Medical Aid and MTB

[Captain Fastbastard Mayhem]

 

 

How does that work? Hospital plan = medical aid?!

 

He's talking about the old Life insurance type of hospital plan like the Liberty Medical Lifestyle plan that pay you a cash amount per day you spend in hospital up to a predetermined maximum, and the amount depends on the severity of the injury and which room you're in (icu vs high care)

 

This compares to med aid which has no limits on daily cover and and and...

 

The 2 cannot be compared. Hospital plans are more like gap cover in that they are designed to bridge the gap between med aid and the charges that you incur from the specialists.

 

In most cases the Hospital Plan would be sorely lacking in cover purely from a rand perspective... and he's right. Hospital plan patients are treated like normal non med aid clients. Pay up front cos there's no guarantee on payment. Generally speaking

[Captain Fastbastard Mayhem]

Btw - hospital plans must not be confused with medical aids that only provide cover in hospital. 2 totally different things.

[CogitoErgoSum]

Apologies for the hijack - then what can sweatsafe be seen as? Not medical aid? Gap cover? Insurance?

 

I am in a sticky situation that forces me not to have medical aid (have instated Labour court action against previous employer. Don't ask...)

 

What will sweatsafe cover?

[Rapunzel]

I'm on coastal core. The difference in premiums between a more comprehensive plan and a basic hospital cover is huge.We rather invest the balance in our access bond and then use it where required for out of hospital expenses. In the year our daughter was born, our family's out of hospital expenses came to R25000 but it still worked out cheaper than being on the comprehensive plan. The biggest concern is that major medical expenses (surgery, chemo, ICU, ...) are covered.

Treatment at hospital outpatients is very expensive. For injuries that are unlikely to need admission, we use Intercare who have longer working hours and an x-ray department on site.

[Mr X]

MTB accidents will lead you to see specialists, for this you need to have gap cover or you will pay out of your own pocket.

[BlinkFan]

Hi there,

 

I'm on Discovery Keycare Plus. It is the lowest plan they have. I don't really need anything more. I need to know if the medical aid will pay for injuries that occurs while I'm mountain biking or should I get additional cover?

 

I'm new to this.

 

Thanks

 

I was on Keycare Plus a couple of years ago. I had a tumble one Saturday and broke my collarbone. Here is what happened:

1. Went to an approved Medi-Clinic and got X-Rays. You have a certain number of X-Rays per year they will cover. Think I might have had to pay R300 to see the doc on duty in emergency unit.
    
   
2. Had to wait till Monday to see my doctor. You have a doctor in your network that you have to see. He then confirms your collarbone is broken, and writes something fancy on a little piece of paper like "Right clavicle fracture". You don't have to pay for the doctor because you get a certain number of visits per year to the doctor in your network.
    
   
3. That little piece of paper then allows you access to a specialist, orthopedic surgeon in this case. You first have to phone Discovery and get authorization. I saw him the Monday.
    
   
4. The specialist then asses your injury and books you into surgery (for Thursday). He also tells you who the anesthetist will be. I think he also tells you the operation code etc. You then phone Discovery again and get authorization for your planned hospital visit. You are also informed that the specialist charges 200% of the normal rate and you will be required to pay in. The anesthetist also charges 200% so you will have to pay in.
    
   
5. You go for the op and they fix you up, and spend a night in hospital.
   

What I'm trying to tell you is that, yes it is a bit more trouble than if you were on a higher medical aid option. BUT, at the end of the day I was able to go to a private hospital within 30km radius of my home, have an good doctor fix my shoulder, and at the end of the day it cost me R2500 out of my own pocket and not R25000.

 

Even a bad medical aid is MUCH better than nothing.

 

EDIT: This was 5 year ago so my facts might not be 100% anymore, and their policies might have changes in the mean time.

Edited January 23, 2014 by BlinkFan

[Stoffies1]

A buddy of mine took a spill over the weekend, and was sorted out in casualty (wasn't admitted or anything). Did X-rays and all kinds of scans, and ended up having to clear his MSA.... The rest of the costs (substantial) he has to carry on his own.

 

Fine print is a bugger, know what you are covered for to avoid (or lessen) the shock and disappointment.

 

Discovery wont pay out if you are not admitted and stay overnight. Be like a footballer and put up a good show to be admitted. My 5c worth!!!

[RuanJvR89]

Hi there,

 

I'm on Discovery Keycare Plus. It is the lowest plan they have. I don't really need anything more. I need to know if the medical aid will pay for injuries that occurs while I'm mountain biking or should I get additional cover?

 

I'm new to this.

 

Thanks

 

Hi there all,

 

Got a solution for my problem.

 

I phoned Discovery again and they said they will only cover serious injuries(back and neck ETC) if I'm admitted into hospital. I unfortunately can't change medical aid now. So I took out the best SWEATSAFE for the bills the medical aid doesn't pay.

 

So I hope I don't need it this year.