Hospital Plan Jargon 101
 

Hospital Plan Jargon 101

If you are unable to afford a more comprehensive medical aid package, then a hospital plan is certainly the way to go with its numerous benefits and affordability. Before you start to feel to wary of the whole process, let’s have a look at some of the important hospital plan jargon that you need to know:

Annual limit: Refers to the maximum amount of cover that you have for medical cover during a specific year.

Child dependent: When we speak of someone who is child dependent, we are referring to a member’s dependent child who is under the age of 23 years. This includes a stepchild or legally adopted child.

Designated service provider: Depending on your hospital plan provider, a designated service provider is appointed to provide certain medical services to members. Hospital plans are generally quite limited though, so you may have to pay out of pocket for a service provider.

Everyday services benefits: These benefits apply to medical treatment which you receive out of hospital, or as an outpatient.

Hospital and trauma benefits: These refer to benefits received for any major medical expenses from being admitted to hospital or from undergoing surgery.

Medical protocols: A set of pre-approved medical treatments which are authorised for certain conditions and need to be followed by service providers.

Pre-authorisation: Pre-authorisation is vital when admitting a dependent into hospital. A member needs to advise their medical aid scheme about the admission into hospital or else there may be penalties.

Shortfall: Most medical aid schemes and hospital plans have a limit, so a shortfall refers to any amount which exceeds this amount to which you are entitled to. It is paid by your scheme on your behalf.

Waiting period: Hospital plans and medical aid schemes usually require an initial waiting period of around 3 months during which the beneficiary may not claim any benefits. There are also condition-specific waiting periods which apply for 12 months after receiving medical advice.


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