10 REAL ways to save money on your medical aid in 2019

Chances are, you are not happy with the new price of your medical aid for 2019. The good news is that you can change your plan within your scheme on 1 January, with no penalty, so now is the perfect time to evaluate whether you are on the right...

PMBs: Mental Conditions

PMB Mental Health conditions These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs (Designated Service Providers) are followed. CODECONDITIONTREATMENT 182T Abuse or dependence on Psychoactive substance, including alcohol Hospital-based management up to 3 weeks/year 910T ...

List of the 27 CDL (PMB) Chronic conditions

Chronic PMB conditions PMB (Prescribed Minimum Benefits), including chronic PMB conditions, are conditions that any medical aid needs to pay for, regardless of what plan you are on. No savings should be used to pay for this treatment, and there should be no co-payments. To find out more about PMBs, view...

Pregnancy cover if you don’t have medical aid

One of the most common questions we get asked is from expectant mothers, who don't have medical aid and want to know if they can still receive cover. Unfortunately, pregnancy is considered "a medical condition", and as such by definition is subject to waiting periods when you join/change medical...

Is your late joiner penalty worked out correctly?

We have found that some schemes and brokers misrepresent or miscalculate how the late joiner penalty is applied. We have laid three complaints with the Council of Medical Schemes. If you are paying a late joiner penalty, you can use the information on this page to determine if you are paying the correct penalty.

Should a medical aid scheme pay for experimental treatment?

Should medical schemes fund experimental treatments if they are a member's only option for survival?
Medical Aid costs

How day-to-day benefit works (savings, threshold, etc)

Savings With plans that have a savings facility as part of the day-to-day benefit, 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...

All about PMBs, and how schemes have to pay for them

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

List of PMB conditions and their prescribed treatment

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...

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.

Medical Aid 101

10 REAL ways to save money on your medical aid in 2019

Chances are, you are not happy with the new price of your medical aid for 2019. The good news is that you can change...

PMBs: Mental Conditions

PMB Mental Health conditions These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs...

List of the 27 CDL (PMB) Chronic conditions

Chronic PMB conditions PMB (Prescribed Minimum Benefits), including chronic PMB conditions, are conditions that any medical aid needs to pay for, regardless of what plan...