Frequently Asked Questions
Do you register above 60 members?
What happens if the Principal member passes on?
The beneficiaries of the deceased can take over membership and continue to be covered by the Society.
What are the waiting periods for various benefits?
All new members are subjected to a waiting period of 90 days after membership commencement. The other waiting periods are as follows:
- Local specialist treatment
- MRI, CT scans and nuclear medicine
- Spectacles or contact lenses
- Dental benefits
- Maternity benefits
- Homes providing constant nursing care
- Foreign specialists treatment
- All internal prosthetic devices
- Chronic Disease-These are diseases which require prolonged treatment on a daily basis in order to sustain life. The member is therefore advised to register for chronic treatment with the Society when registering for membership.
- Renal dialysis
What is the waiting period for Foreign treatment?
Why are shortfalls incurred when one is on medical aid?
Shortfalls are incurred when the fee charged by the Provider of service is higher than the tariff awarded. Shortfalls also arise when a member has exhausted their membership benefit and waiting periods can result in shortfalls. If a member is not eligible for a particular service, they will be asked to pay for the service as they will be on waiting periods.
Are shortfalls claimable from medical aid?
Shortfalls are not claimable from the Society.
How long does it take before a claim expires?
Can I claim from medical aid if I am treated outside the country?
The Society will refund according to the local tariff awards and if the service rendered is not locally available.
How long does pre-authorisation takes?
If there are no issues encountered, the preauthorisation application will be resolved in 24 hours from time of submission
Can l upgrade to a higher package and is there a waiting period?
Registered members can upgrade their package and a waiting period of three months will apply.
Which service providers can l go to?
It depends with the package that one is registered under. We have a list of providers countrywide that do accept our card. Kindly visit our website for the list: Provider Listing
Why are waiting periods imposed?
The aim is to manage the risk of adverse selection and general abuse of the fund and ensure its overall success for the healthcare benefit of all members
How can I obtain spectacles using my medical aid?
If the member is in benefit for spectacles they need to submit a quotation to our claims department for the spectacles and the provider will be paid. The spectacles are renewed once every two years.
Does the medical aid cover PCR Test?
The test is not covered by medical aid but when one tested positive for Covid-19 the Society will cover for the drugs.
Do you have a 24-hour call centre?
Yes, we have a team of dedicated personnel who will assist you on any membership enquiries 24/7. You can look them up on Contact Us