FAQs
These are two different benefits with different rules. The Chronic Benefit pays up to your authorised Chronic Drug Amount (CDA) — the maximum Rand amount approved per drug category. If your medicine costs more than the CDA, you pay the difference. When the same medicine is claimed from savings, the Medical Aid Price (MMAP) applies with no CDA cap, which is why it may be covered in full from savings but attract a co-payment under the chronic benefit.
Yes. OTC medication is paid from your available savings and elective benefits, up to the benefit limit. If your benefits are depleted, you can use any accumulated savings you have built up.
Member records are not transferred between medical schemes. Due to POPIA regulations, Medimed is not permitted to request or obtain medical information from a previous scheme on your behalf. You will need to resubmit your chronic application with a current prescription and the relevant clinical information.
While benefits are equal across members in the same option, your savings allocation is calculated according to your income bracket. The higher your income bracket, the higher the savings amount allocated to you each month.
Medimed pays all claims in line with standardised medical aid tariff rates regulated by the Board of Healthcare Funders. Providers, however, are free to charge above these rates, which is what creates a co-payment. If you have accumulated savings available, you can use those to cover shortfalls by completing the accumulated savings application form.
Any unused savings at the end of the benefit year are automatically transferred to your accumulated savings, which you can draw on in future.
The best way is to confirm rates before your appointment. Ask your provider upfront what they charge and whether it is within the scheme tariff. At the pharmacy, ask about generic alternatives — they contain the same active ingredients as branded medicines but cost less. Members on the Medisave Essential option also have access to a formulary listing medicines covered within scheme rates.
Option changes are only permitted during the annual option change window, which runs from 1 November to 30 November each year. Changes take effect from 1 January the following year.
Benefit changes are reviewed annually in August and remain at the discretion of the Board of Trustees. We will table your suggestion for consideration. Members are also encouraged to raise benefit queries directly with their trustee representatives within their company.
No. Members may consult any provider of their choice for procedures of this nature.
There is a list of preferred GPs for the Medisave Essential option. Members on other options may use any GP of their choice. There are no preferred specialists on any option. If you would like to check whether a specific provider charges within scheme rates, contact Medimed with their practice number and procedure codes and we will confirm on your behalf.
Medimed only has preferred hospitals on the Medisave Essential option. Specialists who practise at these hospitals are not contracted to Medimed and may charge above scheme rates. You are free to choose any specialist — we recommend contacting us in advance with their practice number so we can advise on likely costs.
The standard turnaround time is two weeks from receipt of your claim. This may take longer if there is a backlog, if your banking details on file are incorrect, or if there are outstanding documents required to process the claim.
Yes. Claims are paid according to your available benefits at the time. If your benefit funds are depleted, any accumulated savings you have built up can be used to cover outstanding amounts.
Providers are entitled to charge for their time when discussing results, even if no new examination takes place. We encourage members to have an open conversation with their provider about consultation fees before the appointment so there are no surprises.
Members on the Medisave Essential option may change their GP twice per year. Members moving between GP groups (ECIPA to PEGP or vice versa) may do so at the start of the year. Members on all other options are free to visit any GP of their choice without restriction.
Yes — Medimed is an open scheme, so you can remain a member after leaving your employer. Once you leave, you become responsible for the full monthly contribution, payable in advance on the 1st of each month.
You may add a spouse or children as dependants, with contributions subsidised by your employer. Extended family members such as parents may be added at your own cost — there are no age restrictions for joining the scheme. Full contributions apply for any dependants added outside the standard spouse and child categories.
