Hospital plans mainly cover the treatment costs if you’re admitted to hospital such as ward costs, theatre fees, and accounts from other in-hospital providers such as anaesthetists or radiologists. Hospital plans also typically cover emergency medical expenses, whether you are admitted to hospital or not. To qualify as an emergency, the condition or event must be unexpected and need immediate treatment, for example treatment in the casualty ward of a hospital, trauma counselling or emergency medical services.
What types of expenses does a hospital plan cover?
Usually, a hospital plan covers the following sets of costs to varying degrees:
- The account for hospital costs, such as ward and theatre fees, supplies and medicine dispensed in hospital. In most cases, these hospital costs will be covered in full.
- The accounts from doctors and specialists, such as a gastroenterologist if you’re having an appendectomy. These costs will usually be covered in full if they’re in your medical aid’s network of specialists.
- Accounts from other providers, such as physiotherapists, x-ray departments. These are covered in different rates depending on your plan and provider.
Depending on the plan you have, your hospital plan may also cover certain post-hospitalisation treatment and a set number of days’ take-home medication.
What expenses aren’t covered by a hospital plan?
With a hospital plan, you’re responsible for day-to-day expenses such as a visit to your doctor or buying prescribed medication you may need. Because hospital plans offer a basic level of cover, they’re the cheapest of all medical aid plans available. Also, for some treatments and procedures, you’ll need to pay an amount out of your own pocket, which is called a co-payment. These co-payments apply to the hospital bill and are usually paid upfront to the hospital.
