Xelus shall apply Waiting Periods to the cover of an Insured as outlined below: 1. During the first 3 (three) months of membership, a general waiting period, as defined herein, shall apply. 2. During the first 12 (twelve) months of membership, a condition-specific waiting period, as defined herein, shall apply. 3. Waiting periods shall be applied to the cover of the relevant insured person, from the time that such insured’s cover commences...
All gap covers have extensive exclusions, with which you should familiarise yourself. Here are Kaelo's: Xelus or the Underwriter shall not be liable for any claim caused by or related to, whether such cause or related cause is as a direct or indirect consequence of any of the following: 1. Any Treatment or Medical Procedure related to obesity. 2. Cosmetic surgery except in the case where reconstructive cosmetic surgery is necessitated, in...
Kaelo Xelus offers a gap cover product that we feel has excellent benefits and is well priced. Please read "How gap covers work" if you re unfamiliar with gap products. . The benefits of this gap product are included per each 2018 plan that we show on this website, so you can immediately see the full benefit of the medical aid ad the gap. Simply find your plan using our menu...
How do gap covers work
Paying for shortfalls If you have an in-hospital procedure, very often you will have to pay for services out of pocket, even if you have medical aid. This can be because: Your doctors charge more than your medical aid has agreed to pay them There is a co-payment you have to pay upfront There is a sublimit, and you surpass it ...
Medical Aid costs
Savings With plans that have a savings facility, you get an annual allowance, known as your savings account. It is funded by a portion of your premiums over the year, although the full amount is available to you in January. There is no financial advantage to a savings account, since all of the monies are paid by you. The scheme does not "top up" the account. In addition, a scheme...
We know the medical aid industry is complicated, and the information presented on this site can be overwhelming. Hopefully this page will be a good starting block to help fulfill your goal. What the Medical Aid Bible does and does not do We list and compare all benefits for all open medical aid schemes. An "open" medical aid scheme is one that any person can join, regardless of their employer or...
PMBs are 270 conditions that schemes have to cover without requiring co-payments or savings from you, even if the treatment is provided out-of-hospital. This applies to every plan.
Managed Programs
Below is a list of the Categories (Diagnosis and Treatment Pairs) constituting the Prescribed Minimum Benefits (PMB) Package under Section 29(1)(o) of the Medical Schemes Act (listed by Organ-System chapter). IMPORTANT: For an explanation of general treatments (example: "Medical Management") please click here NOS means "not otherwise specified". BRAIN AND NERVOUS SYSTEM CODECONDITIONTREATMENTFor more in-depth explanation, click here 906AAcute generalised paralysis, including polio and Guillain-BarreMedical management; ventilation and plasmapheresis 341ABasal ganglia, extra-pyramidal disorders; other...
A brief introduction to how medical aids work, the different types of plans, and their obligation to cover out-of-hospital expenses for certain conditions, regardless of plan type.
What is it? A late joiner penalty is a permanent penalty, added as a percentage of the base premium (not the savings portion). It is meant to dissuade or penalise people from not belonging to a medical aid in their youth, when they are presumably healthy, and joining only when they get older, and are a bigger drain on the schemes. Therefore, members who apply for medical aid coverage and are...