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...
by Bongani Molete | May 22, 2026 | Uncategorised
Late Joiner Penalties A late joiner penalty is an extra amount that can be added to your monthly contribution if you join a medical scheme later in life without enough previous medical scheme cover. In South Africa, this generally becomes relevant from age 35, and...
by Bongani Molete | May 22, 2026 | Uncategorised
Waiting Periods/Exclusions A waiting period means you have joined the scheme and you are paying contributions, but certain benefits are not available immediately. Under South African medical scheme rules, a scheme may apply a general waiting period of up to 3 months...
