2021 THEBEMED BENEFIT BROCHURE - Accessible Care Affordable Prices - Thebemed's
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2021
THEBEMED
BENEFIT
BROCHURE
PRIVATE HOSPITAL COVER
COMPREHENSIVE PRIMARY CARE
CHOICE OF BENEFITS
TO SUIT YOUR NEEDS
Accessible Care • Affordable Prices
Subject to CMS approvalENERGY PLAN
Comprehensive Care
• Designed for families needing Comprehensive Healthcare Cover.
• Unlimited Private Hospital Cover.
• Comprehensive Healthcare services out of Hospital.
• Full cover for chronic medicine for all Chronic Disease List (CDL) conditions including
Non-CDL benefit for additional chronic conditions.
• Cover for comprehensive healthcare services for maternity
• Preventative Care tailored for families.
CHOOSE FANTASY PLAN
Comprehensive Primary Care
THE & Savings
• Designed for Single and Young Couples with healthy lifestyles.
OPTION • Unlimited Private Hospital Cover.
• The Medical Savings Account (MSA) provides additional funds to top up
some scheme benefits and also cover for additional medical expenses
THAT IS not covered through risk.
• Full cover for chronic medicine for all Chronic Disease List (CDL)
RIGHT
conditions plus some additional chronic conditions from a Non-CDL benefit.
• Cover for comprehensive healthcare services for maternity
• Preventative Care designed to promote healthy lifestyles.
FOR YOU
UNIVERSAL PLAN &
UNIVERSAL EDO
(Efficiency Discount Option)
Comprehensive Primary Care
• Designed for families looking for Cost Effective Healthcare cover at choice of Designated
Service Provider (DSP*).
• Hospital Cover is at DSP* Private Hospital Groups.
• Primary Care is allowed at 2 Nominated GP’s of choice per beneficiary.
• Full cover for chronic medicine for all Chronic Disease List (CDL) conditions.
• Cover for comprehensive healthcare services for maternity
• Preventative Care tailored for families.
• Contributions are discounted with the Universal EDO Plan at limited DSP* healthcare
providers and hospitals.
PRIVATE HOSPITAL COVER • CHOICE OF DESIGNATED SERVICE PROVIDER • CHOICE OF BENEFITS TO SUIT YOUR NEEDS
Thebemed Medical Aid Scheme is inspired by the vision of the pioneering black-owned Thebe Investment Corporation. The sole shareholder at the time
was Batho Batho Trust, a community-based trust which included Nelson Mandela (Chairman), Walter Sisulu and Reverend Beyers Naude as original
Trustees and Dr Enos Mabuza as the first Chairman of Thebe. Thebe is driven by a commitment to serve the broader interests of communities at large.
ThebeMed Medical Aid Scheme was established on the 12th of September 2002 and is focused primarily on providing healthcare to beneficiaries
previously excluded from cover. The Scheme is providing healthcare predominately in the mining, logistics and agricultural industries. ThebeMed is driven
by a commitment to serve the broader interests of communities at large to provide quality healthcare solutions at affordable and sustainable manner.ENERGY 2021 Members are not allowed to change networks during the year; however members
may change their Primary Care Provider by contacting the Call Centre at the start of
the year. The choice of Network (Core, Medium & Open) is based on member level
and not beneficiary level e.g. the main member will select a Network and all the
family dependants must choose a Primary Care Provider from that specific network.
ENERGY PLAN CONTRIBUTION RATES
CORE MEDIUM OPEN
2 PRIMARY CARE 3 PRIMARY CARE ANY PRIMARY CARE
PROVIDERS PROVIDERS PROVIDERS
Hospital Network: Hospital Network: Hospital Network:
Mediclinic, Life Healthcare, Mediclinic, Life Healthcare, All Hospital Networks
National Hospital Network National Hospital Network
(NHN), Amcoal Highveld (NHN), Amcoal Highveld
Hospital, Vaalpark Netcare Hospital and Netcare.
Medical Centre, N17 Netcare
Private Hospital, Pretoria
Netcare East Hospital
Pathology Network: Pathology Network:
Pathology Network: Medilab, Ampath, Lancet, All providers
Medilab, Ampath, Lancet and Vermaak, Hamadi, Pathcare
Vermaak and Hamadi. and Togalab.
