these schemes, is that you are also “forced” into contributing large sums of money each month which go into a medical savings account.
While an MSA can be useful, many people feel that they could just as easily not pay money into an MSA, and just pay for their day-to-day expenses out of their regular accounts.
A hospital plan, on the other hand, is basically an entry-level medical aid, usually covering you should you need to be admitted to hospital, but not covering you for anything else. A distinct disadvantage here is that “many medical aid plans have restrictive regulations, such as that you are only covered for certain major surgical procedures, or that you must spend the night in hospital for the medical procedure to be covered by the hospital plan.” (www.selfmed.co.za)
The decision between a basic hospital plan and a comprehensive medical aid scheme needs to be your choice, as you need to determine what level of cover you feel most comfortable with.
Some obvious differences between the two are:
A medical aid:
- Covers you for day-to-day medical expenses
- Covers you for most if not all medical specialities and procedure
- Offers comprehensive pregnancy coverage (dependant on your package)
- Usually imposes some form of MSA
- Covers you for hospital procedures without imposing conditions such as having to stay overnight etc
A hospital plan:
- Does not cover any day-to-day expenses
- Does not cover medical specialities or procedures such as MRI’s etc
- Would only cover you for procedures done in hospital, and even then often impose various conditions for a pay-out
- Many hospital plans now also offer a “daily cash provision” scheme whereby you are paid a lump sum of money for each day you are in hospital (this in particular makes this an attractive option to the lower end of the market).
It is interesting to note, however, that:
“the law requires that the medication for 25 chronic conditions must be covered by all medical plans, including hospital plans” (www.health24.com)
which suggests that regulation is changing to ensure basic provision of care and cover even on the most rudimentary of plans.
It is your choice whether to go with a full medical scheme or a hospital plan – research the options, understand the needs of you and your family, and most importantly, ensure that you are fully cognisant of what you are covered for, and of any special terms and conditions which may apply.