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Hospital Plans
13-09-2018, 10:55 AM
Post: #1
Hospital Plans
After my latest 24 hour stay at Louis Leipholdt Medi-Clinic and the subsequent R15k+ bill for said 24 hours along with the acceptance that Hospital stays are going to become a thing for me, I am looking at Hospital Plans.

So far MediHelp and OnePlan have been suggested - Is there such a thing as a plan that covers everything? I have been advised on Gap Cover too? I don't fully understand how this all works. Essentially, I would want to walk in and walk out and not worry about the bill that including the pathology okes and whoever else fiddles with me in between, would this be "unlimited cover"?

Any advice or suggestions or experiences would be appreciated.

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13-09-2018, 11:08 AM
Post: #2
RE: Hospital Plans
I had good experiences with Discovery Coastal Core - Should apply for you since you in CPT.

Check Plan covers the most in hospital procedures.

That will give you and idea of what would suit you.

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13-09-2018, 11:10 AM
Post: #3
RE: Hospital Plans
A hospital plan will only cover in hospital expenses and maybe a few GP visits. You have to be admitted for it to pay. They dont generally cover stuff like dentists or eye tests, OTC medication and specialist visits. A gap cover will cover any short fall when your medical aid doesn't cover it. Many hospital plans also have a network of hospitals you can visit, therefore you may not be able to go to any private hospital of your choice. If you choose a full comprehensive cover, which is expensive you will have very little restrictions. Bear in mind, hospital bills can exhaust any medical aid overtime. Many specialists also require you to pay upfront and claim from your medical aid as they charge above the medical aid rates. Seems you looking for a comprehensive plan. Different people will give you various opinions about different medical aids but make sure the one you choose has a good financial track record. Hope this helps. Thumbs
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13-09-2018, 11:13 AM
Post: #4
RE: Hospital Plans
Depending on the nature of the fiddling, you may find it difficult to get cover even under the most comprehensive plans Fencelook...

Jokes aside, sorry to hear about your dilemma... I'm no expert but have a hospital plan (Bonitas) with gap cover (Zest life)... Seems to be pretty good at covering all 'in-hospital' expenses but be careful with any exclusions relating to being admitted at Casualty - In these instances, I have received separate bills (once again, I'm no expert but I think that the doctors and pathologists contract as service providers)... Please ensure that if you go with the Hospital Plan, that you get gap cover as the hospital plan will likely not cover the full rates that you get charged when admitted... Now I'll keep quiet and let someone a little better informed chime in with more useful advice... Good luck and hope you recover and that your circumstances will just be temporary Thumbs
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13-09-2018, 11:14 AM
Post: #5
RE: Hospital Plans
Depending on the nature of the fiddling, you may find it difficult to get cover even under the most comprehensive plans Fencelook...

Jokes aside, sorry to hear about your dilemma... I'm no expert but have a hospital plan (Bonitas) with gap cover (Zest life)... Seems to be pretty good at covering all 'in-hospital' expenses but be careful with any exclusions relating to being admitted at Casualty - In these instances, I have received separate bills (once again, I'm no expert but I think that the doctors and pathologists contract as service providers)... Please ensure that if you go with the Hospital Plan, that you get gap cover as the hospital plan will likely not cover the full rates that you get charged when admitted... Now I'll keep quiet and let someone a little better informed chime in with more useful advice... Good luck and hope you recover and that your circumstances will just be temporary Thumbs
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13-09-2018, 11:20 AM
Post: #6
RE: Hospital Plans
Contact my brother, this is his field and can really help you

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13-09-2018, 11:22 AM
Post: #7
RE: Hospital Plans
Some extra info:

I dont want full medical aid because I don't feel I need it - I am type 1 diabetic, the actual medicine and insulin is not expensive so a savings component is a bit of a waste for me. I assume the only benefit of a Medical Aid vs a Hospital Plan is this?