INCOME
0 - R4 000 R1 720 R2 148 R 2 418
R4 001 - R7 500 R2 663 R2 958 R 3 479
R7 501 - R10 000 R4 201 R4 544 R 5 450
R10 001+ R4 706 R4 951 R 6 189
0 - R4 000 R2 980 R3 726 R4 192
R4 001 - R7 500 R3 810 R4 231 R4 971
+
R7 501 - R10 000 R5 670 R6 132 R7 359
R10 001+ R6 106 R6 428 R8 033
* 0 - R4 000 R3 152 R3 938 R4 470
+ R4 001 - R7 500 R4 024 R4 471 R5 252
R7 501 - R10 000 R5 993 R6 478 R7 776
R10 001+ R6 450 R6 792 R8 489
0 - R4 000 R1 260 R1 578 R1 774
Adult rate R4 001 - R7 500 R1 147 R1 273 R1 492
R7 501 - R10 000 R1 469 R1 588 R1 909
R10 001+ R1 400 R1 477 R1 844
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR. ALL COSTS PAYABLE AT 100% OF NEGOTIATED TARIFF.
* Additional child dependants above M+2 included free of charge. Additional adult dependants charged at adult rate. Please refer to the rules for definition of dependantsENERGY 2021
OUT OF HOSPITAL BENEFITS ALL BENEFITS ARE PAYABLE AT DESIGNATED SERVICE PROVIDER (DSP)*.
SCHEME RULES, FORMULARY, INTERNAL PROTOCOLS AND PMB’S WILL BE APPLIED WHERE APPLICABLE.
GP CONSULTATIONS SPECIALIST
(If Non-DSP* GP is used voluntarily: PHARMACY ADVISED
25% co-payment is payable by the CONSULTATIONS CHRONIC MEDICATION THERAPY
member / visit) (Subject to appropriate referral by GP) (Subject to Registration; (Over the counter medicines in
• UNLIMITED Pre-authorisation; Internal Treatment consultation with pharmacist, restricted to
M = 3 Protocols & Medicine Formulary;
• 100% OF Negotiated Tariff (Energy M+2 = 5 Schedule 0, 1 and 2 medicines)
PMB* and renewal of prescription
Core and Energy Medium) M+3+ = 7 every 6 months) • Limited to R175 / Script
• 100% of Scheme Tariff (Energy Open) • Limited to 3 visits/beneficiary/year • Subject to Limit of R850 / family / year
• 100% of Cost at Single Exit Price & • 100% Cost at Single Exit Price and
Regulated Dispensing Fee Regulated Dispensing Fee
• Subject to Generic and Scheme
Formulary Services provided by DSP*
• Other chronic (NON-CDL)
medicine: Limited to R12 000 /
PHYSIOTHERAPY ACUTE MEDICATION family and R4 000 / beneficiary / year
(Appropriate referral by GP / Specialist) (Medication, Injection & Material)
• IN HOSPITAL • CDL/PMB Chronic Disease List CONSERVATIVE
Subject to Admitting GP/Specialist M = R4 440 medicine: Unlimited DENTISTRY
Payment up to 3 days, thereafter treatment M+1 = R6 355 Payable first from Other Chronic (Consultations, Fillings and Extractions,
plan and progress report required M+2 = R8 000 Medicine Scaling, Polishing and X-rays)
• OUT OF HOSPITAL M+3+ = R10 145
Limited to R2 700 / family / year • Subject to Pre-authorisation
• Limited to R4 440/beneficiary/year • 100% of Thebemed Dental Rates
100% of Negotiated tariff
• 100% of cost at Single Exit Price and • Based on DENIS* clinical protocols
PMB* based on internal protocols
Regulated Dispensing Fee
• Subject to Generic & Schemes
Formulary
AUXILIARY, ALTERNATIVE
HEALTHCARE PRACTITIONERS SPECIALISED
(Includes Chiropractors,
MEDICAL Homeopaths, Podiatry, DENTISTRY
AND ORTHOPAEDIC Hearing Aid Acousticians, Audiology, (Crown and Orthodontics)
APPLIANCES OPTOMETRY Dieticians, Occupational Therapists, • Limit R2 500 / person limited to
(Services In/Out of Hospital (Frames, Lenses, Readers, Contact Orthotics and Speech Therapists, R5 000 / family / year
Subject to Pre-authorisation and Lenses and Disposable Contact Lenses. Registered Nursing Services and • Subject to Pre-authorisation
GP/Specialist referral. PMB* based on Subject to pre-authorisation) Psychologist) • 100% of Thebemed Dental Rates.
