Hospital cover plans in South Africa will provide cover for mainly in-hospital and related expenses.  It does not typically provide cover for out-of-hospital (day-to-day) benefits like doctors’ visits, acute medication, physiotherapists, etc.

Some hospital plans may also cover certain out-of-hospital expenses, for example both our MED-100 and MED-200 hospital plans offer generous out-of-hospital dental benefits, as well as cover for preventative screening tests such as mammograms, cervical smears and PSA tests.  In addition, our MED-200 hospital plan also provides cover for X-rays / MRI / CT scans, as well as diagnostic scopes such as colonoscopies and gastroscopies.

YES  –  hospital plans in South Africa are generally more affordable that comprehensive medical aid benefit options because “everyday” out-of-hospital expenses, such as GP visits, medication, spectacle frames and lenses, physiotherapy, etc.  are not included in the cover. Hospital plans, however, do provide excellent financial healthcare funding for what is best described as primarily catastrophic cover  –  that is, the big accident or unexpected illness or disease.

Hospital and related accounts, such as theatre costs, X-rays, medication, blood tests, blood transfusions, etc., will usually be covered in full, even on the cheapest hospital plan in South Africa. Hospital cover plans will reimburse doctors’ and specialists’ fees at the medical scheme rate, i.e. 100% or 200%.

As with all medical schemes, Genesis is owned by all its members. Members elect Trustees who act on their behalf. The Trustees form the management committee of the Scheme and are elected to serve in the best interest of all the members.

Yes. A new generation scheme differs from a traditional scheme in that the scheme is primarily concerned with the costs associated with in-hospital treatment and procedures. Most out-of-hospital medical costs are paid from your day-to-day credit facility via a Self Managed Fund (SMF).

Essentially out-of-hospital costs are for your account and the Scheme merely provides the credit facility and administers the claims on your behalf.

As a member of a new generation scheme, you are responsible for managing most of your out-of-hospital costs, while the Scheme provides for the higher costs associated with hospital care.

The Medical Schemes Act prevents a medical scheme from borrowing money. It follows that no medical scheme has financial backing. The success of a scheme is dependent on various factors, including the structure of its benefits, pricing of its premiums, management of its day-to-day activities, the risk of its members and its solvency reserves.

All medical schemes maintain a pool of funds that is used to pay claims. The success of any scheme lies in the ability of a scheme to maintain that pool of funds at a level that is sufficient for its members’ claims; hence the solvency requirements of a scheme as required by the Medical Schemes Act.