How medical aids pay for claims
A quick explanation of how medical aids pay for claims, including the scheme rate, scheme rate, day-to-day claims, and claims for in-hospital services.
Find the right health professional for you:
:: Featured Post ::
10 real ways to save money on your medical aid in 2021!
How to save on medial aid? There are real things you can do to save money and optimize your plan, for example some plans don’t charge for all your kids.
All the jargon explained
Medical aid and PMBs? DSPs? PPNs? We decipher the medical aid jargon in plain English so that you are not as confused 🙂
:: Featured Videos ::
:: Worth Reading ::
10 real ways to save money on your medical aid in 2021!
How to save on medial aid? There are real things you can do to save money and optimize your plan, for example some plans don’t charge for all your kids.
All the jargon explained
Medical aid and PMBs? DSPs? PPNs? We decipher the medical aid jargon in plain English so that you are not as confused 🙂
Question: Will I have to pay a Late Joiner Penalty?
Members who apply for medical aid and who are over 35 years old may have to pay a Late Joiner Penalty.
Question: Do I need a medical aid broker?
A good medical aid broker can save you R1,000s a year – and prevent many admin headaches. And they are free!
Question: When can I change my medical aid plan?
Need a new plan? Determining when you can change your medical plan depends on whether you want to stay with the same scheme or not.
Question: What “waiting periods” will apply to me?
Waiting periods can prevent you from getting the cover that you need – but they are not always applied. Find out rules here.
:: From our Health Hubs ::
:: From the Pressrooms ::
Covid-19 Help
Covid-19: How does medical aid pay for tests?
When does your medical aid have to pay for a Covid-19 test, and when is it left up to its own scheme rules? Avoid nasty...
Covid-19 Definitions
The official Covid-19 definitions as per the Council of Medical Schemes. Confirmed, Suspected and Close Contact persons and cases.
Covid-19: How is it transmitted?
A clear guideline as to how Covid-19 is transmitted, with special attention to asymptomatic and symptomatic patients and the transmission rate
Covid-19 and Telehealth
Can you use telehealth - virtual consults - to get treatment of help with Covid-19, and should this be covered by your medical aid?
Covid-19: What does Medical Aid have to pay for?
A clear summary of which Covid-19 treatments fall under the PMB Level of Care, and should thus be funded fully by your medical aid
Covid-19: Palliative Care and your Medical Aid
Recommendations for how medical aids should fund Covid-19 palliative care, and which aspects and treatments fall under this recommendation
Medical Aid 101
How medical aids pay for claims
A quick explanation of how medical aids pay for claims, including the scheme rate, scheme rate, day-to-day claims, and claims for in-hospital services.
10 real ways to save money on your medical aid in 2021!
How to save on medial aid? There are real things you can do to save money and optimize your plan, for example some plans don’t charge for all your kids.
All the jargon explained
Medical aid and PMBs? DSPs? PPNs? We decipher the medical aid jargon in plain English so that you are not as confused 🙂
Question: Will I have to pay a Late Joiner Penalty?
Members who apply for medical aid and who are over 35 years old may have to pay a Late Joiner Penalty.
Question: Do I need a medical aid broker?
A good medical aid broker can save you R1,000s a year – and prevent many admin headaches. And they are free!
Question: When can I change my medical aid plan?
Need a new plan? Determining when you can change your medical plan depends on whether you want to stay with the same scheme or not.
PMBs 101
List of PMB conditions: Mental Illness
A list of the PMB conditions that need to be covered for diagnosis, treatment and management, in full, by your medical aid.
List of PMB conditions: Muscoloskeletal System
A list of the PMB conditions that need to be covered for diagnosis, treatment and management, in full, by your medical aid.
List of PMB conditions: Skin and Breast
A list of the PMB conditions that need to be covered for diagnosis, treatment and management, in full, by your medical aid.
List of PMB conditions: Endocrine, Metabolic and Nutritional
A list of the PMB conditions that need to be covered for diagnosis, treatment and management, in full, by your medical aid.
List of PMB conditions: Urinary and male genital system
A list of the PMB conditions that need to be covered for diagnosis, treatment and management, in full, by your medical aid.
:: From the Admin Desk ::