internal protocols) • 1 Pair of frames limited to R813 / Appropriate referral by GP / Specialist. • Based on DENIS* clinical protocols
• Limited to an overall R8 000 / beneficiary / 2 years Subject to Treatment Plan and
family / year Progress Report from the provider
• Single and Bifocal lenses covered at
• 100% Negotiated Tariff after the 3rd visit)
100% at DSP* Negotiated rate HOSPITAL &
The following Appliance sub-limits are • Contact Lenses Limited to R1 235 / • OUT OF HOSPITAL:
applicable: beneficiary / 2 years • Collective Limited of R4 000 / family / ANAESTHETICS
• Wheelchair: • No benefit for Contact Lenses if year • Impacted teeth only
One every 3-year cycle / beneficiary Frames are puchased • 100% of Negotiated Tariff • Subject to Pre-authorisation
• Speech and Hearing Aid: • PMB* based on internal protocols • Based on admission protocols
One every 3-year cycle / beneficiary
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.OUT OF HOSPITAL BENEFITS IN HOSPITAL BENEFITS
ENERGY 2021
ALL BENEFITS AND SERVICES MUST BE PRE-AUTHORISED PRIOR TO
ADMISSION, BY THE RELEVANT MANAGED HEALTHCARE COMPANY ON
0861 84 32 36. PRE-AUTHORISATION IS NOT A GUARANTEE OF PAYMENT.
SCHEME RULES, FORMULARY, INTERNAL PROTOCOLS AND PMB’S WILL BE
APPLIED WHERE APPLICABLE.
RADIOLOGY PATHOLOGY
(Including Radiography, Specialised (Managed by Request Form as
Radiology and Angiography. Managed by prescribed by the GP and referred
Request Form as prescribed by the GP Specialist)
and referred Specialist)
• UNLIMITED HOSPITALISATION DIAGNOSTIC
• IN HOSPITAL (Including accommodation, neonatal INVESTIGATIONS
• 100% of Negotiated Tariff intensive care, theatre, materials and all
Subject to Hospitalisation benefits • PMB* based on internal (Pathology and Radiology)
related services) Subject to GP / Specialist referral
• OUT OF HOSPITAL protocols
• UNLIMITED • 100% of Negotiated Tariff
Limited to R3 495 / family / year
• 100% of Negotiated Tariff. • PMB* based on internal protocols
• Based on internal protocols
• Subject to PMB’s
• Based on the Clinical Outcomes
and Tariff Negotiations.
• The Scheme has the right to MRI / PET / CAT SCANS
channel cases to the most (Subject to Pre-authorisation
competitive network and Specialist referral.
PMB* based on internal protocols)
• 2 MRI or CT Scans / beneficiary /
year (In/Out of Hospital).
MRI / PET / CAT SCANS REFRACTION TESTS • 100% of Negotiated Tariff.
(Subject to Pre-authorisation)
• 1 Test / beneficiary / 2 years
• 2 MRI or CT Scans / beneficiary / year • 100% of Negotiated Tariff
(In or Out of Hospital). • Managed by PPN*
• 100% of Negotiated Tariff. PLANNED HOSPITAL
• PMB* based on internal protocols. PROCEDURES
• 100% of Negotiated Tariff.
• R1 000 Co-payment for the planned
procedure: Removal of skin lesions AUXILIARY,
• R1 500 Co-payment for these planned
procedures:
ALTERNATIVE
Tonsillectomy, Adenoidectomy, HEALTHCARE AND
Vasectomy, Functional endoscopic PHYSIOTHERAPIST
sinus surgery.
• R3 500 Co-payment for these planned
PRACTITIONERS
(Includes Dieticians, Occupational
procedures:
Therapists, Physiotherapist and Speech
Back and neck pain without
neurological symptoms, Arthroscopy, Therapists)
Colonoscopy, Gastroscopy, (Referred by treating doctor)
Hysterectomy, Laparoscopy, • 100% of Negotiated Tariff.
Nissen Fundoplication (Reflux Surgery) • PMB* based on internal protocols.
