hospital plan vs full medical aid

Hi There,

We're on Discovery Keycare Plus.
As long as we go to doctors, specialists and hospitals that are on their network list the full amount is covered. Baby is even covered from 12 weeks pregnant up to 30 days after birth under mommy's name (free of charge).

The only disadvantages we've had so far:
1) If you don't like the dr's they cover you have to pay cash.
2) Prescriptions are not covered unless your dr is a dispensing dr.
3) They only cover a percentage for glasses/contact lenses.
4) Elective c-sections are not covered. Only emergency c-sections, or medically declared c-sections are covered in full.

Other than that we're quite happy on the Keycare Plus. We pay roughly R4000 a month, and that's for myself, fiance and 2 children.

Oh forgot to mention. I got my hospital pre-authorisation number at 12 weeks pregnant as well. My biggest fear was that if we're visiting family or friends and not near our chosen hospital, will emergencies or birth be covered somewhere else... Discovery reassured me that even if I go to a hospital not on their list, as long as the hospital codes it as an emergency on the claim form, the hospital bill will be paid in full, for both me and baby. Even if it's a false alarm. (natural birth)

We are on Discovery Delta Core with Liberty Gap cover. We chose this over comprehensive because truth be told, unless you are on a maximum benefit plan, your day-to-day costs are limited and may run out, meaning you'd have to pay the difference anyway. Basically it works out no better than saving the cash, and is limited to certain amounts per different kinds of claims. Unless you or your child suffer from everything covered in each category, you're likely to be losing more money than if you just saved it. Also, to justify being on a maximum benefit plan without limits you'd need to be spending on average R3000pm on day-to-day costs. For us, it just isn't worth it.

We are on discovery coastal core (hospital plan), and gap cover. I put R600 away every month into a capitec accoutn for day to day medical expenses like doctor visits.

My lb had a very bad first year with numerous hospital stays. Everything was covered by the hospital plan (over R75k). As long as they are in hospital, they are covered. It included the visits by the doctors, the physios, the surgeries, the medicines, everything. Sometimes the specialists that did surgeries charged a bit more and that shortfall was covered by gap cover, but everything else was covered by the hospital plan.

We only have hospital plan and put away the difference between full plan and hospital plan (with Gap cover) into an Capitec account. So if we need it, it is there. And we get the interest on it. We very rarely go to the doctor, so we have saved up quite a bit this way.

Hi

We moved from a full medical aid to a hospital plan (includes GP consultations though) when I changed jobs
Instead of paying R4365 per month to go on next option we only pay R2351 .made sure we have gap cover and plan has a separate maternity coverage/benefit.
I put R500 away each month as a back up incase there's anything need to cover for medical aid and rest seen as savings because goes into my son's account.

HI

If its not about affordability, Id suggest you get a full plan with great maternity benefits. Remember young ones do get sick at times so you do not want to get stuck in the middle of the month with a sick child and not having the cash flow to go to the dr because the hospital plan doesnt cover gp / paed appts.

Id go with rather safe than sorry, with a full medical aid. and remember to have that gap cover aswell. some specialists really charge ridiculous fees.

good luck with your ttc journey

Hi Bettyrobble,

Welcome to Moomie!!

I can be quite frugral when it comes to our finances and try and cut corners every months where ever we can. However our medical aid expenses are some of our highest expenditures each month - the premium that is apart from things that doesn't get covered by the medical aid.

What we did is to have me and my LG on the Discovery classic comprehensive plan and my husband is on the Discovery hospital plan. Hubby is generally very healthy and we cash for yearly check ups or odd doctor's visits.

I presume that a baby in ICU should be covered by a hospital plan but sometimes there can be a health issue that perhaps only get discovered a few weeks later or months. Our LG was diagnosed with a rare bladder abnormality that required a few surgeries. After that we had to operate her toes as well as she was born with curly toes which did not improve as time went by. I am not sure if all these expenditures would have been covered by a hospital plan or not, but my gut feeling tells me it would have cost us slightly more if we were only on a hospital plan or perhaps it would have been very similar in cost with only a hospital plan. I think it is a bit of a gamble and one must know it is a risk and one must decide if it is a risk you can afford to take.

My LG was otherwise in relative good health, but you would be surprised how much it costs if your child has regular ear infections or other minor health issues that requires medical attention. Not to speak of peadiatrician costs if needed!

We are definitely planning to move to a cheaper plan once my kids are slightly older and they seem in general good health.

Good luck with your decision!