Select Page

SA's No 1 Insurance Blog


First – grab a copy of your latest medical aid benefit brochure. You know?…the one outlining what your plan you decided on offers in terms of benefits for the year ahead. Here’s a copy of my Discovery Health classic delta saver option for 2011 (It’s number 15 on the page).

Now read through all the fineprint until you get to a section which tells you about your hospital benefits.
Look for the section where it hopefully says “There is no overall limit to your hospital cover”.
On my Discovery Health option for 2011 this appears on page 5.

If you option says that there are no overall limits then breathe a huge sigh of relief!
Take Discovery Health for example – none of their plans has overall annual limits on hospital benefits.
But does this mean you’re safe?

On the other hand…
Your medical aid might state that there are limits to your annual hospital cover! In your case may I suggest you pay close attention from here on in?

But first…

What is the medical aid annual hospital limit anyway?

Basically it means that your family has an overall limit for hospital submissions. When I say hospital expense I’m only referring to the actual cost of staying in hospital – not the costs of your surgeon!

Let’s take John as an example.
John has a family of five and works for the public service. He decides on the GEMS (Government employees medical scheme) Sapphire option which only offers R140, 070 per family per year for hospital expenses in 2011.
Should John, or a member of his family, end up in hospital, then he would be liable for any hospital expenses which exceed the R140, 070 mark!

But what if John and his family of five are involved in a car accident and need hospitalisation?

Basic emergency treatment is covered by all medical aid schemes as a prescribed minimum benefit. This does not mean that all his hospital costs are waived. John will still end up paying for any extended hospital stay.

And what if your scheme has no overall annual hospital benefit?

Be careful here…Even if you have zero overall limits it doesn’t mean that sub limits don’t apply!
For instance, on my Discovery Health option I have an annual sublimit of R133, 000 per person per year on cochlear implants. In this instance I would recommend the Electa-Care medical aid gap cover benefit.

So what can you do about overall annual hospital limits?

Choose a better medical aid option if at all possible.
If not all possible then Medical aid gap cover is available for just this scenario.
Turnberry offers a product called Maxi-Care which focuses in on medical aid plans with sublimits. In fact Maxi-Care now also offers hospital sublimit cover of up to R2, 500 per admission.

There are two options available:

1.       The Standard Maxi-Care medical aid gap cover policy which offers an annual R1, 750, 000 per family in addition to whatever your medical aid plan states
2.       The Extended Maxi-Care medical aid gap cover policy which pays an additional R3, 500, 000 per family

What will it cost you?

The standard Maxi-Care comes in at R105 per month while the extended Maxi-Care clocks in at R125 per month for 2011.

How to decide if it’s for you?

Here’s the lazy man’s way…
1.       Take how much you’re currently paying for your medical aid plan every month
2.       Add to this the cost of the Maxi-Care gap cover option you’re interested in
3.       Look at the cost of the ‘next best’ plan offering you unlimited overall hospital limits
4.       If Maxi-Care works out cheaper – take the Maxi-Care

Are there waiting periods before I can claim?

Unfortunately yes.
A general three month waiting period is applicable as well as a nine month waiting period for maternity benefits.
If you join Maxi-Care at the same time as joining a medical aid scheme, then the waiting period applied by the medical aid scheme will apply.

But what if I want gap cover for more than just hospital limits or co-payments?

The simple answer is you’d need to take out two separate products – Either the Maxi-Care product for overall annual hospital limits or the Electa-Care product for co-payments.

Of course, you could also invest in the Execu-Care option which boasts a combination of medical aid gap cover products.
At R250 per month for your entire family – believe me – its money well spent!

InsuranceFundi has partnered with some of SA’s most reputable insurance and investment companies. We believe that everyone should have access to a wide range of comprehensive and affordable solutions. Pick the product you are interested in below, and expect a call-back from our partners.

Until next time.

The InsuranceFundi Team


Copy link