• R8 000 Co-payment for these planned • Treatment Plan and Progress Report
procedures: should be submitted during the
Spinal Surgery and Joint Replacements. hospital event to manage the clinical
• Subject to PMB’s and internal outcome.
protocols
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.ENERGY 2021 IN HOSPITAL BENEFITS
TAKE HOME ALTERNATIVES TO MATERNITY INTERNAL &
MEDICATION HOSPITALISATION (Home Delivery: By Registered Midwife)
(Subject to Pre-authorisation & EXTERNAL PROSTHESIS
• 7 Days supply / beneficiary / hospital Case Management. PMB* based on • UNLIMITED
stay • Limited to an overall R55 000 /
internal protocols) • Normal, Caesarean & Home
family / year
Delivery
• UNLIMITED • 100% of Negotiated Tariff. Prosthesis sub-limits are applicable:
• At Step Down, Sub-acute & • Maternity Vitamins limited to • Vascular: R22 000
Terminal Care Facilities R100 / month / female beneficiary • Joint replacement R40 000
• 100% of Negotiated Tariff. based on generic substitute and • Functional: R22 000;
• PMB* based on internal protocols Schemes formulary. • Major Musculoskeletal: R17 000
• PMB* based on internal protocols • 100% of Negotiated Tariff and
• 2 Maternity Sonars based on internal protocols
RENAL DIALYSIS
(Including Immune Suppressive
Medication)
• 100% of Negotiated Tariff. With registration on the Thebe
• PMB* based on internal Bambino Programme
protocols and Treatment Plan ORGAN TRANSPLANTS • 1 Additional Sonar
• 100% of Negotiated Tariff. • 2 Additional gynae visits / pregnancy
• PMB* based on Department of • 3 Post Natal Midwife Consultations
Health protocols • Maternity Bag at 7 months - Mother
and baby essentials to get you started
on your journey to motherhood
DRUG & ALCOHOL
REHABILITATION
(Account will only be paid if the full course
of treatment is completed)
BLOOD TRANSFUSIONS • Limited to 21 days / beneficiary / year
& BLOOD • 100% of Negotiated Tariff.
• PMB* based on internal protocols
REPLACEMENT • Subject to Contracted Private Facility
MENTAL HEALTH MEDICAL RESCUE
PRODUCTS (Ambulance, Medical Emergency
(Psychiatric Treatment In and Out of Evacuation Transport to
• 100% of Negotiated Tariff. Hospital). Appropriate referral
• PMB* based on internal protocols Advisory Services)
by GP/ Specialist. Subject to
Pre-authorisation for In and Out of • 100% of Negotiated Tariff at DSP*
Hospital, Treatment Plan Submission • Subject to Pre-authorisation
& Progress Report from the Provider
• Limited to R16 500 / family / year
• 100% of Negotiated Tariff
• PMB* 21 Days based on internal
protocols
ONCOLOGY • Payment up to 3 days for MAXILLOFACIAL
(Radiotherapy, Chemotherapy and Psychologist charging therapy SURGERY
related materials) sessions with Psychiatrist in the
same admission, thereafter • 100% of Negotiated Tariff
• 100% of Negotiated Tariff. • PMB* based on Department of
• PMB* based on internal protocols. pre-authorisation required with
treatment plan and progress report Health protocols
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.FANTASY 2021
1 Call the Thebemed Call Centre
0861 84 32 36 An agent will guide you and
register your DSP*, or send a WhatsApp to
0861 84 32 36 with your member number.
CHOOSING YOUR (Please provide the DSP GP Name and Practice number that must be
linked to the family dependants (Name and date of birth).
DESIGNATED SERVICE 2 Log onto www.thebemed.co.za
and follow the “Providers” then the “Designated
PROVIDER (DSP*) Provider” link to select a DSP*.
Each Family Dependant can select their own DSP*
3 Supply your own family doctor’s details
Primary Care Provider at the start of the year.
to the Thebemed Call Centre. They will contract them
into the Thebemed Doctor Network.
FANTASY PLAN
CONTRIBUTION RATES
PER MEMBER PER
MONTH
INCOME
Premium penalties for persons joining late in life:
Applied in respect of persons over the age of 35 years, who 0+ R1 717
were without medical scheme cover for the period indicated
hereunder after the age of 35 years as follows: Risk R1 511
Savings R206
1 - 4 years @ 0.05 multiplied by the relevant contribution
5 - 14 years @ 0.25 multiplied by the relevant contribution
15 - 24 years @ 0.50 multiplied by the relevant contribution 0+ R1 404
25 + years @ 0.75 multiplied by the relevant contribution
+ Risk R1 235
“creditable coverage” means any period of verifiable Savings R169
medical scheme membership of the applicant or his or her
dependant, but excluding membership as a child dependant,
terminating two years or more before the date of the latest 0+ R706
application for membership. Any years of creditable coverage *
which can be demonstrated by the applicant or his or her + Risk R621
dependant shall be subtracted from his or her current age in Savings R85
determining the applicable penalty.
