In-hospital benefits covered by health insurance

When choosing between a medical aid and health insurance, it’s important to be armed with all the right information. Bloom has partnered with Momentum Health to offer Health4Me, comprehensive medical insurance for those looking to make sure they have access to first-class facilities in case of a medical emergency.

Having health insurance means you can save on the costs associated with a hospital plan, which is covered by a medical aid policy. Let’s unpack this a bit more.

Read our article if you’d like to learn the difference between medical insurance and medical aid.

What does health insurance cover?

Health insurance will cover day-to-day benefits, like doctor’s visits, prescription or chronic medication, optometry and dental care, and major medical events, like a heart attack, which requires in-hospital care. Having health insurance means you can save on the costs associated with a hospital plan, which is covered by a medical aid policy. Let’s unpack this a bit more.

What is a hospital plan?

A hospital plan is a benefit covered by medical aid schemes. This is a form of risk-based insurance that covers your healthcare needs, for which you pay a monthly premium. This type of plan covers members for a set amount of in-hospital needs as well as certain day-to-day benefits.

What’s the difference between a hospital plan & in-hospital health insurance benefits?

The main difference between these two options is that medical aid covers both in-hospital and day-to-day medical costs. There are a set of 26 prescribed minimum benefits such as dental or optometry plans that a medical aid must cover. A medical aid member pays a monthly premium for this service, which has historically proven to become quite a costly monthly expense.

Health insurance provides less in-hospital cover than medical aid and is usually limited to emergencies only. If you have health insurance you will be covered for a list of pre-selected benefits which are serviced through the scheme’s network of approved medical providers.

Health insurance plans can also include death and funeral cover. It works out to be more cost-effective than medical aid because of its flexibility – a member only pays for their selected benefits.  This is called the building block approach.

In-hospital health insurance benefits – what will you be covered for?

Major medical event benefits can only be taken in conjunction with the Health4Me day-to-day benefits. If a health insurance member is scheduled for a surgical procedure, like an elective operation, they will need to provide the hospital with a guarantee of payment letter before being admitted to the facility. These procedures will not be covered by health insurance. The following however is covered:

1) Accident and Emergency Hospital Cover

This means you will be covered for casualty emergencies. It includes the transportation, stabilisation and treatment cost paid in case of an accident or event that requires emergency medical treatment.

Your health insurance plan will cover a private in-hospital casualty benefit in the event of an accident. An accident or event is defined as a medical emergency that is an external, unexpected event that is not traceable, either directly or indirectly, to a member’s state of mind or physical health prior to the event.

An example of which would be if you were involved in a car accident and had to be treated in casualty for a broken arm, or if you suffered a serious burn while cooking in your kitchen. These are unforeseeable medical emergencies that require immediate intervention.

In the case of a medical emergency that does not fit the qualifying criteria, transportation, stabilisation and treatment to a state facility will be covered.

There is also a specialist benefit cover for a heart and/or stroke emergency. As with the in-hospital casualty benefit, your cover will include the transportation, stabilisation and treatment at a private hospital. However, if the benefit limit is exceeded but further treatment is required, you will be transferred from the private facility to a state facility.

2) In-hospital cover for pregnancy and childbirth

Having access to top-quality medical care for the birth of a child is essential. Bloom’s Health4Me health insurance offers a maternity lump sum plan to cover your birth, so that mother and child can be assured of the best possible care during this time.

When it comes to pregnancy cover the in-hospital cash benefit will pay you a daily amount for each day spent in hospital (provided this does not exceed 48 hours). This monetary benefit allows you to pay for any unexpected costs you may incur as a result of your hospitalisation, like supplementing your income while you’ve taken time off work. Should you be admitted to hospital for childbirth, the health insurance plan will pay you a maternity lump sum, irrespective of the number of days for which you are hospitalised.

The hospital cash benefit and maternity lump sum benefit covers a maximum payout of R20,000 payable per member each year. There are waiting periods attached to this benefit.

How much does health insurance cost?

Bloom has partnered with Momentum’s Health4Me, which provides affordable health insurance to those who need to watch their budget. The entry-level health insurance option starts at just R570 per month. So, if you’re over the age of 18 and earn a minimum of R8,000 per month and less than R30,000, you will be eligible for one of our plans.

Finding the right health insurance plan for you

We offer Health4Me Bronze, Health4Me Silver and Health4Me Gold health insurance plans with varying day-to-day benefits.  Health insurance is best suited to those who are relatively healthy and don’t anticipate needing chronic healthcare services, but who still want to protect themselves against extensive emergency costs. Health insurance is also more flexible than medical aid schemes as it allows members to choose from a list of benefits that suit both their budget and individual medical needs.

Bloom’s Major Medical Events Benefits offers both casualty coverage as well as hospital cash benefits, allowing you to minimise your risk of any extra out-of-pocket payments in your time of need. Find out more about our Major Medical Events Benefits and Hospital Cash & Emergency Lump Sum payments.

Contact us for your health insurance quotes.

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Momentum Health4Me is not a medical scheme product, and is not a substitute for medical scheme membership. The information provided on this website does not constitute advice in terms of the Financial Advisory and Intermediary Services Act. Momentum is a division of Momentum Metropolitan Life Limited, an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of Momentum Metropolitan Holdings Limited.

Bloom Gap Cover is not a medical Scheme. Products that are offered are not the same as that of a medical scheme.

© Bloom Financial Services 2023. Bloom Financial Services (Pty) Ltd is an authorised financial services provider (FSP 50140). Bloom Gap is underwritten by Infiniti Insurance Limited a licensed non-life insurer and an authorised financial services provider (FSP No.35914)

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