Designated Service Providers (DSP)


You are urged to please read this section carefully and to pay special attention to its contents, as it will explain exactly what this means for you as a member of Genesis.


Absolutely not!
The choice of where you wish to be treated will always be yours and yours alone to make.


The Medical Schemes Act (“the Act”) is the legislation governing all aspects of a medical scheme. This Act defines some 270 mostly hospital-based illness conditions as Prescribed Minimum Benefits (“PMBs”). According to the Act, Genesis must provide funding benefits for these conditions, regardless of the benefit option you have chosen to join. In addition to this list of 270 conditions, there are a further 25 chronic conditions which must also be covered by Genesis and, in fact, by every medical scheme.


At the time, Government made it clear that the very purpose of identifying PMBs was to prevent medical schemes from designing their benefit options that excluded these very expensive and often serious medical conditions. Had this been the case, members would be forced to go to public hospitals and the medical scheme would refuse to pay, on the grounds that there was no provision for such benefit(s) in its rules. 

The Act further prescribed that when any member of a medical scheme obtains treatment for a PMB illness condition in a public hospital, the medical scheme must reimburse all claims submitted by the public hospital at its published Uniform Patient Fee Schedule (UPFS) tariff that applies to all public hospital patients. In other words, the idea is to prevent the unfunded dumping of members on public hospitals.


The Act prescribes that medical schemes are not allowed to limit reimbursement for the treatment of PMB illness conditions when they are obtained from a public hospital.


The obvious question then is, “What is the difference between being treated for a PMB illness condition in a public hospital and a private hospital?”

The first important point to remember is that private hospitals are not permitted to employ doctors. Public hospitals, by contrast, are permitted to and they do employ doctors, who are paid by the state.

Private doctors work for themselves and charge for their services independently of any hospital. Therefore, when members are treated in a private hospital, each and every provider that provides any treatment or service, is a separate private (profit making) entity.

A typical procedure in a private hospital may result in Genesis receiving separate claims from various providers, such as the hospital, the treating surgeon, the assistant surgeon, the anaesthetist, the radiologist, the pathologist, the pharmacy and so on. Each claim is separate from the other and each provider may charge whatever fees they wish.

In regard to PMBs, the Registrar has previously ruled that Genesis, in the absence of a DSP, must pay each PMB claim in full, irrespective of what the provider has charged. One such outrageous claim that we shared with our members before, was when a provider demanded a fee to the equivalent of R61,000 per hour!

Genesis has entered into tariff agreements with private hospitals.  This means that the whole private hospital claim will usually be paid in full.  Although Genesis has tariff agreements with all the private hospitals, the Scheme has not negotiated separate agreements with the approximately 23,000 private doctors, as it is just not practical.  To this end, the scale of benefits (Scheme Tariff) serves to limit the reimbursement of any doctor or other service provider that seeks to charge above the Genesis scale of benefits.

If you are treated in a public hospital for exactly the same condition, the claims submitted are charged at the published UPFS tariff that includes all doctors, the hospital and in fact, every provider or service that is administered to you.

Understandably, it is not feasible for medical schemes to pay doctors the equivalent of R61,000 per hour.  Therefore, the rules have a scale of benefits (tariff) to limit the amount that doctors will be paid.  The reimbursement level for members on the MED-100 option is 100% of the scale of benefits.  On all other benefit options the rate of reimbursement is 200% of the scale of benefits.

Unless this limit is imposed, medical schemes are at the mercy of that group of doctors that seek to exploit the “pay in full” directive of the Council for Medical Schemes.

It is worth noting that section 29(1)(q) of the Act prescribes that medical schemes must include in their registered rules just such a tariff or scale of benefits to limit the amount that medical schemes are expected to pay to settle claims.


Simply put, if you are diagnosed with a PMB illness condition and you choose treatment in a public hospital, then Genesis cannot limit the reimbursement of your claim, provided that the treatment you receive is the same treatment that is available to any patient that does not have medical aid. Under these circumstances, your claim from the hospital (including treatment by all doctors, radiologists, pathologists, etc.) will be paid in full.

