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...

Kaelo Xelus Gap Cover – Waiting Periods

Kaelo Xelus, like all gap covers, applies waiting periods under certain conditions. They are listed below. You can also view the full policy document, or read about the exclusions on this policy. Kaelo Xelus shall apply Waiting Periods to the cover of an Insured as outlined below: ...

Kaelo Xelus Gap Cover – Exclusions

All gap covers have extensive exclusions, with which you should familiarise yourself. Kaelo's are listed below. You can also view the full policy document here, or read about the waiting periods. Xelus or the Underwriter shall not be liable for any claim caused by or related to, whether such cause...

Fusion Gap Cover – 2018 Benefits and Premiums

About Kaelo Xelus offers a gap cover product, Fusion Gap, that we feel has excellent benefits and is well priced. Please read "How gap covers work" if you are unfamiliar with gap products. You can download the application here. The benefits of Fusion Gap product are included with each 2018...
How do gap covers work

How do gap covers work?

Paying for shortfalls If you have an in-hospital procedure, very often you will have to pay for services out of pocket, even if you have medical aid. This can be because: Your doctors charge more than your medical aid has agreed to pay them ...

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.

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...