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR. ALL COSTS PAYABLE AT 100% OF NEGOTIATED TARIFF.
* Maximum 2 children per family chargedOUT OF HOSPITAL BENEFITS
FANTASY 2021 ALL BENEFITS ARE PAYABLE AT DESIGNATED SERVICE PROVIDER (DSP)*. PRE-AUTHORISATION AND PMB*.
GP CONSULTATIONS EMERGENCY VISITS ACUTE MEDICATION PHARMACY ADVISED
(Facility Fee & Consultations) (Medication, Injection & Material) THERAPY
• UNLIMITED but managed
• 100% of Negotiated Tariff at DSP* • 100% of Negotiated Tariff. • R2 000 / beneficiary, max of R5 500 / (Over the counter medicines in
• Cover for trauma and emergencies, family / year consultation with pharmacist, restricted
Network to Schedule 0, 1 and 2 medicines)
• After the 10th visit / beneficiary any other event covered from Savings. • 100% of Negotiated Tariff at DSP*
based on generic substitute and • Limited to R175 / Script
pre-authorisation is required.
Schemes formulary • R850 from the Savings benefit,
• Member to choose and consult two (2)
• 100% of cost at Single Exit Price thereafter R420 is Subject to Risk
DSP GPs as primary provider
and Regulated Dispensing Fee • 100% Cost at Single Exit Price and
/ beneficiary.
Regulated Dispensing Fee
• 1 Out of Area Emergency Visit
Beneficiary / year
• Non-emergency services obtained from
a Non-DSP Network provider is subject
to Savings SPECIALIST
CONSULTATIONS
(Subject to referral by GP)
• Limited to 5 visits / family / year.
CHRONIC MEDICATION REFRACTION TESTS
(Subject to Registration; • 1 Test / beneficiary / 2 years.
Pre-authorisation; Internal Treatment • 100% of Negotiated Tariff.
Protocols & Medicine Formulary;
MEDICAL AND PMB* and renewal of prescription every • Managed by PPN*
ORTHOPAEDIC 6 months)
APPLIANCES • 100% of Cost at Single Exit Price &
(Services In / Out of Hospital OPTOMETRY Regulated Dispensing Fee.
Subject to Pre-authorisation and GP / (Frames, Lenses, Readers, Contact Lenses • Subject to Generic and Scheme
Specialist referral. and Disposable Contact Lenses) (Subject Formulary Services provided by DSP*
PMB* based on internal protocols) to pre-authorisation) .
• 1 Pair of frames limited to R750 / • Other chronic (NON-CDL)
• Limited to an overall R6 750 /
beneficiary / 2 years. medicine:
family / year.
Limited to R11 500 / family and
• 100% Negotiated Tariff. • Single and Bifocal lenses covered at
R4 000 / beneficiary / year.
DIAGNOSTIC
100% at DSP*
Negotiated rate.
PROCEDURES
The following Appliance sub-limits are (Pathology and Radiology
• Contact Lenses Limited to R1 • CDL/PMB Chronic Disease List
applicable: Managed by Request Form
185/beneficiary / 2 years. medicine: as prescribed by the GP and
• Wheelchair: One every 3-year
• No benefit for Contact Lenses if Unlimited. referred Specialist)
cycle / beneficiary;
Frames are puchased. Payable first from Other Chronic
• Speech and Hearing Aid: • 100% of Negotiated Tariff at DSP*
Medicine.
One every 3-year cycle / beneficiary.
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.OUT OF HOSPITAL BENEFITS IN HOSPITAL BENEFITS
FANTASY 2021
ALL BENEFITS AND SERVICES MUST BE PRE-AUTHORISED PRIOR TO ADMISSION,
BY THE RELEVANT MANAGED HEALTHCARE COMPANY ON 0861 84 32 36.
PRE-AUTHORISATION IS NOT A GUARANTEE OF PAYMENT. SCHEME RULES,
FORMULARY, INTERNAL PROTOCOLS AND PMB’S WILL BE APPLIED WHERE
APPLICABLE.
