Medical Aid vs Hospital Plan

A common myth is that a hospital plan and a medical aid are two different products. They are not. A hospital plan is simply a type of medical aid option. Both are registered medical schemes, both are regulated by the Council for Medical Schemes, and both must cover Prescribed Minimum Benefits. The real difference is how much day-to-day (out-of-hospital) cover you get. This is a plain-language explainer by an FSCA-registered broker (FSP 44098).

What a hospital plan is

A hospital plan is a benefit option within a registered medical scheme that covers your in-hospital costs and your Prescribed Minimum Benefits, with little or no cover for everyday expenses like routine GP visits, dentistry or optometry. It is built to protect you against the big, unpredictable costs of being admitted to hospital, at a lower monthly contribution than a comprehensive plan.

What a comprehensive medical aid adds

A full or comprehensive medical aid covers everything a hospital plan does, and adds day-to-day benefits. These are usually funded through a Medical Savings Account, an annual amount you can spend on out-of-hospital claims. Richer plans add an above-threshold benefit that resumes day-to-day cover once you have spent your savings and crossed a set threshold. You pay a higher contribution for this everyday cover.

Which one is right for you?

A hospital plan tends to suit younger, healthier members and those on a tighter budget who mainly need protection against major hospital costs and chronic cover, and who can pay for routine GP or dental visits out of pocket. A comprehensive plan tends to suit families, older members and anyone with regular out-of-hospital or chronic needs who wants predictable everyday cover. Because both are real medical schemes that cover Prescribed Minimum Benefits, the decision is about the breadth of day-to-day cover you need, not about safety or legitimacy.

Is a hospital plan the same as medical aid?

Yes, in the sense that a hospital plan is a type of medical aid option offered by a registered medical scheme. It is not a separate or lesser kind of product. It simply focuses on in-hospital cover and Prescribed Minimum Benefits, with little day-to-day cover.

Does a hospital plan cover Prescribed Minimum Benefits?

Yes. Every registered medical scheme option, including hospital plans, must cover the Prescribed Minimum Benefits by law. That includes emergencies, a defined list of conditions and the chronic conditions on the Chronic Disease List.

Can I see a GP on a hospital plan?

You can see a GP, but a pure hospital plan generally will not pay for routine out-of-hospital visits, so you would pay for them yourself. If you want everyday cover for GP visits, dentistry and similar, a comprehensive plan or a plan with day-to-day benefits is the better fit.

Not sure whether a hospital plan or a comprehensive plan suits you?