Hospital co-pay ensures your healthcare decisions are not negatively influenced by a penalty imposed by your medical scheme when you elect to make use of an ‘out of network’ hospital.
Many members of medical schemes may be unaware that their plan doesn’t always permit them to use any hospital of their choice. Most schemes have a list of designated network service providers, requiring you to visit a hospital that may not be your first or most convenient choice.
For instance, your preferred medical specialist may not operate from any of the network hospitals on the list or the hospital may be located very far away from where you live. Should you elect to visit a hospital of your own choice, you will be charged (in the form of a co-payment) around R15 000 per admission.
So while you may be saving money every year by paying the lowest medical scheme premium available, those savings will quickly disappear should you or a member of your family elect to visit a hospital outside of the network.
That’s where our innovative hospital co-pay plan comes in. We have specifically developed this product to give you the privilege of choice without forgoing the savings afforded by a lower-premium medical aid plan.
Choose the hospital you want and still enjoy the benefit of a lower monthly premium on your medical scheme plan.
- Co-payment Cover
Allows for reimbursement of the co-payment imposed by your medical scheme as a penalty for utilising a hospital outside of the medical scheme’s preferred provider network. It is important to note that this policy is specifically designed to cover elective hospital admission co-payments and is limited to R15 000 per person per event. It does not cover emergency room admission costs or procedural co-payments.