Use every benefit your plan already pays for
Most South Africans never use the preventative, PMB and chronic benefits sitting in their medical aid plans. At our walk-in labs we don't submit claims to medical aids ourselves. You pay on the day, and we give you a tax invoice with all the codes your scheme needs, so you can claim the cost back.
Your medical aid plan probably covers more than you think. South African schemes work with three different "pots" of benefits: preventative screening, prescribed minimum benefits (PMBs) for serious or chronic conditions, and chronic benefits for ongoing care. Most people never use them all.
At Epicentre, our job is to help you actually use what you are already paying for. At our walk-in labs we don't submit claims to medical aids ourselves. You pay on the day, and we give you a tax invoice with all the codes your scheme needs, so you can claim the cost back. No doctor? We can put you in touch with a partner doctor who can see you and write a referral.
One thing worth knowing upfront: for medical aid to pay for testing, your scheme almost always requires a doctor's referral. If you want to skip the referral, you can walk in and pay cash; we make that easy too. The medical aid route just has one extra step at the start.
Cover depends on your scheme and plan. Please check with your medical aid before your test.
The three benefit categories most people miss
Your medical aid keeps these in separate pots, so they do not eat into your day-to-day savings.
Preventative benefits
Money your medical aid sets aside each year for screening tests that catch problems early. They reset every year, so anything you do not use is lost. Even hospital plans include preventative benefits.
- Cholesterol and lipid checks
- Blood sugar (glucose) screening
- HPV testing and cervical screening
- PSA test for men
- Annual flu vaccination
A doctor's referral is required for most preventative claims. You'll claim these back yourself using our tax invoice.
See how to claimPrescribed minimum benefits (PMBs)
Required by law. Every medical aid in South Africa must cover these, no matter your plan or how much of your day-to-day savings is left.
- Any life-threatening emergency
- 271 defined serious medical conditions
- 27 chronic conditions on the CDL list
- Childbirth and maternal care
- Mental health emergencies
Prescribed Minimum Benefits cover the diagnosis and treatment of certain conditions. Whether a test is paid under PMBs depends on the result, your scheme's rules and a doctor's referral, so check with your scheme first.
Read about PMBsChronic benefits
A separate pot for ongoing care of registered long-term conditions. Once approved, your tests, consultations and related medication for that condition come out of this pot.
- High blood pressure (hypertension)
- Diabetes (Type 1 and Type 2)
- Thyroid disorders (hypothyroid and hyperthyroid)
- Asthma and chronic respiratory conditions
- And many other registered chronic conditions
If you're registered for chronic benefits, ask your doctor to include your ICD-10 code on the referral. It will appear on your tax invoice when you claim.
Read about chronic benefitsHow claiming works
At our walk-in labs you claim the cost back yourself. Here's how.
Book or walk in
Book online or walk into any branch, Monday to Friday 08:30 to 16:00.
Bring your referral
Most schemes need a doctor's referral with an ICD-10 code. No doctor? We can put you in touch with one.
Pay on the day
Pay the cash price at the branch. Most visits take just a few minutes.
Get your invoice
We email you a tax invoice with practice number 1117394 and the billing codes.
Claim back
Send the invoice to your medical aid. Cover depends on your scheme and plan.
Need a referral?
Most schemes want a doctor's referral before they pay for a test. No doctor? We can put you in touch with a partner doctor who can see you and write a referral.
Connect me with a partner doctorCommon questions
Everything you might want to know before you book.
What are preventative benefits?
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. You'll claim these back yourself using our tax invoice. The list of covered tests can expand year to year, so always check with your provider for your specific plan.
What are chronic benefits?
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.
How does Epicentre help me claim from medical aid?
At our walk-in labs we don't submit claims to medical aids ourselves. You pay on the day, and we give you a tax invoice with all the codes your scheme needs, so you can claim the cost back.
Can you tell me what my plan covers before I test?
We can't check your cover for you. Cover depends on your scheme and plan. Please check with your medical aid before your test. We give you a tax invoice with practice number 1117394 and the billing codes so you can claim back.
What if I don't have a doctor?
No doctor? We can put you in touch with a partner doctor who can see you and write a referral. Chronic benefit applications are made by your doctor directly with your scheme.
Do all medical aids work with Epicentre?
Our tax invoice carries the practice number and billing codes that South African schemes use. Cover depends on your scheme and plan. Please check with your medical aid before your test.
What if my medical aid does not cover everything?
You pay the full price on the day and your scheme refunds what your plan covers. If you want to know what that is, check with your medical aid before your test, and you can always drop a few tests or come back when your benefits reset.
What are Prescribed Minimum Benefits (PMBs)?
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.
Prescribed Minimum Benefits cover the diagnosis and treatment of certain conditions. Whether a test is paid under PMBs depends on the result, your scheme's rules and a doctor's referral, so check with your scheme first.
What is an ICD-10 code and why do I need it?
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.
If you're registered for chronic benefits, ask your doctor to include your ICD-10 code on the referral. It will appear on your tax invoice when you claim. Without the code, your scheme may pay the claim from day-to-day savings instead of your chronic benefit.
Is it different at corporate wellness days?
Yes. At workplace wellness days we submit the claim to your medical aid for you on the day. See Corporate wellness.
Stop leaving benefits on the table
Book your test, pay on the day and claim the cost back with our tax invoice. Cover depends on your scheme and plan. Please check with your medical aid before your test.