• Benefits, Genesis Plan, in-hospital, out-hospital, Scheme Plans

Genesis Med 200 Plus:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Genesis Med 200 Plus. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

Terminology:

  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Genesis:Med 200 Plus (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,400
  • R3,400
  • R675
Savings:
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,900
  • R9,900
  • 0
Children Rates:
  • Under 21 yrs
  • Pay for all children
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In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Genesis: Med 200 Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 200% scheme rate
Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Any hospital
Penalty for using other hospital:
  • n/a
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments:
  • Out of hospital MRIs etc: 50% co-payment>
Note:
  • If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here
  • There might be other co-payments, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • MRI and CT Scans: Covered at scheme rate
  • Scans related to conservative treatment of back / neck conditions : R8,000 per scan, and 50% co-payment.
Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • Colonoscopy : R7,500 per person, per procedure
  • Gastroscopy : R5,000 per person, per procedure
  • Gastroscopy and Colonoscopy : R9,500 per person, per event
  • Pathology (related to scopes): R1,650 per person
  • Limited to 2 claims per person
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Immunosuppressant medication: R84 000 per person
Dialysis:
  • R300,000 per family
Exclusions: .
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Hospice accommodation: scheme rate
  • Home care consults: R200 per day
  • Home visits by medical practitioner: scheme rate
Casualty/ER:
  • From day-to-day benefit
Gap Cover:
Can cover ER claims
(Plans coming soon)
Other:
  • Epidural injection for pain relief: R7,500 per person and at 75% scheme rate
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

Out-of-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Genesis: Med 200 Plus
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,900
  • R9,900
  • 0
Other Day-to-Day Funds:
PMBs out of hospital:
  • All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine.
  • PMB benefits must never be paid from your savings account.
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
GP consultations:
  • From day-to-day benefit
Childcare:
  • No extra benefits
 Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • R5,500 per person with a 50% co-payment
Specialised radiology:
  • R8,000 per person with a 50% co-payment
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • Colonoscopy : R7,500 per person, per procedure
  • Gastroscopy : R5,000 per person, per procedure
  • Gastroscopy and Colonoscopy : R9,500 per person, per event
  • Pathology (related to scopes): R1,650 per person
  • Limited to 2 claims per person
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • Internal: R30,000 per person
  • Shared with internal prosthetics
  • External, for fractures: R19,000 per person
  • Otherwise, day to day benefit
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Genesis: Med 200 Plus
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R9,900
  • R9,900
  • 0
Other Day-to-Day Funds:
Chronic: .
Acute (prescribed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • From day-to-day benefit
On Discharge:
  • From day-to-day benefit
Biological:
  • From day-to-day benefit
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

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