It is very important to know the differences between hospital plans versus hospital insurance in South Africa. Why is that? This will determine the amount of medical coverage you will receive monthly and your related costs for medical assistance plans.

What are these and which one should I pick? Many people are left with this question, so we decided to find the best answers for you.

Buckle up for Episodic Medical, the trailblazer in custom medical aid quotes!

If you’re below 65, get ready to experience a quote that’s tailored specifically to your lifestyle, health considerations, and budgetary constraints.

Get a Quote!

What Is A Hospital Plan?

A hospital plan is a type of medical insurance that is limited to treatment provided at a hospital. Every medical visit outside of the hospital is the patient’s own financial responsibility.

With a hospital plan, you need to cover your day-to-day medical expenses yourself – but the costs bound to a hospital plan are significantly lower than medical schemes. This means that whenever you are admitted to the hospital due to an accident or illness, your expenses are covered. Do take note that this is set within the limits of your particular plan.

The South African law requires that 27 chronic conditions – known as Prescribed Minimum Benefits – must be covered by all medical plans – hospital plans included! Everything outside of your day-to-day hospital costs, you are required to cover yourself. This list includes visits to the doctor, specialists, and medicine.

It is important to take note that there can be a shortfall between what your hospital plan pays and the actual amount asked by hospitals and specialists. The difference then needs to be covered by you. A GAP Cover or hospital insurance policy can help you to cover the outstanding amount.

Who Needs A Hospital Plan?

Who needs a hospital plan? First of all, it is important to assess your own health. If you are young, fit, and healthy and do not have any serious medical condition, a hospital plan can be a good option for you. In this case, it is highly unlikely that you will have many day-to-day medical visits.

If you are older and have existing medical conditions, your out-of-hospital expenses can be very high which would require you to consider a more effective medical aid scheme plan.

A hospital plan provider will only pay out if you are admitted to a hospital that forms part of their specific network of service providers – make sure to find out which hospitals are covered and which ones are not.

What Does A Hospital Plan Cover?

It is important that you are aware of how a hospital plan works when you get admitted to a hospital.

Every hospital plan provider is part of a specific network of service providers (hospitals). This means that if the hospital you go to is not part of the specific network of service providers your plan is connected to, you won’t be covered.

Take note that most hospital plans only cover you when you are admitted to the hospital. So, if you’re visiting the Emergency Room but you’re not admitted, most hospital plans won’t cover it.

• Hospital plans are required to cover you for the 27 prescribed medical conditions (which means your chronic medication for those conditions will be covered by the plan)
• Find out if the hospital you are going to is included in the list of hospitals on your hospital plan

The Pros & Cons Of A Hospital Plan

Let’s measure up the advantages and disadvantages of having a hospital plan.

Advantages Of A Hospital Plan

• A hospital plan covers your in-hospital stays and check-ups
• Significantly lower cost than medical aid scheme

Disadvantages Of A Hospital Plan

• You can’t visit hospitals that aren’t listed in your hospital plan
• You are responsible to cover every out-of-hospital visit (doctors, specialists, medicines)

What Is Hospital Insurance?

Hospital Insurance is not the same as medical aid coverage. Hospital insurance (or medical insurance) is part of the umbrella term, Health Insurance, and consists out of hospital insurance and GAP Cover. But what does this mean?

Hospital insurance is not medical aid. The insurance will provide you with cash benefits if you are admitted to the hospital – in case of an accident, illness or the need for intensive care. The cash amount gets paid out to you 3-5 days after your admission to the hospital, and you can use it however you please. However, the new amendments right aims on paying the patient after day one of being admitted to the hospital.

So medical insurance focuses more on life-changing events. If you’re covered by medical insurance, they will pay out when something happens to you. It basically works like car insurance. When you’re in an accident or your car gets stolen, your car insurance will cover it. Medical insurance works the same way.

What is GAP Cover?

If your medical aid or hospital plan doesn’t cover all the costs for the hospital procedure or emergency surgery, you can take out GAP Cover.

A GAP Cover helps you pay the difference between special extra charges and the amount covered by your hospital plan. Depending on the policy of your hospital plan, this amount can differ. A lot of people purchase GAP cover in addition to their hospital plans to provide for additional coverage that may occur.

It is important to know that GAP Cover doesn’t cover general healthcare-related costs, andcan only be used in situations where specialist service costs are added to the medical bill.

Medical Insurance: What Does Hospital Insurance Cover?

Hospital insurance is not part of a medical aid but is governed by the Financial Services Board and the Long-term and Short-term Insurance Act.

The insured receives cash benefits if they are admitted to hospital in case of an accident, illness or when they are in need of intensive care. Hospital insurance will potentially cover personal accident risk; which includes disability and loss of limbs, the inability to work, salary protection and death and funeral cover.

Pros And Cons of Hospital Insurance

Advantages Of Hospital Insurance

• You will receive cash benefits paid to your account and you can decide how to use it
• Hospital insurance potentially covers personal accident risk

Disadvantages Of Hospital Insurance

• Hospital insurance is a set amount that might not cover your medical and hospital bills
• Health Insurance and GAP Cover aren’t tax deductible

Affordable Hospital Plans

We have gone on a search to find the most affordable hospital plans in South Africa. With so many different plans to choose from, you can be sure to find a hospital plan that will fit you.

