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Affinity Health Hospital Insurance Plan (🇿🇦 2025)

Overall, the Affinity Health Hospital Insurance Plan is a trustworthy and comprehensive medical insurance plan that offers 24/7 medical emergency assistance and in-hospital cover. The Affinity Health Hospital Insurance Plan starts from R1,348 ZAR.

👤 Main Member Contribution	R1,348
👥 Adult Dependent Contribution	R1,248
🍼 Child Dependent Contribution	R408
🔁 Gap Cover	None
🏥 Hospital Cover	Up to R275,000 per policyholder, R325,000 per family
📉 Annual Limit	Up to R275,000 per policyholder, R325,000 per family
💶 Prescribed Minimum Benefits (PMB)	✅ Yes
😷 Screening and Prevention	✅ Yes
💵 Medical Savings Account	None
💙 Maternity Benefits	✅ Yes

Affinity Health Hospital Plan – 7 Key Point Quick Overview

✅ Affinity Health Hospital Plan Overview
✅ Affinity Health Hospital Plan Contributions
✅ Affinity Health Hospital Plan Benefits and Cover Comprehensive Breakdown
✅ Affinity Health Hospital Plan Exclusions and Waiting Periods
✅ Affinity Health Hospital Plan vs Similar Plans from Other Medical Schemes
✅ Our Verdict on the Affinity Health Hospital Plan
✅ Affinity Health Hospital Plan Frequently Asked Questions

Affinity Health Hospital Plan Overview

The Affinity Health Hospital plan is one of 3 options, starting from R1,348, and includes hospital cover up to R275,000 per policyholder, serious illness benefits, maternity, day clinic procedures, and more. According to the Trust Index, Affinity Health has a trust rating of 9.9.

💙Affinity Health has the following three options to choose from:

Affinity Health Hospital Plan Contributions

🟥 Category	🟧 Policyholder	🟨 Spouse	🟩 Adult Dependent	🟥 Child Dependent
🟧 Typical	R1,348	R1,248	R1,248	R408 per child
🟨 Junior	n/a	n/a	n/a	R1,228 first child Additional children – R408 each
🟩 Senior	R1,478	R1,388	R1,388	R408 per child

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Affinity Health Hospital Plan Benefits and Cover Comprehensive Breakdown

Hospital Plan Main Benefits

⚠️ Accidental Hospital Cover	Limited to R275,000 per individual or R325,000 per family per event. Covers casualties and hospitalization.
☀️ Daily Illness Hospitalisation	This benefit provides covers as follows: Day 1 to 3 – Up to R22,000 or R27,000 when the patient is admitted to the ICU. Day 4 and 5 – Up to R11,000 or R14,000 when the patient is admitted to the ICU. From the 6th day, the benefit pays R3,500 and covers up to 21 days per insured person per illness event.
🟨 Sub-Acute Hospitalisation	Members have access to Affinity Health-affiliated sub-acute care. Limited to R20,000 per member annually.
🟡 Serious Illness Hospital Benefit	The maximum Serious Illness Benefit for the lifetime of the policy is R300,000. The maximum benefit for confirmed Strokes and Cancer is R150,000.
🍼 Maternity	Natural, home, and water birth is limited to R30,000 per birth. Maternity C-Sections are covered up to R40,000.
🅰️ Day Clinic Procedures	Affinity Day Clinics for procedures up to R25,000 per member per year. Procedure-specific sub-limits will apply.
🅱️ Diagnostic Procedures	Affinity Health Diagnostic Formulary procedures covered up to R20,000 per single member or R25,000 per family policy per year. Benefit limits and co-payment apply.
🚗 Motor Vehicle Accident Benefit	This aids Road Accident Fund claims. Affinity Health’s attorney network will assess the accident at no cost to the member and assist with Road Accident Fund reimbursement.
📌 Workmen’s Compensation Benefit	This benefit covers occupational injuries and diseases. Affinity Health advises and assists members with third-party recovery, informing them of claim progress.
📍 Post-Hospital Private Home Nursing	Private nurse assistance is covered up to R11,500 per single member policy or R13,500 per family policy per year.
✅ Hospital Home Care Benefit	In-home and virtual visits with remote monitoring provide patients with timely, hospital-level care at home.

Hospital Plan Optional Benefits

🅰️ Intensive Care Benefit	Up to R27,000 cover per day in ICU or up to R24 000 per day in High care for the first 3 days and R14,000 for day 4 and day 5. This is dependent on the admission dates.
🅱️ Hospital Accident Booster	Starting at an additional R139pm for up to R350,000 cover, up to a maximum of R1,150,000 cover, dependent on the option chosen.