AUXILIARY, CONSERVATIVE
ALTERNATIVE HEALTHCARE DENTISTRY
(Consultations, Fillings and Extractions,
AND PHYSIOTHERAPIST Scaling, Polishing and X-rays) HOSPITALISATION DIAGNOSTIC
PRACTITIONERS (Including accommodation, neonatal
(Limited to Chiropractors, Podiatry,
• Subject to Pre-authorisation.
intensive care, theatre, materials and all INVESTIGATIONS
• 100% of Thebemed Dental Rates. related services) (Pathology and Radiology
Hearing Aid Acousticians, Subject to GP / Specialist referral)
• Based on DENIS* clinical
Audiology, Dieticians, Occupational • UNLIMITED
protocols. • 100% of Negotiated Tariff
Therapists, Physiotherapist and • 100% of Negotiated Tariff.
Speech Therapists) • PMB* based on internal protocols
• Based on internal protocols
(Appropriate referral by GP or • Subject to PMB’s
Authorised Specialist) • Based on the Clinical Outcomes and
• Limited to R1 050 / family / year. Tariff Negotiations.
• The Scheme has the right to channel MRI / PET / CAT SCANS
• Subject to Savings. (Subject to Pre-authorisation and Specialist
cases to the most competitive network
• 100% of Negotiated Tariff. referral)
• 2 MRI or CT Scans/beneficiary / year
(In / Out of Hospital).
• 100% of Negotiated Tariff.
SPECIALISED PMB* based on internal protocols.
DENTISTRY
(Crown and Orthodontics)
• Limited R2 500 family / year. MATERNITY
• Subject to Savings. (Home Delivery: By Registered Midwife)
• 100% of Thebemed Dental Rates. • UNLIMITED
• Based on DENIS* clinical protocols. • Normal, Caesarean & Home
Delivery
• 100% of Negotiated Tariff.
• PMB* based on internal protocols TAKE HOME
• 2 Maternity Sonars MEDICATION
• Maternity Vitamins. Limited to R100 /
month / female beneficiary based on • 7 Days supply / beneficiary / hospital stay
generic substitute and Schemes
formulary
With registration on the Thebe
Bambino Programme
• 1 Additional Sonar
• 2 Additional gynae visits / pregnancy
• 3 Post Natal Midwife Consultations ONCOLOGY
(Radiotherapy, Chemotherapy and
• Maternity Bag at 7 months - related materials)
Mother and baby essentials to get
you started on your journey to • 100% of Negotiated Tariff.
motherhood • PMB* based on internal protocols.
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.FANTASY 2021 IN HOSPITAL BENEFITS
PLANNED HOSPITAL
PROCEDURES BLOOD TRANSFUSIONS ALTERNATIVES TO INTERNAL &
• 100% of Negotiated Tariff. & BLOOD HOSPITALISATION
• R1 000 Co-payment for the planned (Subject to Pre-authorisation &
EXTERNAL PROSTHESIS
procedure: REPLACEMENT Case Management.)
(Subject to PMB Conditions only)
Removal of skin lesions PRODUCTS • UNLIMITED
• Limited to an overall R50 000 /
• R1 500 Co-payment for these planned family / year
• 100% of Negotiated Tariff. • At Step Down, Sub-acute &
procedures: • PMB* based on internal protocols Terminal Care Facilities Prosthesis sub-limits are applicable:
Tonsillectomy, Adenoidectomy, • 100% of Negotiated Tariff. • Vascular: R20 000
Vasectomy, Functional endoscopic • PMB* based on internal • Joint replacement R35 000
sinus surgery. protocols • Functional: R20 000;
• R3 500 Co-payment for these planned • Major Musculoskeletal: R15 000
procedures: • 100% of Negotiated Tariff and
Back and neck pain without based on internal protocols
neurological symptoms, Arthroscopy,
Colonoscopy, Gastroscopy, RENAL DIALYSIS
Hysterectomy, Laparoscopy, (Including Immune Suppressive
Nissen Fundoplication (Reflux Medication)
Surgery)
• 100% of Negotiated Tariff.
