Frequently Asked Questions: Benefits

How do I know what the best option is for me and my family ?

Medical scheme brochures outline benefits and contributions for the year. It is important for you to firstly ascertain what your family’s needs for the year are and then look for the best option to suit those specific needs. The cost of a monthly contribution also plays a vital role but should not outweigh the importance of ensuring that the coverage you have is sufficient for the year. We recommend that you contact us to assist you with this process.

Can I change options during the year

No. Medical aid schemes usually allow you to change options once a year only, which is at the end of the year for the new year. Certain schemes however under extenuating circumstances may allow this but you would need to motivate to get approval.

Is my medical scheme compelled to provide cover for certain medical conditions?

Yes, these are known as Prescribed Minimum Benefits (PMBs). They were introduced into the Medical Schemes Act to ensure that members would not run out of benefits for certain conditions and find themselves forced to go to state hospitals for treatment. These PMBs cover a wide range of close to 300 conditions, which are normally regarded as life threatening conditions. Many schemes opt to use designated service providers that you can obtain your medication from. If you have any PMB conditions and are looking to change medical aids or join a new scheme it is important for you to ascertain whether your medical condition is classified as a PMB. We recommend that you contact us for further advice if you think you may fall within this particular category.

Am I entitled to benefits while serving notice of termination?

Yes, normally one month's notice is needed when terminating your membership, you will enjoy cover until the last day provided contributions are being paid.