Hospital Plan 24/7 Emergency Services

⚠️ Trauma Support Services	Telephonic trauma support counseling and mental health wellness support for sexual assault, crime, gender-based violence, death, attempted suicide, and domestic violence by qualified and dedicated professionals.
➡️ 24-Hour Emergency	This includes 24/7 medical advice, ambulance services, inter-hospital transfers, hospital pre-authorization, and treating facility authorization.
✅ Major Trauma	Trauma covers paraplegia, quadriplegia, severe burns, internal and external head injuries, polytrauma, and limb loss. The cover is up to R1,100,000 for the policy’s duration.
☑️ Immediate Emergency Casualty Room Treatment	Limited to 1 ER Accident-related room treatment up to R3 500 per policy.
📊 Casualty Room Treatment	Emergency Room treatment for medical conditions and accidents up to R4,500 per policy per year.

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Affinity Health Hospital Plan Exclusions and Waiting Periods

Hospital Plan Exclusions

💙The Affinity Health Hospital Plan will not cover any of the following:

✅If a pre-existing condition causes injury within the first 12 months of cover.
✅If an injury is due to suicide, intentional self-injury, or exposure to obvious risk (excluding attempts to save human life).
✅If an injury is caused by alcohol, drugs, or narcotics (unless prescribed by a medical professional).
✅If an injury is caused by exposure to atomic energy or nuclear reaction.
✅If an injury occurs while traveling by air, participating in riots, civil commotion, or war, or during professional sports.
✅If an injury results from mountaineering, rock climbing, skydiving, or similar activities unless agreed upon by the Assurer.
✅If an injury is caused while intentionally unlawful acts or driving a vehicle without proper authorization.
✅If an injury results from a gradually operating condition known to the Assured Person.
✅If an injury is due to congenital abnormalities, chronic diseases, or disorders.
✅If an injury is related to regular medical treatments, contraceptive medication, or fertility-related therapies.
✅If an injury results from elective cosmetic surgery, corrective optical or laser surgery, or treatment.
✅If an injury results from male or female birth control, infertility, or assisted reproduction.
✅If an injury is due to a pandemic or epidemic.
✅If an unregistered healthcare professional provides the treatment.
✅If a superbug or multi-drug-resistant illness causes an injury.
✅If the Assured Person(s) is covered by a statutory body for a defined event, the policy will pay only the maximum benefit amount.
✅If the Assured Person(s) does not follow a doctor’s medical advice or instructions.
✅If fertility treatment leads to multiple births.

Hospital Plan Waiting Periods

💙Affinity Health applies the following waiting periods to the Hospital Plan:

✅Benefits have a waiting period of 3 months from the Commencement Date unless mentioned otherwise.
✅Pre-existing Conditions have a waiting period of 12 months from the Commencement Date.
✅Each Benefit may have its specific Waiting Period according to the policy.

Affinity Health Hospital Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Affinity Health Hospital	🥈 Bonitas Hospital Standard Plan	🥉 Sizwe Hosmed Access Core
👤 Main Member Contribution	R1,348	R2,964	R2,418
👥 Adult Dependent Contribution	R1,248	R2,610	R2,085
🍼 Child Dependent Contribution	R408	R1,127	R486
💙 Hospital Cover	Up to R275,000 per policyholder, R325,000 per family	Unlimited	Unlimited for PMBs

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Our Verdict on the Affinity Health Hospital Plan

💙 Affinity Health’s Hospital Plan is a comprehensive medical insurance offering coverage of hospitalization and related expenses. The plan is designed to support individuals and families during an unexpected medical emergency financially. The plan offers many benefits, including hospitalization, surgery, and medical treatment coverage. It also covers the cost of medication prescribed during a hospital stay and includes a 24-hour emergency helpline. One of the key features of Affinity Health’s Hospital Plan is its affordability. The plan is priced competitively and is accessible to individuals and families with different budget levels.

💙 Additionally, the plan is flexible, allowing members to choose from different options to tailor their cover to their specific needs. However, there are some drawbacks to the plan. For example, the cover is limited to hospitalization and does not include cover for outpatient services or preventative care. This can be added at additional cost. Additionally, there are waiting periods for some benefits, such as maternity benefits.

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Affinity Health Hospital Plan Frequently Asked Questions

What does the Affinity Health Hospital Plan cover?

The Affinity Health Hospital Plan covers hospitalization, surgery, emergency medical treatment, and medication prescribed during a hospital stay.

Does the Affinity Health Hospital Plan cover outpatient services?

No, the Affinity Health Hospital Plan does not cover outpatient services or preventative care.

Is the Affinity Health Hospital Plan affordable?

Yes, the Affinity Health Hospital Plan is competitively priced and designed to be affordable for individuals and families with different budget levels.

Can I customize my cover with the Affinity Health Hospital Plan?

Yes, the Affinity Health Hospital Plan is somewhat flexible. It allows members to add certain benefits at additional cost.

Are there waiting periods for benefits with the Affinity Health Hospital Plan?

Yes, there are waiting periods for some benefits, such as maternity benefits.

Is there a 24-hour emergency helpline with the Affinity Health Hospital Plan?

Yes, the Affinity Health Hospital Plan includes a 24-hour emergency helpline.

Can I enroll in the Affinity Health Hospital Plan at any time?

Yes, enrollment is open throughout the year. However, there may be waiting periods for certain benefits.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.

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