PMBs: Mental Conditions

MENTAL ILLNESS CODECONDITIONTREATMENT 182T Abuse or dependence on Psychoactive substance, including alcohol Hospital-based management up to 3 weeks/year 910T Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs Hospital-based management up to 3 days 901T Acute stress...

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,...

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

"I'm pregnant but not covered by medical aid. Can I join now?" 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...

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 costs

How day-to-day benefits work (savings, threshold, etc)

Savings With plans that have a savings facility, 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 to a savings account, since...

Medical Aid 101

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...

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.