Hospital plans vs comprehensive medical aid



South African consumers are feeling the pinch. While some have had to tighten their belts by cutting out luxuries, for many, rising fuel costs and the higher costs of living have also meant sacrificing important cover like short-term insurance and medical aid or downgrading from a comprehensive medical aid plan to a more affordable hospital plan.

Comprehensive medical aid plans or ‘full cover’ provide the member with hospital cover as well as a medical savings account (MSA) portion for a set contribution or premium every month. The MSA portion can be as much as 25% of the member’s total medical aid contribution, and is the member’s own money which is made available to them upfront at the beginning of the year to pay for day-to-day medical expenses such as GP visits, over-the-counter medication or a pair of prescription glasses, for example.

The MSA portion of comprehensive plans makes them more expensive than hospital plans. The member is also required to pay the full contribution amount every month, irrespective of whether or not they have used the MSA portion. Any unused MSA funds are transferred to the following year.

A hospital plan, on the other hand, offers cover for hospital related procedures and expenses only. Depending on the option the member chooses, members can use any private hospital or be restricted to a hospital network but at a reduced rate. Hospital plans don’t have an MSA portion for day-to-day medical expenses, which makes them more affordable than comprehensive medical aid options. However, the member then has to cover day-to-day expenses from their own pocket.

Until recently medical aid members were faced with choosing either a comprehensive medical aid option or a hospital plan. Fedhealth aims to bridge this gap and has introduced what it calls a “supercharged hospital plan” which also covers certain day-to-day medical expenses.

“We are allowing members unprecedented levels of control over how their medical aid cover is structured,” reveals Jeremy Yatt, Fedhealth principal officer. “Our flexiFED plans are all supercharged hospital plans, which means that apart from in-hospital cover, they also pay for certain day-to-day benefits from Risk by default. Fedhealth calls these our unique benefits.”

These day-to-day benefits include unlimited network doctor’s visits; post-hospitalisation treatment for up to 30 days after discharge from hospital; take-home medication; specialised radiology; trauma treatment at a casualty ward; female contraception; in-hospital dentistry for children under the age of 7; child rates for financially dependent children up to 27 years of age; and upgrades to higher options at any time of the year. What this means is that members are provided with much more value than the average hospital plan; a plan which is more like a comprehensive plan but at a much more affordable price.

What really differentiates Fedhealth’s hospital plans from other hospital plans however is that they offer members a back-up facility or safety net. Should the member find during the year that they have a big day-to-day expense they can’t afford to pay out of their pocket or that is not covered from the unique benefits mentioned above, they can simply access a facility from which they can fund these day-to-day expenses. Members then pay back to the Scheme however much they’ve used for these expenses, and not a cent more.

Yatt explains that the intention is to provide members with cover for unforeseen costs. And it’s only if members access these funds that they would need to start paying back the portion they have used, over 12 months. “This is a total game-changer that allows more South Africans peace of mind medical aid they can actually afford,” he says.


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