Use Every Benefit Your Plan Already Pays For

Preventative benefits are an amount your medical aid sets aside each year to pay for screening tests that catch health problems early. They are separate from your day-to-day savings and your chronic benefits.

Most plans cover basic tests like cholesterol, blood sugar (glucose), HPV testing, PSA testing for men and cervical screening. Even hospital plans include preventative benefits. A doctor's referral is usually required for the scheme to pay. The list of covered tests can expand year to year, so always check with your provider for your specific plan.

Chronic benefits are an amount your medical aid sets aside to cover ongoing care for long-term conditions, such as high blood pressure, diabetes, thyroid disorders, asthma and many others.

To unlock chronic benefits, you usually need a doctor to apply on your behalf with proof of diagnosis. Once approved, your tests, consultations and any related medication for that condition come out of your chronic pot rather than your day-to-day savings.

We take care of the claim for you. When you book your test, just give us your medical aid details. We check what your plan covers and submit the claim to your medical aid on your behalf. You only pay the difference, if any.

There is no extra charge for this service.

Yes. Bring your medical aid details when you book or send them to us in advance, and we will check your coverage before any tests are run. You will know exactly what your plan pays for and what (if anything) you need to pay out of pocket, so there are no surprises.

We can help you with that too. We work with a network of partner doctors who care about getting your chronic benefits sorted. They can review your case, confirm a diagnosis where appropriate and apply to your medical aid for chronic benefit approval on your behalf.

Once approved, ongoing tests and consultations for that condition come out of your chronic pot instead of your day-to-day savings.

We submit claims to all major South African medical aids. The amount each scheme pays varies plan by plan, which is why we always check your coverage upfront. If your scheme has unusual requirements, we will tell you when you book.

You only pay the difference between what your medical aid covers and the full price of your tests. We are upfront about every cost before you test, so you can decide whether to go ahead with the full panel, drop a few tests or come back later in the year when your benefits reset.

PMBs are a set of conditions that every medical aid in South Africa is legally required to cover, regardless of plan. They include any life-threatening emergency, 271 defined serious conditions, 27 chronic conditions on the CDL list, childbirth and mental health emergencies.

If a diagnostic test is needed to identify a PMB condition, your scheme must pay for it in full. We help confirm whether your situation falls under PMBs and bill accordingly so you do not pay out of your savings for something the scheme is required by law to cover.

When your medical aid approves a chronic condition, they assign an ICD-10 code to your registration. For example, hypertension is I10, Type 2 diabetes is E11, asthma is J45.

You need to know your ICD-10 code and tell us when you book or arrive for testing related to that condition. We use the code to bill your tests against your chronic benefit pot, not your day-to-day savings. Without the code, the claim defaults to day-to-day savings and depletes the pot you use for everything else. Save the code in your phone next to your medical aid number.