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The Differences between Hospital Plans & Health Insurance Hospital Cover

With so many different medical plans and offerings available, choosing the right healthcare option that includes in-hospital cover and benefits can be a tough and confusing choice. That’s why it’s so important to make an informed decision. Bloom Financial Services, in conjunction with their partner, Momentum Health4Me, offer a range of health insurance plans to fit your unique medical needs, including hospital cover.

Find out what the differences are between a traditional hospital plan and health insurance that includes hospital cover, and then choose the options to suit your needs.

What is a hospital plan?

A hospital plan is a benefit covered by medical aid schemes only. This hospital plan will assist you in covering expenses if you’re hospitalised for a medical emergency or a procedure, like an operation. It’s important to note that not all medical aid hospital plans will cover the same costs as certain details and limitations will exist between the respective medical aid providers and your medical aid plan. They are likely to contribute towards your admission, treatment, doctors and specialist bills, and other medical costs that are directly related to your hospitalisation. Medical aid hospital plans also include cover for prescribed minimum benefits (PMBs), which is a feature of the Medical Aid Schemes Acts, and includes 270 hospital-based emergencies and 27 chronic conditions, like asthma.

What is health insurance hospital cover?

In-hospital cover as offered by health insurance is limited to emergencies and accidents only and should not be confused with a hospital plan. Insurance products include a variety of different options for in-hospital benefits, like hospital cash plans or gap cover. A hospital cash plan, like those offered by Health4Me, pays out a fixed lump sum to the member. This payout covers the cost of lost income and expenses associated with the health event, which is usually related to an accident or an emergency, and some cases pregnancy or childbirth, and may not be directly related to the medical expenses itself.

How does hospital cover work for Health4Me?

In-hospital benefits with a medical insurance plan, like Momentum’s Health4Me, cover private hospital treatment for accidents and emergencies, like a car accident, stroke or a heart attack as well as pregnancy and childbirth benefits. If you require a surgical procedure, like hip replacement, you will not automatically be covered by your in-hospital benefit. You will have to first provide the hospital with a guarantee of payment letter in order to facilitate your admission. Be advised that some benefits will differ according to the specific health insurance plan and the respective waiting periods and/or limitations of that benefit option.

Benefits: hospital plans and in-hospital cover

The benefits of a simple medical aid hospital plan are as follows, you will get:

  • Unlimited private hospital cover at a network hospital
  • Guaranteed full cover in-hospital for specialists on a pre-authorised payment arrangement
  • Cover for medical emergencies if you’re travelling
  • Comprehensive pre- and postnatal healthcare services for maternity and early childhood
  • Cover for the 27 chronic disease conditions according to prescribed minimum benefits

*This comparison with not apply to all medical aids

The benefits of in-hospital cover with health insurance plans are as follows:

  • Accident and emergency cover – including the transportation, stabilisation and treatment in the case of an unforeseen accident or event. This also covers you in case of a member suffering a heart attack or stroke.
  • In-hospital cover for pregnancy and childbirth – in this case, the member will be paid a daily benefit per day that they are in hospital (up to 48hrs) and they will also be paid out a maternity lump sum of up to R20,000 per member for childbirth.

Costs: hospital plans and in-hospital cover

Medical aid hospital plan options start at R1,200 per month for a single member. Bloom Financial Services, together with Momentum’s Health4Me offers affordable Bronze, Silver and Gold medical insurance plans that include in-hospital benefits. In order to qualify you need to be over the age of 18 years and earn a minimum of R8,000 per month and less than R30,000.

1. Your personal medical needs and requirements

Hospital plans are generally better suited for healthy people with no dependents. In other words, young single people who don’t have the responsibility of raising a family and who don’t suffer from any chronic conditions, which may require visits to a specialist or specialised medical treatment, like dialysis or chemotherapy.

2. Your unique financial situation

You should also consider whether this type of healthcare is comprehensive enough for you, and if you have the financial resources to pay out of pocket for certain specialists and medicines that will not otherwise be covered. If you think that you may need to have surgery, or might need to visit a specialist, or if you or your partner could be expecting a baby in the near future, then you may want to reconsider the hospital plan option. Otherwise, you might also choose to take out a gap cover policy alongside your hospital plan. This will help to prevent any co-payments for certain treatments, specialists or procedures.

3. Get expert help

We understand that making sense of a healthcare plan and selecting the right option can be confusing and, at times, completely overwhelming. That’s why we have a team of expertly trained consultants to help you make an informed decision. Book an appointment for a chat with our team and we’ll be happy to explain the fine print.

4. Shop around and get some comparative quotes

It’s always worth the exercise of getting as many quotes as possible from different medical insurers. This way, you can get a clearer sense of the average price per month and find the plan that best suits your budget.

How much does a hospital plan cost?

Bloom Financial Services, together with Momentum’s Health4Me offers affordable Bronze, Silver and Gold medical insurance plans that include in-hospital benefits (or hospital plans). The entry-level health insurance option starts at just R447 per month. In order to qualify you need to be over the age of 18 year and earn a minimum of R8,000 per month and less than R30,000.


At Bloom, we are passionate about healthcare. That’s why our day-to-day benefits are designed to promote optimal health and prevent the need for hospitalisation. However, should you find yourself in need of extra coverage we also provide major medical event benefits that include a variety of in-hospital and cash benefits. Contact us today and let one of our expert staff members take you through your Bloom options, benefits and cover.