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Mediclinic News : Hospital insurance may not be what you think


Hospital insurance may not be what you think




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SUNDAY TIMES Consumers who cannot afford medical aid often opt for hospital insurance plans thinking they have comprehensive emergency cover, only to find out that they don’t. When Jade Cherice Smith’s baby started bleeding after a “bout of gastro” last October, she called the providers of her R580-a-month hospital insurance policy to ask for authorisation for her daughter to be admitted to hospital. The insurer said it would authorise it only if the baby was critically ill or had been in a car crash. Smith, of Springs in Gauteng, said she was told her baby’s condition did not sound severe enough, “so keep an eye on her and if it gets worse go the nearest state hospital”. Fortunately, the bleeding stopped. Smith has switched to a medical aid, saying she feels safer with medical aid than with insurance because “there’s always fine print you happen to miss”. Research by the Competition Commission, titled “Market Inquiry for Health” and released in November, found that consumers did not understand the difference between medical aid hospital plans, hospital insurance and hospital cash plans. Hospital insurance usually pays a lump sum for each day spent in hospital to cover lost income. Medical aid hospital plans have a legislated set of basic benefits. Jill Larkin, head of healthcare consulting at GTC Financial Services, said insurance usually pays out on the third day in hospital and hospitals may even refuse one entry because they know they will not get paid for the first two days. A hospital insurance plan was not a substitute for medical aid, she said. In April, the law on hospital insurance plans will change to limit the amount such plans can pay a patient to R3 000 a day, with a cap of R20 000 a year. Casper de Vries, an actuary at Alexander Forbes, said it is hoped limiting hospital plans will increase medical aid membership by young people and bolster the industry.
Created at 2017/02/08 02:33 PM by Mediclinic
Last modified at 2017/02/08 02:33 PM by Mediclinic