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FAQ'S

Important questions from our members

If a member applies to register a newborn or newly adopted child within 30 days of the date of birth or adoption, together with the relevant documents, such a child shall then be registered by the Scheme as a dependant.

Increased contributions shall then be due as from the first day of the month of birth or adoption and benefits will accrue as from the date of birth or adoption. Where a newly born or newly adopted child is not registered within 30 days, such a child will be regarded as a new application and be subject to the Scheme underwriting guidelines for new members.

This is the sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organs, or would place the person's life in serious jeopardy.

Prescribed Minimum Benefits (PMB's) is a set of defined benefits to ensure that all the Scheme's members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and wellbeing and to make healthcare more affordable.

PMB's are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:

  • any emergency medical condition;
  • a limited set of 270 medical conditions;

and 25 chronic conditions defined in the Chronic Disease List.

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