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
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
Access to the Chronic Illness Benefit is subject to clinical entry criteria.
These entry criteria are in line with evidence based practices and legislative
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 clicking here.
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
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
Click here to access the application form.