Kindly note that a referral protocol is applied in the public sector at hospital level, unless it is an emergency.

If, however, you choose to be treated in a private hospital for one of the PMB conditions, then your claim will be subject (and may be limited) to the benefits that apply to your selected benefit option, as detailed above.

All Genesis benefit options make provision for all private hospital accounts relating to the treatment of PMB conditions to be paid in full (except for specific exclusions listed in the rules, or in the case of personal expenses).

It is important to remember that, unlike treatment received in a public hospital, your private hospital account does not include charges for your treatment by doctors (or other healthcare providers). These charges are billed for separately by each and every provider independently of the hospital claim. In regard to these service providers (the doctors etc.; not the hospital), the limits as set out in the rules of Genesis will apply. According to these rules, Genesis will reimburse claims at 100% of the Genesis tariff for members on the MED-100 Option and at 200% of the Genesis tariff on all other benefit options.

In summary thus far, if you choose treatment of a PMB illness condition in a private hospital and your doctor charges more than the Genesis tariff, you will be liable for the co-payment (difference in cost).

Although the majority of doctors’ charges usually fall within the Genesis tariffs, there may be some doctors who will charge above these rates. It is therefore important that you find out from the doctor(s) that will be treating you in hospital as to what their charges will be and that you are aware of any co-payments that may apply.


Some doctors are taking advantage of the Council for Medical Scheme’s ruling that medical schemes must reimburse all PMB claims in full, no matter how excessive and / or outrageous the doctor’s charges may be.  We have previously referred to and advised members of the case of the doctor that charged the equivalent of R61,000 per hour.  We also have examples of doctors charging similar rates for the treatment of non-life threatening, non-emergency procedures.   Consequently, if medical schemes are being forced to pay these high charges, then member contributions will in turn have to increase proportionately, resulting in members being forced out of private healthcare coverage due to unaffordability. By having the option of a DSP, you as a member are now able to negotiate with your doctor,

because unless you are willing to pay the difference between what your doctor wants to charge and the Genesis scale of benefits, you can choose to be treated at the DSP, in which case the claim will be reimbursed in full by Genesis.

The misconception that some members may have that they pay for private healthcare, but only have access to treatment in public hospitals, is unfounded.

Members of Genesis are not forced to seek treatment in a public hospital just because there is a DSP in their area.  If, however, there is a DSP in your area and you choose to be treated for a PMB condition in a private hospital, then you will be liable for the difference between what the doctor charges and the Genesis scale of benefits. 

It is important to note that, further to our ongoing communication to our members regarding Genesis’ DSP contracts with the Western Cape, Northern Cape, Gauteng and KwaZulu-Natal Departments of Health, the Scheme has also elected to select all  public hospitals in the Free State, North West, Limpopo, Mpumalanga and the Eastern Cape as its DSPs.  In other words, the Scheme has now selected every public hospital in the country as its DSP.


If you choose to be treated for a PMB illness condition in a public hospital and there are no beds available, you must obtain a letter from the hospital manager or administrator of the hospital, stating that there is no bed available for you on that particular day. This letter must be sent to Genesis and you may then select a private hospital to have your PMB condition treated, in which case your claim will then be paid in full, subject at all times to the treatment being at the same level of care as that available to a public hospital patient.


Please note that the information above does not apply to emergency treatment. 

An emergency is defined in the Act as any life-threatening condition which, without immediate treatment, will or may result in the loss of your life. Note that there is a difference between urgent treatment and immediate treatment.   A condition that requires urgent treatment is not necessarily a life threatening emergency. An emergency is a condition that requires immediate treatment. In the case of an emergency, you must be admitted to the nearest hospital, regardless of whether it is private or public.  Under these circumstances Genesis will cover the claim in full.

List of public sector facilities

The following table lists the DSP hospitals in the respective provinces.

