Photo: Ossewa, Wikimedia Commons, CC BY 4.0Hospital plan vs comprehensive medical aid vs hospital cash plan
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The three products side by side
| Hospital plan option | Comprehensive option | Hospital cash plan | |
|---|---|---|---|
| What it is | A benefit option of a medical scheme | A benefit option of a medical scheme | Insurance: "non-medical expense cover as a result of hospitalisation" |
| Supervised by | Council for Medical Schemes | Council for Medical Schemes | Insurance regulator (Demarcation Regulations, category 2) |
| Law behind the product | Medical Schemes Act | Medical Schemes Act | Long-term or Short-term Insurance Act regulations |
| Prescribed Minimum Benefits | Yes, in full (Regulation 8) | Yes, in full (Regulation 8) | No |
| Day-to-day doctor visits, medicine | Limited or none, per the option's rules | Yes, within the option's limits | No |
| Price based on | Income and dependants only (s.29(1)(n)) | Income and dependants only (s.29(1)(n)) | Group rating; higher premium allowed by entry age |
| What it pays | Hospital accounts, per the option's rules | Hospital and day-to-day accounts | A fixed sum per day or a lump sum, not linked to the bill |
Sources: the Medical Schemes Act and Regulations and the Demarcation Regulations.
A hospital plan is still medical aid
Because a hospital plan is a scheme option, you get every protection of the Medical Schemes Act: no refusal by an open scheme (s.29(3)(a)), contributions set only by income and dependants (s.29(1)(n)), and the waiting-period limits of s.29A (see medical aid).
Regulation 8(1) obliges any benefit option to pay the PMBs in full — so a hospital plan must also pay for the 26 chronic conditions on the Chronic Disease List and the PMB conditions treated out of hospital, through its designated service providers (see PMBs).
What a hospital plan usually leaves to you: GP visits, acute medicine, dentistry and optometry that are not PMBs. The CMS reports that hospital services were 35.95% of all benefits paid by schemes in 2024 (CMS Annual Report 2025/26) — hospital cover is the biggest risk a scheme carries for you.
Hospital cash plans: the limits for 2026
Category 2 of the Demarcation Regulations allows insurers to pay a fixed sum per insured person per day in hospital, or a maximum lump sum per year whatever the number of days. The benefit must start no later than after 3 days in hospital, then counts from day 1, and may not be paid to the hospital or doctor. It may not indemnify you for medical expenses (Regulation 7.3(1)).
| Limit (from 1 April 2026) | Long-term Insurance Act table | Short-term Insurance Act table |
|---|---|---|
| Per insured person per day | R4,537.18 | R4,537.61 |
| Maximum lump sum per year | R30,250.74 | R30,312.74 |
Sources: Treasury's 2026 escalation tables for the Long-term and Short-term Insurance Acts, published with the 1 September 2026 media statement (CPI 3.2%). The two annexures print slightly different amounts; the original 2017 limits were R3,000 per day or R20,000 per year.
Which one fits you?
- You want protection against a big hospital bill at the lowest contribution: compare hospital plan options of registered schemes. Check the hospital network (DSP) and co-payments for specific procedures in the rules.
- Your family sees a doctor often or takes regular non-chronic medicine: price a comprehensive or savings option over a full year, not just the monthly contribution.
- You already have medical aid and worry about specialist shortfalls: that is the job of gap cover, not a hospital cash plan.
- You want cash for transport, childcare or lost income while in hospital: a hospital cash plan can help, within the 2026 daily limit — but it does not pay medical bills.
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Frequently asked questions
What does a hospital plan cover in South Africa?
Hospital admissions according to the option's rules, plus all Prescribed Minimum Benefits in full, including the 26 chronic conditions — because a hospital plan is a medical scheme benefit option.
Is a hospital cash plan the same as a hospital plan?
No. A hospital cash plan is an insurance policy that pays a fixed amount per day in hospital (about R4,537 per day from 1 April 2026) for non-medical costs. It is not medical aid and does not pay PMBs.
Can I have a hospital plan and gap cover together?
Yes. Gap cover pays part of the difference between a provider's bill and what your scheme paid, within R226,881.03 per insured person per year from 1 April 2026.
Is a hospital plan cheaper than medical aid?
A hospital plan is a medical aid option, so compare it inside each scheme's own contribution table: it leaves out most day-to-day benefits, which is what you trade for the lower contribution. The CMS 2026 averages across all options are R3,759 a month for a main member and R6,204.78 for an average family (gross) — see medical aid.
Does a hospital plan cover emergencies?
Yes. Any emergency medical condition is a Prescribed Minimum Benefit (Regulation 7), and every benefit option, including a hospital plan, must pay PMBs in full (Regulation 8); in an emergency the scheme may not stop treatment before authorisation (Regulation 8(6)).
Can a hospital plan refuse me because of my health?
An open scheme may not refuse you (section 29(3)(a)) or price you on your health (section 29(1)(n)), but it can apply waiting periods under section 29A and a late-joiner penalty if you are 35 or older.
Sources
- Council for Medical Schemes — Medical Schemes Act 131 of 1998 and Regulations (consolidated copy, Web Archive)
- National Treasury — Short-term Insurance Act regulations, Part 7 (Demarcation Regulations, GN 1582 of 23 December 2016)
- National Treasury — Media statement: Demarcation Regulations, 2026 escalation of policy benefits (1 September 2026)
- National Treasury — Long-term Insurance Act, Regulation 7.2(2): policy benefits escalation table (2026)
- National Treasury — Short-term Insurance Act, Regulation 7.2(2): policy benefits escalation table (2026)
- Council for Medical Schemes — Annual Report 2025/26 (copy tabled in Parliament, hosted by PMG)