Shortfalls are the difference between what specialists charge and what your medical scheme pays for these services, often resulting in large shortfalls.
A co-payment or deductible is a fixed, upfront fee, payable by the member on hospital admission and applies to procedures and certain diagnostic services.
If you have an accident and need emergency treatment at a hospital casualty ward, most medical schemes will not pay these costs from the hospital benefit. The accidental casualty benefit is for emergency out-patient treatment in a hospital casualty ward as a direct result of accidental harm, such as bodily injury caused by sudden violent, unintentional, external and physical means.
External appliances include and are limited to crutches, knee braces, arm slings and moon boots.
The total maximum compensation limit payable for all In-Hospital, Out-of-Hospital and Benefit Extender benefits will be limited to R150 000 (One hundred and fifty thousand rand) per family member per annum.