Eastern Cape

Aberdeen Provincial Hospital aberdeen
adelaide hospital adelaide
aliwal hospital aliwal north
all saints hospital ngcobo
andries vosloo hospital somerset east
b j vorster hospital kareedouw
bambisana hospital port st johns
bedford hospital bedford
bedford orthopaedic hospital mthatha
bhisho hospital amatola view
burgersdorp hospital burgersdorp
butterworth hospital butterworth
cala hospital cala
canzibe hospital mthatha
cathcart hospital cathcart
cecilia makiwane hospital east london
cloete joubert hospital barkly east
cofimvaba hospital cofimvaba
cradock hospital cradock
dora nginza hospital port elizabeth
dordrecht provincial hospital dordrecht
dr malizo mpehle memorial hospital tsolo
ecpg department of health east london
elizabeth donkin hospital port elizabeth
elliot hospital elliot
empilisweni hospital sterkspruit
empilweni tb hospital port elizabeth
fort beaufort hospital fort beaufort
fort england hospital grahamstown
frere hospital east london
frontier hospital queenstown
glen grey hospital lady frere
greenville hospital bizana
grey hospital king william’s town
hewu hospital whittlesea
holy cross hospital taweni
humansdorp hospital humansdorp
indwe provincial hospital indwe
isilimela hospital port st johns
jamestown provincial hospital jamestown
jose pearson hospital port elizabeth
joubertina comunity health joubertina
komani hospital queenstown
komga provincial hospital komga
lady grey provincial hospital lady grey
livingstone hospital port elizabeth
maclear general hospital maclear
madwaleni hospital elliotdale
madzikane ka zulu memorial hospital mount frere
margery parkes tb hospital graaff-reinet
marjorie parrish tb hospital port alfred
martje venter hospital tarkastad
midland hospital graaff-reinet
mjanyana hospital engcobo
molteno hospital molteno
mount ayli ff hospital mount ayli ff
mthatha general hospital umtata
nelson mandela academic hospital mthatha
nessie knight hospital butterworth
newhaven chronic sick home east london
nompumelelo (peddie) hospital grahamstown
orsmond tb hospital uitenhage
port alfred hospital port alfred
port elizabeth hospital port elizabeth
s s gida hospital keiskammahoek
sawas memorial hospital jansenville
settlers hospital grahamstown
sipetu hospital mount frere
st barnabas hospital libode
st elizabeth’s hospital port st johns
st francis hospital aliwal north
st lucy’s hospital tsolo tsolo
st patrick’s hospital bizana
sterkstroom hospital sterkstroom
steynsburg hospital steynsburg
stutterheim provincial hospital stutterheim
sunday’s valley provincial hospital kirkwood
tafalofefe hospital amatola view
tayler bequest hospital (elundini) matatiele
taylor bequest hospital mount fletcher
tower hospital fort beaufort
uitenhage hospital uitenhage
umlamli hospital sterkspruit
victoria hospital alice
wilhelm stahl (middelburg) hospital middelburg
willowmore provincial hospital willowmore
zitulele hospital mqanduli
kareedouw hospital kareedouw
komani hospital queenstown
settlers hospitals grahamstown

Free State

albert nzula district hospital trompsburg
boitumelo regional hospital kroonstad
bongani hospital welkom
botshabelo hospital bloemfontein
diamant district hospital jagersfontein
dihlabeng hospital (bethlehem) bethlehem
dr j s moroka hospital ga-rapulana
elizabeth ross hospital phuthaditjhaba
embekweni district hospital zastron
fezile dabi district ambulance services zamdela
free state psychiatric complex hospital bloemfontein
itemoheng hospital (senekal) senekal
john daniel newberry district hospital clocolan
katleho hospital (virginia) virginia
mafube district hospital frankfort
mantsopa hospital ladybrand
metsimaholo hospital (sasolburg) zamdela
mofumahadi manapo mopeli hospital phuthaditjhaba
mohau hospital hoopstad
nala hospital viljoenskroon
national district hospital bloemfontein
nketoana hospital (reitz) reitz
parys hospital parys
pelonomi hospital bloemfontein
phekolong hospital bethlehem
phumelela hospital vrede
phuthuloha district hospital ficksburg
stoffel coetzee district hospital smithfield
thebe hospital (harrismith) harrismith
tokollo hospital (heilbron) heilbron
universitas hospital bloemfontein
winburg provincial hospital winburg


