Pregnancy cover if you don’t have medical aid

Pregnancy is considered a medical condition, and as such is subject to waiting periods when you join/change medical aid schemes. Waiting Periods If you have not had medical aid for more than 90 days and are pregnant, a scheme can impose a 12 month waiting period on your pregnancy when you...

How to use this site

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 you find your perfect cover. What does and does not do We list and compare all benefits for all open medical...

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.

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?

The Late Joiner Penalty is paid by medical aid members who are 35yr+ and who have not always had medical aid. Find out how the LJP is calculated, and whether it applies to you or not.

How do I complain about a medical aid issue?

Medical Aids are complicated and there is often misunderstanding and disagreement between the scheme administrator and the member. You should know that when a medical aid refuses to pay for a benefit that you feel you are entitled to, there are a lot of recourses for you to sort...

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, unless you have participated in fraudulent activities with that scheme. A medical scheme is 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 and late joiner penalties. A scheme is also not allowed to...

All the jargon explained

DSP A 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 (see below for definition of PMBs). (source: Council for Medical Schemes) Formulary This is a list of approved medicines...