The issue with my diabetes is that I personally am prone to Diabetic Ketoacidosis and I have had it twice this year, this requires hospitalisation, a drip, lots of meds and monitoring to get my bloody acidity levels back to non-lethal levels. General stay is three days, which I have had to pay up front R15k just to be admitted and then once I check out the hospital refunds the balance and then I get the pathology invoice, x ray invoice, physicians invoice, the dispensary invoice etc and thats another R7-8k. So I am usually booked in for 2 days max (about R10k just for the bed with about R5k refunded to me) plus the additional bills so each time I end up in the hospital its R17-20k.

I want something that can cover that bill - The meds pre and post hospital I am not phased by, my doctors visits for my scripts I am not too phased by as they are budgeted expenses, its the out of the blue hospitalisation bills that I want some kind of insurance for.

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13-09-2018, 11:38 AM
Post: #8
RE: Hospital Plans
(13-09-2018 11:22 AM)SMRTARSX1 Wrote:  Some extra info:

I dont want full medical aid because I don't feel I need it - I am type 1 diabetic, the actual medicine and insulin is not expensive so a savings component is a bit of a waste for me. I assume the only benefit of a Medical Aid vs a Hospital Plan is this?

The issue with my diabetes is that I personally am prone to Diabetic Ketoacidosis and I have had it twice this year, this requires hospitalisation, a drip, lots of meds and monitoring to get my bloody acidity levels back to non-lethal levels. General stay is three days, which I have had to pay up front R15k just to be admitted and then once I check out the hospital refunds the balance and then I get the pathology invoice, x ray invoice, physicians invoice, the dispensary invoice etc and thats another R7-8k. So I am usually booked in for 2 days max (about R10k just for the bed with about R5k refunded to me) plus the additional bills so each time I end up in the hospital its R17-20k.

I want something that can cover that bill - The meds pre and post hospital I am not phased by, my doctors visits for my scripts I am not too phased by as they are budgeted expenses, its the out of the blue hospitalisation bills that I want some kind of insurance for.

You need to check how the plan you choose works out since you already have a pre-existing condition. I could be wrong, but they could have a waiting period.

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13-09-2018, 11:47 AM
Post: #9
RE: Hospital Plans
From what I've learned about medical aid/hospital plans.

1. If you have any pre-existing condition like diabetes you have a 1 year waiting period before you will be covered.
2. "Hospital plan" only kicks in if/when you are admitted to the hospital it does not cover "casualties/emergency ward/ongevalle", that you will need to pay out of your own pocket.
3. You can get unlimited hospital cover to an extent.

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13-09-2018, 11:48 AM
Post: #10
RE: Hospital Plans
So many catches, its also nearly impossible to compare like for like, its not like with car insurance where a logical decision can be made.

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13-09-2018, 11:52 AM (This post was last modified: 13-09-2018 11:53 AM by yush1.)
Post: #11
RE: Hospital Plans
It seems you just need a good hospital plan. Thats it. smile bounce
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13-09-2018, 12:26 PM
Post: #12
RE: Hospital Plans
From what I can see Discovery Smart Plan, with Gap Cover and Vitality is a pretty good setup, and they include unlimited cover for my Hospital of choice. About R2k a month though. Hammerhead

Seems the waiting period is standard and the exclusion period dependent on each individual.

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r0ckf1re
13-09-2018, 12:56 PM
Post: #13
RE: Hospital Plans
Discovery Smart Plan & Gap cover will work yes...uses their list of doctors etc. Coastal Core was the old plan as far as i know...they are working it out...R50 doctors visits & covers some of your meds

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r0ckf1re
13-09-2018, 01:17 PM
Post: #14
RE: Hospital Plans
There will probably be a waiting period, so rather pick the one with the least hoops to jump through and the smallest waiting period. Even with just a hospital plan, chronic medication is still covered by medical aid (I stand to be corrected here).

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13-09-2018, 05:32 PM
Post: #15
RE: Hospital Plans
(13-09-2018 11:22 AM)SMRTARSX1 Wrote:  Some extra info:

I dont want full medical aid because I don't feel I need it - I am type 1 diabetic, the actual medicine and insulin is not expensive so a savings component is a bit of a waste for me. I assume the only benefit of a Medical Aid vs a Hospital Plan is this?