Natalspruit HopitalBoksburg
1 Military Hospital Pretoria
Bheki Mlangeni District Hospital Johannesburg
Bronkhorstspruit District Hospital Bronkhorstspruit
Charlotte Maxeke Hospital Johannesburg
Chris Hani Baragwanath Academic Hospital Johannesburg
Cullinan Care and Rehabilitation Centre Cullinan
Dr Yusuf Dadoo Hospital Krugersdorp
Edenvale Hospital Johannesburg
Far East Rand Hospital Springs
Fochville Hospital Fochville
George Mukhari Hospital Ga-Rankuwa
Germiston Hospital Germiston
Heidelburg Hospital Heidelburg
Helen Joseph Hospital Johannesburg
Kalafong Hospital Pretoria
Kopanong Hospital Vereeniging
Leratong Hospital Krugersdorp
Mamelodi Hospital Mamelodi
MEDUNSA Oral Health Centre Pretoria
Mmamethlake Hospital Hammanskraal
Nasrec Field Hospital Johannesburg
Odi Hospital Mabopane
Oral & Dental Hospital – Pretoria Pretoria
Pholosong Hospital Brakpan
Pretoria West Hospital Pretoria
Raheema Moosa Hospital Johannesburg
Sebokeng Hospital Sebokeng
Sizwe Tropical Disease Hospital Johannesburg
South Rand Hospital Johannesburg
Sterkfontein Hospital Krugersdorp
Steve Biko Hospital Pretoria
Tambo Memorial Hospital Boksburg
Tara H Moross Centre Hospital Johannesburg
Tembisa Hospital Ivory Park
Tshwane District Hospital Pretoria
Tshwane Rehabilitation Hospital Pretoria
Weskoppies Hospital Pretoria
Wits Dental Hospital Johannesburg


Addington Hospital Durban
Appelsbosch Hospital Pietermaritzburg
Benedictine Hospital Mahlabatini
Bethesda Hospital Bethesda
Catherine Booth Hospital Pietermaritzburg
Ceza Hospital Pietermaritzburg
Charles James Specialised TB Hospital Ezimbokodweni
Charles Johnson Memorial Hospital Nqutu
Christ The King Hospital Umzumkulu
Church Of Scotland Hospital Tugela Ferry
Clairwood Hospital Durban
Don Mckenzie Specialised TB Hospital Ethekwini
Doris Goodwin Specialised TB Hospital Pietermaritzburg
Dr. Pixley Ka Isaka Seme Regional Hospital: Ethekwini District Durban
Dundee Hospital Dundee
East Griqualand and Usher Memorial Hospital Kokstad
Edendale Hospital Pietermaritzburg
Ekhombe Hospital Nkandla
Ekuhlengeni Hospital Durban
Emmaus Hospital Winterrton
Eshowe Hospital Eshowe
Estcourt Hospital Estcourt
Fort Napier Hospital Pietermaritzburg
GJ Crookes Hospital Scottburg
Gamalakhe Community Health Centre Gamalakhe
Greys Hospital Pietermaritzburg
Greytown Hospital Greytown
Hillcrest Hospital Hillcrest
Hlabisa Hospital Hlabisa
Inkosi Albert Luthuli Hospital Durban
Itshelejuba Hospital Queensburg
King Dinuzlu Hospital Complex Durban
King Edward VIII Hospital Durban
Ladysmith Hospital Ladysmith
Madadeni Hospital Newcastle
Mahatma Gandhi Hospital Durban
Manguzi Hospital Ingwavuma
Mbongolwane Hospital Kwa Pett
McCord Eye Care Hospital Durban
Montebello Hospital Dalton
Mosvold Hospital Ingwavuma
Mseleni Hospital Nhlamvu
Murchison Hospital Port Schepstone
Newcastle Hospital Newcastle
Ngwelezana Hospital Empangeni
Niemeyer Memorial Hospital Utrecht
Nkandla Hospital Nkandla
Nkonjeni Hospital Mahlabatini
Northdale Hospital Pietermaritzburg
Pietermaritzburg Assessment & Therapy Centre Inanda
Phoenix Assessment & Therapy Centre Phoenix
Port Shepstone Hospital Port Shepstone
Prince Mshiyeni Memorial Hospital Chatsworth
Queen Nandi Regional Hospital Empangeni
R.K. Khan Hospital Chatworth
Richmond Specialised TB Hospital Richmond
Rietvlei Hospital Empangeni
SA Noodhulpliga Hospital Pongola
St. Aidan’s Hospital Durban
St. Andrew’s Hospital Kokstad
St. Appollinaris Hospital Umzinto
St. Francis Hospital Ulundi
St. Margaret’s TB Hospital Umzimkhulu
St. Mary’s – Kwamagwaza Hospital Melmoth
St. Mary’s Hospital Ethekwini Health District Chatsworth
Stanger Hospital Stanger
Tongaat Community Health Day Hospital Tongaat
Townhill Hospital Pietermaritzburg
Umgeni Waterfall Institute Hospital Howick
Umphumulo Hospital Stanger
Umzimkhulu Hospital Umzimkhulu
Untunjambili Hospital Kranskop
Vryheid Hospital Vryheid
Wentworth Hospital Durban


