How it works
Hospital plan explained
By Naledi Mokoena · 6 min read · Updated 24 June 2026
- Covers
- In-hospital treatment, surgery, PMBs, PMB chronic conditions
- Does not cover
- Most day-to-day GP visits and acute medicine
- Cost
- Cheapest plan type (indicative: low hundreds of rand per adult)
- Best for
- Healthy people wanting big-cost protection
A hospital plan is the most affordable type of medical aid that covers in-hospital treatment and Prescribed Minimum Benefits, but little to no day-to-day cover. It pays for admissions, surgery and PMB chronic conditions from the risk pool, while you pay for GP visits and everyday medicine yourself.
Hospital plans are popular because they protect you against the big costs - a hospital stay can run into hundreds of thousands of rand - at a fraction of the price of a comprehensive plan. This guide explains exactly what is and is not covered so you can decide if it fits.
What a hospital plan covers
A hospital plan covers care that happens in hospital:
- Hospital admissions and ward fees
- Surgery and anaesthetics
- In-hospital specialists and procedures
- Emergencies
- Prescribed Minimum Benefits, including PMB chronic conditions
Most hospital plans require you to use a network hospital and to get pre-authorisation for planned admissions.
What it does not cover
A hospital plan generally does not cover day-to-day, out-of-hospital costs:
- Routine GP and specialist visits
- Acute (non-chronic) medicine
- Dentistry and optometry
- Out-of-hospital scans and tests (unless linked to a covered admission)
You pay these yourself, which is why hospital plans are cheaper.
Chronic cover on a hospital plan
A common myth is that a hospital plan has no chronic cover. In fact, the 27 PMB Chronic Disease List conditions must be covered even on a hospital plan, because they are PMBs. So conditions like diabetes, asthma and hypertension are covered when you register and use the scheme's DSP. Non-PMB chronic medicine, however, is usually not covered. See chronic disease benefits.
Hospital plan vs full medical aid
| Feature | Hospital plan | Comprehensive plan |
|---|---|---|
| Hospital and surgery | Yes | Yes |
| PMBs and PMB chronic | Yes | Yes |
| Day-to-day GP and medicine | No | Yes (via savings) |
| Dentistry and optometry | No | Often yes |
| Monthly cost | Lowest | Higher |
If you are young and healthy, a hospital plan plus gap cover is a common low-cost combination. If you have regular medical needs, a savings or comprehensive plan may work out better.
Who a hospital plan suits
A hospital plan suits people who:
- Are generally healthy and rarely see a GP
- Want protection mainly against large, unexpected costs
- Can pay small day-to-day costs out of pocket
- Want to add gap cover for specialist shortfalls
Families with young children or chronic non-PMB needs often find a plan with day-to-day cover more practical.
Frequently asked questions
What does a hospital plan cover?
A hospital plan covers in-hospital treatment, surgery, in-hospital specialists, emergencies, and Prescribed Minimum Benefits including PMB chronic conditions. It usually requires a network hospital and pre-authorisation.
Does a hospital plan cover day-to-day visits?
Generally no. Routine GP visits, acute medicine, dentistry and optometry are not covered on a hospital plan. You pay those yourself, which is why hospital plans are the cheapest option.
Does a hospital plan cover chronic medication?
It covers the 27 PMB Chronic Disease List conditions, because those are PMBs. Non-PMB chronic medicine is usually not covered. Register the condition and use the scheme's DSP.
Is a hospital plan worth it?
For healthy people who mainly want protection against large hospital bills, yes. Many pair a hospital plan with gap cover. If you have frequent day-to-day needs, a plan with savings may suit better.
What is the difference between a hospital plan and medical aid?
A hospital plan is a type of medical aid that covers in-hospital care and PMBs only. A comprehensive medical aid adds day-to-day cover through a savings account, at a higher cost.
Do I still get emergency cover on a hospital plan?
Yes. Emergencies are a Prescribed Minimum Benefit, so they are covered on any plan including a hospital plan. Use the nearest facility in a true emergency and notify the scheme.