Genesis Hospital Plan

The Genesis hospital plan will cover you for scheduled in-hospital appointments as well as emergency admissions. Both hospital plans featured by Genesis cover benefits for basic dentistry. This is one of Genesis best benefits.

There are no networks connected to Genesis Medical which means that with your hospital plan you can visit any private hospital, doctor or medical specialist in South Africa.

There are two hospital plan options provided by Genesis. Check them out here.

Discovery Hospital Plan

Discovery Health offers a value-for-money hospital plan that also provides essential cover for chronic diseases.

Discovery offers in-hospital cover for specialists they have a payment arrangement with. They also cover in-hospital costs within the hospital network they form a part of. If you have one of the prescribed chronic conditions that Discovery has listed on their plan, they will cover your cost for medicine when you make use of MedXpress or any MedXpress network pharmacy.

Take a look at Discovery’s hospital plan video for a break down of their hospital plan options.

Affinity Hospital Plan

Affinity Health offers you an affordable hospital plan that gives you access to a wide range of benefits and features in the result of an accident, illness or medical emergency.

The best thing about Affinity hospital plans is that they offer casualty room benefit and 24-hour Emergency Medical Services (EMS). More benefits include maternity cover and access to a very wide range of private hospitals.

To read more about Affinity Health’s hospital plans, click here.

Momentum Hospital Plan

Momentum Health offers the Momentum Custom Option hospital plan, one of the best hospital plans on their list.

Unlimited hospitalization at any provider, a flexible option that allows you to additional savings through the health saver and The Health Platform benefit are all part of this hospital plan. You can customize this plan to lower the cost even more and suit your personal health needs.

Read this to find out more about Momentum hospital plans.

Bonitas Hospital Plan

Bonitas focus on offering low-cost hospital plans for people who do not have a lot of money to spend on medical care. They also focus on younger families who have an excellent state of health but want to ensure that they are covered for emergency situations.

The Bonitas Standard Hospital plan would suit you if you want cover at any good hospital in South Africa. The Bonitas Hospital Plus plan offers cover at 200% of Bonita’s rate, also available at any hospital in South Africa.

The BonEssential hospital plan offers the benefit of receiving cover if you have one of the 27 prescribed chronic conditions, offers maternity consultations and will cover 100% of the scheme’s rate for unlimited hospitalization at any hospital in South Africa.

Affordable Hospital Insurance

There are quite a few medical insurance providers who offer quite a comprehensive cover and private medical facilities. We’ve compared them for you, so you can easily decide which one would best fit your needs, and your budget.

Essential Med Medical Insurance

Essential Med has some packages available specifically aimed at different groups in the country. They offer packages for students, single persons, single parents and couples with two children. However, you can also customize your plan to choose the benefits that will fit your lifestyle.

Students and single persons have the benefit of accident hospitalisation, permanent disability and both included funeral cover. Price packages start at R250 a month – making these a very affordable option.

Single parents can look forward to the benefit of day-to-day cover, accident hospitalisation, emergency casualty visits. Families receive the same benefits but added to your package you’ll find illness hospitalization and permanent disability cover. Read more about the packages Essential Med has on offer.

GetSavvi Health Medical Insurance

GetSavvi Health Medical Insurance makes the promise of no copayments or shortfalls. They offer three plans. The Get Care Plan, a Primary Care Plan and a Primary Care Plus plan.

GetSavvi Health: Medical Insurance Plans

The Get Care Plan only included hospital cover. It starts at R250 a month, includes Netcare 911 emergency services, a funeral, and accidental death cover. This is the most affordable plan GetSavvi has on offer, however, there is no top-up available.

The Primary Care Plan is a day-to-day only cover. Doctors and dentists visits are included, as well as funeral and accidental death care cover and Netcare 911 emergency services. Single member plans are starting at R340 per month and families can expect pricing to start at R560.

The Primary Care Plus plan is the best plan as it combines day-to-day and hospital cover. This means that your doctors and dentist visits are included and funeral and accidental deaths are covered. This plan is the best plan because it includes cover for chronic and acute medication, maternity and blood tests.

If you need more information or want to get a quote that will suit you or your family, you can find more information on their website.

Affinity Health Insurance

Affinity Health offers competitive insurance products that are specifically designed to protect you and your family against medical expenses you didn’t plan on covering. Affinity offers a wide variety of healthcare options and hospital cover for individuals and families alike.

You can choose from two plans: Day-to-day cover and a Hospital Plan. The day-to-day cover includes an out-of-hospital health cover, which covers doctor consultations and medication. This plans also cover dentistry, radiology and family funeral cover. Prices start at R509 per month.

The hospital plan package offered by Affinity Health is a bit more expensive, but it includes your hospital plan, as well as health insurance. This means that your hospital stay costs and medical costs will be covered if you have Affinity Health’s hospital cover. The hospital plan starts at R819 per month.

Need more information? Take a look at the detailed plan.

Final Thoughts

With all this information at hand, it is quite safe to say that you will now know which choice would be best for you. Hospital plans are a good option if you don’t have any extreme medical condition, and health insurance can help you to cover unforeseen costs.

Hospital plans cover basic healthcare in the event of emergencies where you need to be hospitalised and the health insurance covers life-changing events. Comparing all the different prices and plans will help you to make the best decision to fit your health, and your pocket. So pick a plan now, and know that you’re covered to ensure that medical expenses are the least of your worries.