Choosing a plan
Hospital plan vs comprehensive cover
By Naledi Mokoena · 7 min read · Updated 24 June 2026
A hospital plan covers your in-hospital costs and chronic PMBs but leaves you to pay for day-to-day expenses like GP visits, so it is cheaper, while a comprehensive plan adds day-to-day cover and extended benefits and costs more. The right choice depends on how much routine medical care you actually use through the year.
Healthy individuals and couples often do well on a hospital plan, while families with chronic conditions or regular GP, dental and optometry needs may get better value from a comprehensive plan.
This guide compares the two and shows how to decide.
What each plan type covers
- Hospital plan: in-hospital procedures, surgery, hospital stays and chronic PMB medicine. You pay for out-of-hospital GP visits, dentistry and non-PMB medicine yourself.
- Comprehensive plan: everything a hospital plan covers, plus a medical savings account and extended day-to-day benefits, often with higher limits and broader chronic cover.
Both must cover the Prescribed Minimum Benefits. The difference is the day-to-day layer.
Cost difference
| Plan type | Entry contribution (indicative, per adult) | Day-to-day | Best for |
|---|---|---|---|
| Network hospital plan | from ~R1,200 to R2,000 | None (you pay) | Healthy, budget-focused |
| Open hospital plan | from ~R1,900 to R2,800 | None (you pay) | Want any private hospital |
| Savings plan | from ~R2,800 to R4,500 | Savings account | Some day-to-day needs |
| Comprehensive plan | from ~R5,500 upward | Savings plus extended | Heavy day-to-day or chronic needs |
Indicative bands - confirm current rates on the scheme's site.
Who each suits
Choose a hospital plan if you are healthy, rarely see a doctor and mainly want protection from a large hospital bill. Pay day-to-day costs from your own pocket and you come out ahead.
Choose a comprehensive plan if you have a chronic condition, a young family, or regular GP, dental and optometry needs, where the day-to-day cover earns its higher cost.
The middle ground
A savings plan sits between the two: a hospital plan with a medical savings account funded from your contribution. It gives you some day-to-day cover without the full cost of a comprehensive plan. For many members this middle option is the sweet spot. Estimate your typical year of medical costs to see where you land.
Waiting periods and your rights
Both plan types can apply a 3-month general and up to a 12-month condition-specific waiting period to new members. Both must cover PMBs. If a scheme does not resolve a complaint, you can escalate to the Council for Medical Schemes (CMS) at medicalschemes.co.za, the statutory regulator for all registered medical schemes in South Africa.
Frequently asked questions
What is the difference between a hospital plan and comprehensive cover?
A hospital plan covers in-hospital costs and chronic PMBs only, so you pay day-to-day expenses yourself. Comprehensive cover adds a savings account and extended day-to-day benefits. The hospital plan is cheaper; comprehensive costs more for more cover.
Is a hospital plan worth it?
Yes, if you are healthy and mainly want protection from large hospital bills. You pay GP visits and routine costs yourself, but the contribution is much lower. For heavy day-to-day or chronic needs, a higher plan may be better value.
What does a hospital plan not cover?
A hospital plan does not cover out-of-hospital day-to-day costs such as GP visits, dentistry, optometry and non-PMB medicine. It does cover in-hospital procedures and chronic PMB medicine. Read the plan rules for any co-payments and exclusions.
How much cheaper is a hospital plan?
A hospital plan is significantly cheaper than a comprehensive plan because it drops the day-to-day savings and extended benefits. A network hospital plan is cheaper still. Compare current rates on each scheme's site for the exact gap.
Should a family get a hospital plan or comprehensive?
Families with regular GP, dental and chronic needs usually get better value from comprehensive or savings plans. A young, healthy family on a budget can do well on a hospital plan and pay day-to-day costs directly. Estimate your typical year.
What is a savings plan?
A savings plan is a hospital plan with a medical savings account funded from your contribution to pay day-to-day costs. It sits between a hospital plan and comprehensive cover, giving some day-to-day cover at a lower cost than full comprehensive.
