Important to Remember!

How to get the most out of your option

  • Have an annual check-up at your general practitioner to make sure that you are healthy and, if there are any concerns, request your doctor to start treatment sooner rather than later.
  • Remember to check if your option has network providers – using these providers will reduce or even prevent a co-payment.
  • Where possible, use a day clinic for day procedures, e.g. for a tonsillectomy or adenoidectomy.
  • Register on the chronic medicine programme as soon as you’ve been diagnosed with a chronic condition.
  • Visit for any new or updated information.

Member online access (Web-based self-help facility)

Using the Scheme’s self-help facility at allows you to check your personal and medical scheme information. You can update your contact details, language preferences and other information and view your benefit information and claims statements.

Network Providers

The Scheme has negotiated rates with preferred and designated service providers to ensure that these providers do not charge you more than the agreed rate. This will ensure that your benefits last longer and you get value for money.

Depending on the option you selected, the network providers have agreed to charge negotiated rates, which means that you will not incur a co-payment unless you select a non-network provider.

Members on the Optimum, Classic and Hospicare options have the choice to select their own general practitioners and specialists for non-PMB treatment. It is recommended that one of the preferred providers is used, as this will reduce or eliminate out-of-pocket payments.

Members on the Custom, Classic Network and Hospicare Network options must use the Life Healthcare Group of hospitals as the network provider for in-hospital treatment; alternatively a 30% co-payment will apply.

On the Classic Network and Hospicare Network options, members must use the Medipost Pharmacy network for chronic medication to avoid incurring a 30% co-payment.


It is important that you check whether the Scheme will pay for any procedure, treatment or medicine before accepting it. Failure to check upfront whether it is covered may result in you having to pay for certain services out of your own pocket.

Exclusions to some of the prescribed minimum benefits (PMBs) may be applied upon joining the Scheme.

The diagnosis and treatment of PMBs on the Custom and Essential options are paid in accordance with the registered rules of Scheme. These options are exempt from PMB legislation.

Rates charged by healthcare providers

Ask your doctor whether he or she will be willing to negotiate reduced rates in line with your benefit cover. Should you be admitted to hospital, make use of a network specialist; this will give you peace of mind that the specialist will charge Scheme rates.

Visit for a list of providers in your area or contact the call centre on 0861 000 300.


A co-payment of R1 200 for in-hospital treatment will apply. The following procedures will always incur a co-payment of R1 200 when performed in hospital (to be paid directly by member to the healthcare provider).

Classic, Classic Network and Optimum options

  • Arthroscopy
  • Colonoscopy
  • Gastroscopy
  • Sigmoidoscopy
  • Joint replacements

Custom Option

  • Functional nasal and sinus surgery
  • Nail surgery
  • Removal of skin lesions
  • Treatment of headaches
  • Colonoscopy
  • Gastroscopy
  • Sigmoidoscopy
CUSTOMSubject to network formulary/pharmacyN/ASubject to protocolsSubject to network formulary/pharmacy30%
HOSPICARE NETWORKMedipost Pharmacy30%20%N/A30%
HOSPICAREScheme pharmacy network30%20%N/AN/A
CLASSIC NETWORKMedipost Pharmacy30%20%Scheme pharmacy network30%
CLASSICScheme pharmacy network30%20%Scheme pharmacy networkN/A

Useful tips:

Pharmacies, doctors and hospital networks: Use the stipulated networks to ensure no co-payments will apply

Pharmacies (generic versus original, brand-name medicine): Where possible, ask your doctor or pharmacist to prescribe and dispense generic medicine instead of original, brand-name medicine.