Compare and find the best medical aid plans for your needs

Frequently asked questions:

How medical aids work

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.

Will I have to pay a Late Joiner Penalty?

What is it? A late joiner penalty is a permanent penalty, added as a percentage of...

Do I need a medical aid broker?

No, you can apply to become a member of any medical aid directly to the...

How do I complain about a medical aid issue?

Start by speaking to your scheme. Put all your communication in writing. Some schemes will...

When can I change my medical aid plan?

Determining when you can change your medical plan depends on whether you want to stay with the same scheme or not.

What are “Waiting periods”?

Waiting periods are imposed by the medical aid scheme on new members, based on their medical history. The waiting periods can also be applied to Prescribed Minimum Benefits (PMBs).

Can I be refused membership of a Medical Aid Scheme?

No. A medical scheme is generally not allowed to refuse you membership, including on the...

How do I change my medical aid plan?

A quick guide to how you can change your medical aid plan, including the resignation procedure, and things to look out for, such as imposed waiting periods from your new scheme

All the jargon explained

DSP A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is...

About us:

We understand that access to quality private healthcare and medical aids is expensive, but that it is a priority for you and for your family. We are committed to helping you make the best choices by giving you the information that you need, in a format that is easy to understand and comparable across all offerings.

At the core of this website are our three pillar values: transparency, neutrality and clarity. We hope that by offering this information – free of charge whether you are our client or not – you and your family can benefit from the best healthcare that your money can buy.

If you would like us to receive individual advice or you would like to appoint a broker (free of charge to you), please visit our commercial partner, AskAdam.co.za.

Jargon Explained

DSP: Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition. Could be a State facility.

Formulary: List of approved medicines for each condition. Each scheme has its own formulary which determines how it pays for medication. Some schemes have different lists (formularies) for different plans. If the medication you need is not on the formulary, the scheme might not pay for it, or might ask you for a co-payment.

Network Provider: A healthcare service provider (doctor, pharmacy, hospital, optometrist etc) with whom the scheme has a payment or service arrangement. Your plan might limit you to only providers in the network, or might require you to make a co-payment if your provider is not part of the network. Often, if you use network providers, the scheme will cover the cost in full, but check your plan for details.

PMB: Prescribed Minimum Benefits, is a set of conditions and their treatments that every plan must cover, in and out of hospital, regardless of what plan you are on, how much money (if any) is in your medical savings account etc. There are 270 recognised PMBs, including all emergency (life threatening) conditions and 27 chronic conditions. We have a more detailed explanation on PMBs here.

Scheme Rate: 100% is pre-set amount that the Scheme will pay for a service. If they pay at 200%, it means they will pay double what they normally would. You or your gap cover must pay the difference, if any. strong>There is no public reference as to what each Scheme pays out for what service.

More Jargon explained here

About Us

Medical Aid Bible has a simple purpose: to help you choose the best healthcare cover for your needs and your budget. We do this by comparing apples to apples, explaining the jargon and generally adding transparency to the whole complicated process!

Although utmost care was taken to show accurate information, we take no responsibility for errors. Always consult your broker or scheme provider before making any decisions concerning your medical aid.

We work with MC De Villiers Brokers to offer you the XelusGap Cover. MC De Villiers Brokers is an authorised Financial Service Provider (FSP:7241)

Unfortunately we cannot answer individual queries about your cover or claims, but you can contact us on [email protected] to tell us how we can improve, or how we helped you find the best cover!

Medical Aid Bible