Membership information

  1. How do I know what benefits I have ?
    You will receive a member guide with your membership card when you join. Please read through the member guide carefully to understand your benefits. A copy of the member guide is also available here.
    For more information about your benefits, you can contact our Customer Care department, or visit our on-site consultants.

  2. How do I know which Doctor, Dentist or Optometrist I am allowed to visit?
    Click here to view the lists of providers, or visit our on-site consultants.

  3. Which blood tests, x-rays and medication will be covered when I visit my provider?
    Should a doctor give you a prescription or refer you for blood tests or x-rays kindly confirm with the doctor if these will be covered. Click here to view the lists of blood tests and x-rays covered.

  4. Is out-patient treatment at the hospital covered?
    You are covered for 1 after-hours GP or casualty visit per beneficiary per year, with a maximum of 2 visits per family per year. This benefit is subject to authorise - you need to autorise within 72 hour of the consultation, otherwise 

    you will have a co-payment of 30% on the hospital account and the Scheme will be responsible for 70% of the negotiated tariffs

    . The benefit is limited to R950 per event, and you need to pay 10% of the account from your own pocket. Please note that out-patient treatment does not form part of a hospital admission claim. Only once you are hospitalised will funds be paid from your hospital cover.