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 Joining the scheme

 
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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 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 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.

 

 Choosing your plan

 
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In an effort to simplify the decision process around which option would be most appropriate to meet your family’s medical needs, please follow the following steps:

Step 1

Ensure that you understand the implications (underwriting) of not joining the company’s preferred scheme within 90 days of being employed.

Step 2

When evaluating your medical needs, one needs to ask yourself three important questions, in order to ascertain what hospital, chronic and day-to-day cover you and your family require.

Step 3

Read through the medical scheme options carefully. Write down the benefits you need and the set of plan options you are considering. You can access the plan range or compare the benefits.

Step 4

Do all the necessary calculations to ensure that your monthly medical scheme payments are within your budget.

Step 5

Once you have decided what the best medical scheme option will be for you and your family, please complete the relevant medical scheme application form. You must fill in all of the details on the form, including the dates of birth for your dependants; otherwise, your application form will not be processed.