Cheap Hospital Plan Pitfalls ? Hopefully this article will help you avoid any disasters that lurk in the misty waters of Cheap Hospital Plans. You are aware of the fact that if nothing else, you do need to at least hold some kind of coverage in the case that you end up in the hospital. But you really don’t want to spend a lot of money to get it, so you have been thinking about taking out the cheapest plan you can find. It’s better than nothing right?
Remember the old adage you get what you pay for? In some cases hospital only plans are very much a good example. Those policies may seem wonderfully cheap but lurking away – often in the very fine print – are sometimes restrictions and exceptions that may make the cheap hospital plan a very bad deal indeed. Here are some of the things you should be looking for before you make the decision to go with a bare bones hospital only plan:
Cheap Hospital Plan Pitfall 1.
The 100% of Fund/Scheme Rate Rule
If the hospital plan you are considering says it pays out ‘100% of Fund/Scheme Rate’ that, on the face of things sounds great. The problem is that the fund/scheme rate is set by the medical aid or insurance company and it does not reflect what the hospital – and the medical professionals who treat you there – are actually going to bill you.
In the case of many of the cheapest hospital plans the fund rate is very low when compared to real life rates and may leave you far further out of pocket than you had banked on. A better idea is to seek out a policy that offers a higher rate in general or take out a gap policy to cover any overages.
Cheap Hospital Plan Pitfall 2.
The Network Hospital Rules
Some plans will only cover that 100% rate if you use a ‘network hospital’ for anything but the direst of emergencies. Some will also require that even in a very serious situation a pre-authorization is obtained or your coverage level may be reduced.
Cheap Hospital Plan Pitfall 3.
Some of the ‘bargain basement’ hospital plans require members to pay an upfront, on the spot co-payment upon hospital admission for anything other than a life threatening emergency or emergency admission to a maternity ward. If that is the case you would have to be prepared to ensure that you know how much that would be and that you have access to that amount before you go to hospital.
Cheap Hospital Plan Pitfall 3.
Co Payments on Certain Procedures
Often in the case of a lower cost hospital cover plan you will be required to make an upfront co-payment for certain procedures before they are performed. This means that it will be crucial that you check the co-payment schedules before any procedure so that you know upfront just how much of the cost you are going to be responsible for.
Cheap Hospital Plan Pitfall 4.
Many people leave the hospital with prescriptions for medications. If you were treated for a non-chronic condition – one not covered under the PMB Chronic Disease Conditions protocols – then the cost of that medication will almost always have to be paid for by the patient under a hospital only plan. If you were treated for one of the 27 PMBs the plan will have to – by law – pay for the medication but many attach a rand value that they will cover and may dictate specific medications that they will not cover.
The fact that hospital only plans dictate, in many cases, that a generic medication be prescribed over a brand name is OK. Generics are governed by all kinds of laws and apart from the lack of a catchy name and maybe a prettier box are exactly the same things. The problem can come though if even they are not covered in full because that rand value that was assigned has been met already. Some plans also require you use only certain pharmacy chains or medical delivery services, so you’ll need to check in advance if those are available in your area.
So please remember to check for these Cheap Hospital Plan Pitfalls before you sign on the dotted line, or if you are unsure contact one of Our Professional Medical Aid Consultants to find out more.