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Question
Posted by: Broke | 2004/01/07

Hospital Plan

I am currently working as a contractor so I don't have medical benefits from a company. At the moment I am on a medical aid but because I don't have a medical savings account there is nothing to claim when I go to the doctor anyway.

I want to downgrade to a hospital plan. I have made a few enquiries about this and this seems to be the way to go. What worries me is that only certain hospitals are contracted to the scheme. however, in an emergency they will take you to any private hospital to be stabilised.

Obviously this then limits the doctors that you see and if for example you need surgery it would have to be done by a surgeon at a particular hospital even if other doctors at other hospitals come highly recommended.

These limitations do cause concern for me but I don't see any other way out.
Do you know of any other hospital plans that are not so restrictive in terms of what hospital you have to go to??

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Our expert says:
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Your primary dilemma seems to relate to cost versus benefits.

Most medical schemes started out offering access to any hospital anywhere enabling you to select the surgeon of your choice – but relatively speaking these were far more expensive. Providing access to a network was seen to be a competitive advantage as it reduced price without compromise in care. The primary objective of a scheme is provide the best possible health care for its members, so when a restrictive list is provided those hospitals and services are generally selected because they provide good quality healthcare at affordable rates. By limiting the network of hospitals medical schemes can also negotiate keener rates for the procedures performed at those hospitals.

Therefore, most schemes have offered the middle road solution, where they have a preferred provider network of hospitals. However if you want to go to your own hospital, some medical schemes cater for this by imposing a levy which would be payable by you.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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Our users say:
Posted by: Mpho | 2004/03/25

Impressed by MarksRE pls supply details. highly appreciated MM

Reply to Mpho
Posted by: mark | 2004/02/24

i was on a medical aid and paying about 1700 rand a month , i went to a product called medicash with an essential hospital plan.

i now know that i am covered for major health care needs and have a payment card with a savings plan attached. it costs meless than R 1000 and i can withdraw my unused savings ..

i was really happy with this and the service was good.

i think there is a tax insentive also?

Reply to mark
Posted by: JTEE | 2004/02/18

Discovery offers a plan called Foundation Plus which covers hospital at med aid rates, limited to R400 000pa with a benefit called the Medicross network (capitation based) whic covers basic non-hospital treatment. This plan would set you back about R700pm. This plan does not restrict you to a network of hospitals. There is another plan - Essential Core which offers hosp cover only, unlimited, at med aid rates R590pm.

Reply to JTEE
Posted by: BJ | 2004/02/16

Hi Broke,

As Medical money advised, various schemes offer "full"hospital cover. One thing to keep in mind - You pay for what you get. If you wish to have the option of any hospital treatment, you would pay in the region of R600-R700 for a hospital plan. I am of the opinion that hospital cover is not something that you should play with so be aware of schemes applying annual limits on hospital benefits as well as the rate at which the medical scheme would reimburse these claims.

Reply to BJ

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