- Private healthcare fees are unregulated. Doctors and specialists can charge what they want. Without medical aid, you’ll have to pay for treatment and procedures out of your own pocket, or be prepared to sit in long queues at state-owned hospitals and clinics. (Contact us for advise on Gap cover for percentages charged during in hospital procedures over the medical scheme tariffs. )
- If you are over the age of 35 or 40 (depending on the scheme) and have, at any time, been without medical aid for more than 90 consecutive days, you may be required to pay a late joiner fee. Penalties are based on the number of years you’ve been without cover, and can be up to 1.75 times the monthly contribution amount.
- Prescribed Minimum Benefits (PMB’s) should always be covered. The list includes 270 medical conditions and 25 chronic conditions for which medical schemes are compelled by law to grant to it’s members. That is, the client will receive benefits towards the cost of diagnosis, treatment and care for the PMB conditions listed, no matter what medical aid plan they are on. This means that in the unfortunate event that they are faced with one of the serious illnesses listed to receive PMB, you can rest assured that you will be well taken care of.
- You can only upgrade you plan to a higher plan once a year (1 January), but you can downgrade your plan any time of the year. Keep in mind that you might have to pay back a percentage of your savings benefit already used.
- Joining a new medical scheme may have waiting periods, depending on whether you made a voluntary or involuntary move to a new scheme, or if you have not had previous medical aid, or have not had cover for more than 90 consecutive days. General waiting period (up to three months) – you are not entitled to any benefits, in some instances not even Prescribed Minimum benefits (PMB’s), during this period. Any claims submitted during a waiting period will not be paid. Condition-specific waiting periods (up to 12 months) – you are not entitled to use any benefits for a particular condition for which medical advice, diagnosis, care or treatment was recommended or received.
Suikerbosrand Brokers
Cnr of, 72 Merz & Mare Str
Heidelberg, Gauteng, 1441Monday – Friday
8:00 AM – 16:30 PM
Heidelberg, Gauteng, 1441Monday – Friday
8:00 AM – 16:30 PM
