WELCOME TO
GENESIS MEDICAL SCHEME

Providing affordable medical aid cover and peace of mind since 1995

We have a really great story to tell!

With a proud heritage spanning since 1995, Genesis Medical Scheme has an intimate and profound understanding of private healthcare in South Africa.

As one of the leading medical aid schemes in South Africa, we have a proud legacy of providing our members with access to exceptional healthcare funding benefits at very affordable rates.

Rated as one of the most successful open medical schemes in South Africa – as measured by the benefits we provide vs contributions levied, our solvency and net healthcare result (in other words, our financial stability), our membership size and growth, the average age of our beneficiaries and the service levels we provide to our members as indexed on Hellopeter.com (*) – all Genesis members are in good hands.

(*) The GTC Medical Aid Survey: Benefit and cost comparisons – 2018

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It’s all about our members
Intensive care is a verb. One that we take very seriously.

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Our core focus is your wellbeing, your healthcare, your peace of mind and what you think of our service.

Our passion for delivering unparalleled client services means that every member is treated as a real person, by another real person.

Affordable medical aid cover is what we do best
Medical aid cover in 2019 for adults starts from as little as R1,150 per month on our Private Choice benefit option,

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while our Private Comprehensive cover is a mere R2,400 per month. Rates for children are considerably lower. Depending which benefit option is selected, child beneficiaries are covered for only R390 / R455 per month.

Flexibility and freedom of choice
Unless expressly stated to the contrary, all Genesis members have the luxury to choose their preferred hospital,

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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.

Solvency level and financial stability
The Medical Schemes Act requires a minimum solvency of 25% of gross annual contributions to be maintained by all medical schemes.

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Currently Genesis has in excess of 6 times the minimum level 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.

Rated as one of the best value-for-money medical scheme benefit options in South Africa
In the most recent GTC Healthcare Consulting Medical Aid Survey,

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our Private Choice hospital plan received a 95% score and was rated as one of the best hospital plan benefit options in South Africa, with a high likelihood of support. A total of 41 hospital plans competed in this category.

Lowest contribution increase of all open schemes for 8 consecutive years
Our members recognise the direct relationship between exceptional cover and the bottom-line savings.

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Our members recognise the direct relationship between exceptional cover and the bottom-line savings.

Over the last 8 years, we have been at the forefront of containing the lowest contribution increases, coupled with increased benefits. This is a tribute to the sound management and administration of the Scheme.

With an average effective annual contribution increase of only 5.4% for 2020, which is the lowest of all open medical schemes for the 7th consecutive year, Genesis members continue to save on below-inflation contribution increases.

The below table contains a summary of our average contribution increases from 2013 to date.

Year Average contribution Increase
2013 4.95%
2014 6.40%
2015 5.30%
2016 5.50%
2017 4.70%
2018 5.80%
2019 5.50%
2020 5.40%

Dental benefits on all plan options
All Genesis members, irrespective of their chosen benefit option, enjoy generous basic, as well as some enhanced dentistry benefits.

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Dentistry benefits on Genesis are covered from members’ risk benefits, meaning that members don’t have to pay for their basket of available dental benefits from their medical savings of Self Managed Fund (SMF) accounts, or their own pockets.

Benefits of self-administration
Genesis is one of only 5 (of 18) open medical schemes in South Africa that is self-administered.

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Apart from the indirect benefit of significant cost savings on administration fees, Genesis members don’t pay VAT on administration fees; hence one of the reasons why we have been able to boast the lowest annual contribution increases of all schemes in the open scheme market, for the past 8 consecutive years.