The issue with my diabetes is that I personally am prone to Diabetic Ketoacidosis and I have had it twice this year, this requires hospitalisation, a drip, lots of meds and monitoring to get my bloody acidity levels back to non-lethal levels. General stay is three days, which I have had to pay up front R15k just to be admitted and then once I check out the hospital refunds the balance and then I get the pathology invoice, x ray invoice, physicians invoice, the dispensary invoice etc and thats another R7-8k. So I am usually booked in for 2 days max (about R10k just for the bed with about R5k refunded to me) plus the additional bills so each time I end up in the hospital its R17-20k.

I want something that can cover that bill - The meds pre and post hospital I am not phased by, my doctors visits for my scripts I am not too phased by as they are budgeted expenses, its the out of the blue hospitalisation bills that I want some kind of insurance for.
Ok so there you go - have you just been diagnosed as Type 1. let me tell you - it would be wise to get your sugar stabilized and you will never have to do those stays.... but having said that I would advise you get a full med aid (discovery have great plans for Diabetes) and will be needing to see many other specialist in time to come.

good luck

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08-11-2018, 03:26 PM
Post: #16
RE: Hospital Plans
Discovery has this Key Care thing which covers hospital stays and also has a fund for specialists. That should cover exactly what you need. Perhaps just add gap cover in case they don't contribute full
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08-11-2018, 04:08 PM
Post: #17
RE: Hospital Plans
Just something I am not seeing mentioned yet, Gap cover only covers the doctors costs if they charge more then 100% or what have you.

Example: some doctors/specialists most of the time charge you in the neighborhood of 500% of the recommended fee, medical aid will stipulate they only cover up to 200%, the other 300% is then what you have gap cover for. Hope I explained it correctly.

Then as was mentioned, casualty at a hospital is not the hospital, I got this surprise when I was in a motorcycle accident, luckily momentum cover most of the cat scan Thumbs

I now have a savings plan together with my hospital plan to lighten the blow in such a case but pay most of my medical expenses out of my pocket, will just use the medical aid should I need to be admitted to hospital for some reason

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09-11-2018, 10:37 AM
Post: #18
RE: Hospital Plans
Anyone on Discovery Coastal Core plans should switch to Classic Smart Plan. The difference is: for R30 (thirty rand) extra per month you get 200% cover instead of 100% and you get doctor consultations for R50 per consult.

Just be sure to check your hospital of choice is on the list and your GP is on their network. Also avoid all the "Essential" and "Key" plans if your budget allows it.

If you're lucky enough to be able to select your own medical aid, I've heard Bonitas is very good value for money, but I haven't done enough research to comment.

Also another tip that I do... (may not be for everyone)... I don't have the medical savings option, I rather deposit the money into a Capitec savings account and gain the 7% interest. But I am quite responsible with money.
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12-11-2018, 09:17 AM
Post: #19
RE: Hospital Plans
I see there is a few things that was mentioned that isn't correct and could cost you a helluva lot!
Firstly, gap cover will only cover you if your medical has paid a portion of the cost for that specific code.
Eg 1: You get a scan done that your medical aid doesn't cover and that scan costs R10k. Your gap cover isn't going to cover it because medical aid didn't pay any portion of it.
Eg 2: You get a scan done that costs R10k. Your medical aid pays R5k towards it. Then your gap cover will pay the remaining R5k.

Secondly, you are going to need to declare your condition when taking out a policy.
They are going to give you a lengthy waiting period for that condition.

Thirdly, Key Care premiums depend on your income.
The more you earn, the more you pay.
The frustrating thing is ANY money that comes into your account is considered an income. Even if that money comes in and leaves immediately after, it is an income and will force your premiums up yearly.
If you earn below R10k a month then it is a plan to consider, if you earn anything more than that then it's not a cost effective plan.

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