by Bongani Molete | Oct 1, 2026 | Uncategorised
Submitting a Claim Submitting a claim means sending your medical account to the scheme so it can pay the provider directly or reimburse you if you have already paid. Sometimes the doctor or hospital sends the claim for you. Sometimes you need to submit it yourself...
by Bongani Molete | May 22, 2026 | Uncategorised
Pre-authorisation Pre-authorisation is when the scheme needs to approve certain treatment, procedures, scans, or hospital admissions before they happen. It is a normal part of medical scheme administration and is especially common for planned hospital care and some...
by Bongani Molete | May 22, 2026 | Uncategorised
Network Providers /DSPs A network provider is a doctor, specialist, hospital, or pharmacy that has an agreement with the scheme to provide services at agreed rates. A DSP, or Designated Service Provider, is the provider a scheme may require you to use for certain...
by Bongani Molete | May 22, 2026 | Uncategorised
Medical Savings Accounts A medical savings account is a portion of your medical scheme contribution set aside for approved day-to-day healthcare expenses, depending on the option you have chosen. It is commonly used for things like GP visits, medicine, and other...
by Bongani Molete | May 22, 2026 | Uncategorised
Prescribed Minimum Benefits (PMBs) PMBs, or Prescribed Minimum Benefits, are a set of minimum health benefits that all registered medical schemes in South Africa must cover by law. They include emergency medical conditions and cover for a defined list of conditions...
