WELCOME TO
GENESIS MEDICAL SCHEME

while our Private Comprehensive cover is a mere R2 350 per month. Rates for children are considerably lower. Depending which benefit option is selected, child beneficiaries are covered for only R370 / R415 per month.

doctor or medical specialist along with a choice of funding model. Members are not forced to seek treatment in network hospitals, nor are they required to make use of network medical practitioners.
Genesis covers all approved conditions, including Prescribed Minimum Benefits (PMBs), in private hospitals, where the benefits and limits, as set out in the Rules, apply. Hospital accounts, including treatment for PMBs, will usually be paid in full in terms of tariff agreements with the hospital. In private hospitals, the charges of attending doctors / specialists and other healthcare service providers, even for PMBs, will be reimbursed at 100% or 200% of Medical Aid Rate, depending which benefit option you are on.
This funding applies to all claims for treatment in private hospitals, even if the condition is listed as a PMB. Shortfalls relating to treatment received in private hospitals usually pertain to charges for attending doctors / specialists if they charge more than 100% or 200% of the Medical Aid Rate. To this end, should your claim be listed as a PMB and you want it to be paid according to the law as provided for in section 29(1)(p) of the Medical Schemes Act (“paid in full subject to PMB level of care”), then treatment must be obtained from any public or state hospital in South Africa and the Uniform Patient Fee Schedule (UPFS) tariff will apply. In short, PMB treatment in private hospitals is reimbursed in terms of the Rules where limits may apply. PMB treatment in public or state hospitals will be reimbursed subject to PMB level of care as prescribed in the Medical Schemes Act. This means that you will receive the same entitlement to treatment that applies to a public or state hospital patient as set out in the regulations to the Act. If in any doubt, please call our Call Centre for further information.

Currently Genesis has in excess of R0.5 billion, which is more than 6 times the legal minimum required by the Medical Schemes Act.
As a result of the consistent financial performance of the Scheme, Genesis is able to boast a very high claims paying ability to help put members’ minds at rest that claims will be paid.

It is a free, personalised and convenient tool that members and their dependants can use to stay in touch and up to date, managing their most important medical aid information from the palm of their hand, 24/7. And, the beauty is, members have one less card to carry!