Keep an eye on the limited funds for private hospital
Costs can run into thousands of rands
Healthcare plans that cover doctor visits and other out-ofhospital benefits are often sold bundled with insurance policies so they appear to offer cover for your medical needs both out-of-hospital and in-hospital.
You need to remember that hospital cover that is limited to an insured rand amount may often be woefully inadequate for private hospital cover.
In terms of regulations under the insurance acts, policies may not offer cash payouts for days in hospital that exceed R3 000 a day or R20 000 a year.
Some of the bundled plans operating under exemptions from the Medical Schemes Act, however, offer a lump sum of, for example R150 000, for private hospital cover for accidents only.
Some plans include some cover for illnesses and some for elective procedures but many do not.
Some plans include insurance cover that pays a set lump sum, such as R200 000, for a severe illness or dread disease such as cancer or a heart attack or stroke. And some include funeral cover.
Private hospital costs, however, can run into hundreds of thousands of rands.
If you do not have a medical scheme, private hospitals often demand a large upfront payment to secure your stay.
Your insurance benefit may not be sufficient or may only last a few days, leaving you at risk of being transferred to a government hospital if your hospital stay is long.
Vernon Chorn, CEO of Unity Health, which provides primary healthcare plans, cites some examples of hospital costs: A diabetic patient with renal ● failure spent 38 days in hospital and incurred costs of about R2.1-million or R55 800 a day. A patient with respiratory
● pneumonia spent 29 days in hospital and incurred costs of R1.5-million or R54 500 per day. A patient who had chronic
● obstructive pulmonary disease spent 33 days in hospital and incurred about R1-million in costs or R31 300 a day. A patient who was involved
● in an accident spent 39 days in hospital, incurring about R425 800 or R10 900 a day.
But Richard Blackman, CEO of Day1 Health, says many state facilities are dysfunctional and anyone who can afford to should have the right to have some access to private hospitals even if there is a risk that the benefits may be inadequate for a prolonged stay.
Jason Crisp, Day1 Health’s legal and risk officer, says the average hospital stay is 2.3 days. He says you may run into trouble if you have an extended stay.