Joining The Scheme
1. What kind of hospital cover do you need?
Medical service providers can charge different rates. All medical
schemes have a predetermined rate of reimbursement which is called
the scheme rate.
Should your service provider be charging their own private rate,
then you need to understand that you will be liable for the
difference in cost between what the doctor is charging and the
applicable Medical Scheme rate.
Specific plans make use of a network of hospitals, thus it is
important to note that if you select one of these options you will
be compelled to make use of the hospitals within the network for all
planned procedures. One needs to take cognisance of the fact that if
a hospital outside of the network is used for a planned hospital
procedure, a deductible will be applicable.
Deductibles are applicable on certain plans. On these plans you
would need to pay a specified upfront payment to the hospital when
admitted for a defined list of procedures.
2. Do you need cover for any chronic conditions?
The Chronic Illness Benefit is a benefit that covers medicine for
a specified list of conditions according to your chosen Medical
Plan. These conditions have been selected according to clinical
criteria. This means that although a condition may be defined as
chronic, it may not meet the criteria for cover from this benefit.
Access to the Chronic Illness Benefit is subject to clinical
entry criteria. These entry criteria are in line with evidence based
practices and legislative requirements.
Should you have a chronic illness, you need to ensure that you
are familiar with the rules and conditions of the particular medical
scheme you are making application to and ensure that your condition
is covered by the scheme and the option you are considering to join.
If you need to access the Chronic Illness Benefit, please
complete the chronic application form, by
3. What kind of day-to-day cover do you need?
The out-of-hospital Benefits provide you with cover for medical
treatment received outside of hospitalisation and approved chronic
conditions. It therefore provides for the more frequent, but
controllable (non life threatening) medical expenses such as general
practitioner and specialist consultations, prescribed medication,
x-rays, blood tests, dentistry and optometry.
To access the Scheme brochures, please
click here. Please take the time to carefully read through all
the information on the benefit plans and consider what benefits best
suit you and your family’s medical needs and requirements.
Making the right decision for you and your family is extremely
important. We understand this and are committed to helping you make
the most appropriate plan selection.
Click here to access the application form.