It’s all about our members

Intensive care is a verb. One that we take very seriously. 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.

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genesis medical scheme offers good service to members

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, 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.

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genesis medical scheme offers best value for money medical aid options

Dental benefits on all plan options

All Genesis members, irrespective their chosen benefit option, enjoy generous basic, as well as some enhanced dentistry benefits.

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 Self Managed Fund (SMF), or their own pockets.

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genesis medical scheme dental benefits

Lowest contribution increase of all open schemes

Our members recognise the direct relationship between exceptional cover and the bottom-line savings. For almost a decade now, 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 4.9% for 2021, or R85 per adult member per month, Genesis members continue to save on below-inflation contribution increases. The below table contains a summary of the Rand value of our average adult contribution increases from 2013 to date.

Year Average contribution Increase
2013 R56
2014 R75
2015 R71
2016 R80
2017 R70
2018 R123
2019 R88
2020 R90
2021 R85
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Benefits of self-administration

Genesis is one of only 5 (of 18) open medical schemes in South Africa that is self-administered. 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 at the forefront of offering low annual contribution increases whilst at the same time increasing benefits for almost a decade now.

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genesis medical scheme is a self_administered medical aid scheme

Flexibility and freedom of choice

Unless expressly stated to the contrary, all Genesis members have the luxury to choose their preferred hospital, 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.

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genesis medical scheme members can use private hospital or doctor

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.

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.

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genesis medical scheme has strong reserves and a high solvency ratio

Affordable medical aid cover is what we do best

Medical aid cover in 2021 for adults starts from as little as R1,340 per month on our Private Choice benefit option, while our Private Comprehensive cover is a mere R2,640 per month. Rates for children are considerably lower. Depending which benefit option is selected, child beneficiaries are covered for only R440 / R530 per month.

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