botlokwa hospital polokwane
dikolong hospital polokwane
donald fraser hospital sibasa
dr cn phatudi hospital tzaneen
elim hospital louis trichardt
ellisras hospital ellisras
evuxakeni hospital giyani
fh odendaal hospital modimolle
george masebe hospital potgietersrus
groblersdal hospital groblersdal
hayani psychiatric hospital sibasa
hellen franz hospital polokwane
jane furse hospital burgersfort
kgapane hospital tzaneen
lebowakgomo hospital polokwane
letaba hospital letaba
louis trichardt hospital louis trichardt
malamulele hospital malamulele
mankweng hospital polokwane
maphutha l malatji hospital phalaborwa
matlala hospital marble hall
mecklenburg hospital burgersfort
mokopane hospital potgietersrus
musina hospital messina
nkensani hospital giyani
philadelphia hospital dennilton
polokwane hospital polokwane
sekororo hospital trichardtsdal
seshego hospital polokwane
sil oam hospital sibasa
south african military health service hoedspruit
st ritas hospital glen cowie
thabamoopo mental hospital polokwane
thabazimbi hospital chromite
tshilidzini hospital thohoyandou
van velden hospital tzaneen
voortrekker district hospital potgietersrus
w f knobel hospital lonsdale
warmbaths hospital warmbaths
witpoort hospital ellisras
zebediela hospital polokwane
h c boshoff hospital belfast


amajuba memorial hospital volksrust
barberton hospital barberton
bernice samuel hospital delmas
bethal hospital bethal
bongani tb hospital acornhoek
carolina hospital carolina
elsie ballot hospital amersfoort
embhuleni hospital belfast
ermelo hospital ermelo
evander hospital evander
h a grove hospital middelburg
kwamhlanga community hospital bronkhorstspruit
lydenburg hospital lydenburg
mapulaneng hospital bushbuckridge
matibidi hospital nelspruit
matikwana hospital acornhoek
middelburg hospital middelburg
piet retief hospital piet retief
rob ferreira hospital nelspruit
sabie hospital sabie
shongwe hospital schoemansdal
standerton hospital standerton
themba hospital white river
tintswalo hospital nelspruit
tonga hospital komatipoort
waterval boven hospital middelburg
witbank hospital witbank
witbank tb hospital witbank

