Medical Aid 101

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.

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...

Start by speaking to your scheme. Put all your communication in writing. Some schemes will have an appointed person who deals with escalated queries or complaints. If your complaint is not resolved to your satisfaction, ask your scheme if the matter can be escalated. You can also contact the Council of Medical Schemes. This is "a statutory body established by the Medical Schemes Act to provide regulatory supervision of...

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

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).

No. A medical scheme is generally not allowed to refuse you membership, including on the grounds of past-ill health, or you being a high risk. A scheme, can, however impose waiting periods. A scheme is also not allowed to charge you a different (higher) premium because of your past medical history. It can, however, impose a "late joiner penalty", which can range from an extra 5% to extra 75%...