What it costs to use a hospital outside your plan’s network

Most South African medical aid plans restrict you to a list of hospitals for planned admissions. Go elsewhere and you pay — sometimes a fixed amount, sometimes a percentage of the whole bill, sometimes the entire account.

All 153 plans on our panel, shown as — options — income bands and the Hospital/Savings twins of one option are listed once. Each figure is quoted from the scheme’s own document, with the file and page it came from.

How to read a co-payment

A stated rand amount caps what you pay. R15 025 per admission is R15 025, whatever the hospital charges.

A percentage does not. 30% of the account grows with the bill — and the scheme funds the rest only up to its own rate, so anything charged above that rate is yours as well. The percentage is a floor, not a ceiling.

No cover is neither. It is an exclusion rather than a price: the whole account is yours, and a private admission is rarely less than R15 000.

Where are the hospitals?

We do not publish hospital lists. They change, and a stale list is worse than none — check your scheme’s own finder before you are admitted, not on the day. What this page tells you is the part schemes bury: what it costs you if the hospital you need is not on the list.

Want this worked out for your household?

The number that matters is not the co-payment on its own — it is that co-payment weighed against what the unrestricted version of the same plan costs you every month. That varies by scheme, and by who is on your plan.