North West

bophelong psychiatric hospital mahikeng
brits hospital rustenburg
carletonville hospital carletonville
christiana hospital christiana
delareyville hospital delareyville
ganyesa community hospital vryburg
gelukspan hospital mahikeng
general de la rey hospital lichtenburg
job shimankana tabane hospital rustenburg
jubilee hospital sannieshof
klerksdorp hospital klerksdorp
lehurutshe hospital lerato
mafiqkeng provincial hospital mahikeng
moses kotane hospital rustenburg
nw:health schweizer-reneke
nw:health swartruggens
ottosdal hospital ottosdal
potchefstroom hospital potchefstroom
sannieshof hospital sannieshof
schweizer-reneke hospital schweizer-reneke
taung hospital taung station
thusong hospital itsoseng
tshepong hospital klerksdorp
ventersdorp hospital ventersdorp
verster j d hospital koster
vryburg hospital vryburg
witrand hospital potchefstroom
zeerust hospital zeerust

Northern Cape

alexanderbay hospital alexander bay
b j kemp memorial hosp victoria west
batlharos (tshwaragano) hospital kuruman
brandvlei hospital calvinia
calvinia (abraham esau) hospital calvinia
carnarvon hospital carnarvon
colesberg (manne dipico) hospital colesberg
de aar (central karoohospital de aar
dr harry surtie hospital upington
hartswater (connie vorster) hospital hartswater
hester malan hospital douglas
jan kempdorp provincial hospital jan kempdorp
joe slovo hospital garies
kakamas hospital kakamas
keimoes hospital keimoes
kuruman hospital kuruman
loeries-fontein hospital niewoudtville
nababeep hospital springbok
pofadder hospital pofadder
port nolloth hospital port nolloth
postmasburg hospital postmasburg
prieska (bill pickard) hospital prieska
prof z k mathews hospital barkly west
richmond hospital richmond
robert mangaliso sobukwe hospital kimberley
springbok (dr van niekerk) hospital springbok
sutherland hospital fraserburg
warrenton hospital warrenton
wege hospital kimberley
west end hospital kimberley
williston hospital springfontein
van niekerk provincial hospital springbok

Western Cape

Alan Blythe Hospital Ladismith
Alexandra Hospital Athlone
Beaufort West Hospital Beaufort West
Booth Memorial Hospital Kaapstad
Caledon Hospital Caledon
Ceres Hospital Ceres
Citrusdal Hospital Piketberg
Clanwilliam Hospital Clanwilliam
Department of Health Athlone
Eerste River Hospital Eerste River
False Bay Hospital VisHoek
Faure Hospital Somerset West
GF Jooste Hospital Athlone
George Hospital George
Groote Schuur Hospital Athlone
Helderberg Hospital Somerset West
Hermanus Hospital Hermanus
Karl Bremer Hospital Bellville
Khayelitsha Hospital Khayelitsha
Knysna Hospital Knysna
Lady Michaelis Hospital Hospital Plumstead
Lapa Munnik-Hospital Porterville
Laingsburg Hospital Laingsburg
Lentegeur Psychiatric Hospital Mitchells Plain
Lapa Munnik Hospital Porterville
Mitchells Plain Hospital Mitchells Plain
Montagu Hospital Montagu
Mossel Bay Hospital Mossel Bay
Mowbray Maternity Hospital Clareinch
Murraysburg Hospital Beaufort West
Orthotic & Prosthetic Centre Rugby
Otto Du Plessis Hospital Bredasdorp
Oudtshoorn Hospital Oudtshoorn
Paarl Hospital Paarl
Prince Albert Hospital Prince Albert
Radie Kotze Hospital Piketberg
Red Cross War Memorial (Children) Clareinch
Riversdale Hospital Riversdale
Robertson Hospital Robertson
Rusthof Day Hospital Gordon’s Bay
Somerset Hospital Cape Town
Stellenbosch Provincial Hospital Stellenbosch
Stikland Psychiatric Hospital Bellville
Swartland Hospital Malmesbury
Swellendam Hospital Swellendam
Tygerberg Hospital Elsies River
Tygerberg Oral Health Centre Parow
Uniondale Hospital Uniondale
Valkenburg Hospital Cape Town
Victoria Hospital Athlone
Vredenburg Hospital Vredenburg
Vredendal Hospital Vredendal
Westfleur Hospital Atlantis
Western Cape Rehabilitation Centre Mitchells Plain
Worcester Hospital Worcester