Hospital Plans & Cover Options

A hospital plan is usually cheaper than a comprehensive medical aid plan and provides cover for hospitalisation costs, but not for out-of-hospital treatment. All hospital plans in South Africa also need to cover expenses for the 27 chronic conditions listed in the Medical Schemes Act as Prescribed Minimum Benefits (PMBs).

What is a hospital plan and what does it cover?


A hospital plan helps you pay for medical costs that arise if you're hospitalised. Your scheme will pay a specific amount towards your admission, stay, doctors' bills, and other costs incurred. Hospital plans aren't created equal, as some have richer benefits and fewer co-payments, while others have stricter rules, exclusions and limits.


It's important to note that hospital plans only cover you for expenses incurred when you are admitted to the hospital. You'll need to pay for out-of-hospital costs, like visits to your GP and acute medication, yourself. However, all medical aid plans, including hospital plans, are obligated to provide medication cover for a defined list of 27 chronic diseases listed in the Medical Schemes Act as Prescribed Minimum Benefits (PMBs), even if you are not hospitalised.


Before you're admitted to hospital, you'll need to obtain pre-authorisation from your provider, except in the case of an emergency, when the hospital will arrange admittance with your provider.


All medical aids are entitled to impose a 3-month general waiting period, during which no claims will be paid, and/or a 12-month exclusion for any pre-existing medical conditions. No waiting periods apply for hospitalisation because of an accident. Benefits will also not be paid if the start date of the hospitalisation falls within the waiting period and hospitalisation continues beyond the waiting period.


Hospital Plans for Pensioners


As a pensioner, it is important to have some kind of medical cover, as the need to access medical care increases with old age and the ability to earn an income decreases. Even though a hospital plan would mean that a portion of the annual medical costs would be self-funded by the pensioner, they would have the plan available to pay for the biggest medical expenses associated with an in-hospital stay.


If you're over the age of 35 and haven't been on medical aid since April 2001, or if you've allowed your medical aid to lapse for more than three consecutive months, you may be liable for a late-joiner fee, which is calculated as a percentage of your overall contribution. Depending on how long you've not had medical aid, the fee can range from 5% of your contribution to 75%. So it's always a good idea to get medical aid as soon as possible.


 Hospital Cover in you're pregnant


As a pregnant woman on a hospital plan, you will need to cover the costs of any out-of-hospital expenses. But the hospital visit for the childbirth, and associated costs, will be covered. A maternity hospital plan is a cost-effective alternative that covers the biggest costs associated with childbirth. If you're on a hospital plan that doesn't cover all your expenses, you may need to consider gap cover, which pays the difference between the medical aid rates and the higher fee charged by the hospital. So gap cover is something you add on to your existing medical aid or hospital plan. will instantly source online hospital plan quotes in real time directly from the live databases of Discovery Health, Momentum, Medihelp, KeyHealth, Profmed, Bestmed, Bonitas, Health Squared, Medshield and Fedhealth.


If you're looking for a hospital plan, it's best to do your research before you apply. If you go into the medical aid comparison tool, it will give you the option to only search for hospital plans. Compare benefits and prices online with and you'll be on the right path to finding the best deal for you.