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.

Share Your Thoughts About Hospital Plan Jargon 101 using Facebook

Rate Hospital Plan Jargon 101

Rate Hospital Plan Jargon 101