Difference Between a Hospital Plan and Belonging to a Medical Aid

Medical aid schemes in South Africa offer both hospital plans and comprehensive medical options. But what is the difference between a hospital plan and belonging to a medical aid? Before we look at the differences let us look at what hospital plans and medical aids are.

What is a medical aid?

Medical aid is risk-type insurance. One takes out the insurance against your health to cover your private medical needs. For a monthly premium, the medical aid will cover your health costs in and out of hospital depending on the plan you choose. Plus you have guaranteed cover for dozens of conditions and chronic diseases in terms of the Medical Schemes Act.

What is a hospital plan?

A hospital plan is also a form of medical insurance, although this only covers your medical care in hospital. You also pay a monthly premium. Medical schemes offer these but also by insurance companies.Difference Between Hospital Plan and Medical Aid

What is the difference between a hospital plan and belonging to a medical aid?

  • Both medical aids and hospital plans are provided by medical aid schemes, while insurance companies only offer hospital plans without prescribed minimum benefit cover.
  • Medical aid options have medical plans available that cover both hospital and day-to-day expenses; these can be at private medical service providers or network providers.
  • Hospital plans only cover medical care should you be a patient in hospital. The rest of the medical costs come from your own pocket.
  • Both medical aids and hospital plans from medical have to pay for treatment of the prescribed minimum benefits and the 25 chronic conditions on the list. Insurance companies do not have to follow these regulations.
  • Medical aids tend to cover more chronic conditions than hospital plans.
  • There are hospital plans available with additional medical savings accounts to cover some of your day-to-day medical costs, though these accounts are limited.


More Differences Between the Two

  • Most of the medical aids available have unlimited annual cover where hospitalisation is concerned; this, however is not always available with hospitals plans, and overall annual limits on treatment are present.
  • Both hospital options and medical aids can be network plans that are based at network service providers.
  • Both hospital plans and medical aids pay your medical costs at scheme rates, although the rates are normally higher on medical aids.
  • Hospital plans are a more affordable medical aid option, even though treatment is limited to hospitals.
  • Both hospital and medical aids have to pay for medical care pertaining to life threatening medical emergencies.
  • Medical aids have additional bonus benefits such as maternity programmes, health screening programmes, dental and optometry benefits, chronic medical treatment out of hospital, benefits for over-the-counter medication and sometimes even rewards programmes.


The main difference between a hospital plan and belonging to a medical aid is that, with a medical aid, you will receive comprehensive medical cover in and out of hospital, whilst with a hospital plan the cover is limited to in-hospital treatment and treatment of prescribed minimum benefit diseases if the hospital plan is run by a medical aid scheme.

All info was correct at time of publishing