• R8 000 Co-payment for these planned
• PMB* based on internal protocols ORGAN TRANSPLANTS
procedures: • 100% of Negotiated Tariff.
and Treatment Plan
Spinal Surgery and Joint • PMB* based on Department of
• Subject to PMB’s
Replacements. Health protocols MAXILLOFACIAL
• Subject to PMB’s and internal SURGERY
protocols
• 100% of Negotiated Tariff
• PMB* based on Department of
Health protocols
MENTAL HEALTH
(Psychiatric Treatment including Clinical
AUXILIARY, ALTERNATIVE Psychology)
DRUG & ALCOHOL
Appropriate referral by
HEALTHCARE AND GP / Specialist. Subject to REHABILITATION
PHYSIOTHERAPIST Pre-authorisation for In and Out of (Account will only be paid if the full course
PRACTITIONERS hospital, Treatment Plan Submission & of treatment is completed) MEDICAL RESCUE
Progress Report • Limited to 21 days / beneficiary (Ambulance, Medical Emergency
(Includes Dieticians, Occupational Evacuation Transport to Advisory Services)
Therapists, Physiotherapist and • PMB Conditions Only. / year
Speech Therapists) • 100% of Negotiated Tariff. • 100% of Negotiated Tariff. • 100% of Negotiated Tariff at DSP*
(Referred by treating doctor) • Payment up to 3 days for • PMB* based on internal protocols • Subject to Pre-authorisation
Psychologist charging therapy sessions • Subject to Contracted Private Facility
• 100% of Negotiated Tariff.
with or without a Psychiatrist in the
• PMB* based on internal protocols.
same admission, thereafter pre-
• Treatment Plan and Progress Report
authorisation required with treatment
should be submitted during the
plan and progress report.
hospital event to manage the clinical
outcome.
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.UNIVERSAL 2021
1 Call the Thebemed Call Centre
0861 84 32 36 An agent will guide you and
register your DSP*, or send a WhatsApp to
0861 84 32 36 with your member number.
CHOOSING YOUR (Please provide the DSP GP Name and Practice number that must be
linked to the family dependants (Name and date of birth).
DESIGNATED SERVICE 2 Log onto www.thebemed.co.za
and follow the “Providers” then the “Designated
PROVIDER (DSP*) Provider” link to select a DSP*.
Each Family Dependant can select their own DSP*
3 Supply your own family doctor’s details
Primary Care Provider at the start of the year.
to the Thebemed Call Centre. They will contract them
into the Thebemed Doctor Network.
UNIVERSAL PLAN
CONTRIBUTION RATES
PER MEMBER
PER MONTH
INCOME
Premium penalties for persons joining late in life:
Applied in respect of persons over the age of 35 years, who 0 - R500 R555
were without medical scheme cover for the period indicated R501 - R2 500 R1 381
hereunder after the age of 35 years as follows: R2 501- R7 500 R1 514
1 - 4 years @ 0.05 multiplied by the relevant contribution R7 501+ R2 132
5 - 14 years @ 0.25 multiplied by the relevant contribution
15 - 24 years @ 0.50 multiplied by the relevant contribution 0 - R500 R555
25 + years @ 0.75 multiplied by the relevant contribution R501 - R2 500 R1 185
+
R2 501- R7 500 R1 299
“creditable coverage” means any period of verifiable
medical scheme membership of the applicant or his or her R7 501+ R2 010
dependant, but excluding membership as a child dependant,
terminating two years or more before the date of the latest 0 - R500 R555
application for membership. Any years of creditable coverage * R501 - R2 500 R648
which can be demonstrated by the applicant or his or her +
dependant shall be subtracted from his or her current age in
R2 501- R7 500 R711
determining the applicable penalty. R7 501+ R827
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR. ALL COSTS PAYABLE AT 100% OF NEGOTIATED TARIFF.
* Maximum 2 children per family chargedUNIVERSAL 2021 OUT OF HOSPITAL BENEFITS
ALL BENEFITS ARE PAYABLE AT DESIGNATED SERVICE PROVIDER (DSP)*, PRE-AUTHORISATION AND PMB*.
PHARMACY ADVISED CHRONIC MEDICATION
GP CONSULTATIONS DIAGNOSTIC (Subject to Registration; Pre-
(If Non-DSP* GP is used voluntarily; THERAPY
25% Co-payment is payable PROCEDURES (Over the counter medicines in authorisation; Internal Treatment
(Pathology and Radiology consultation with pharmacist, restricted to Protocols & Medicine Formulary; PMB*
by the member / visit) and renewal of prescription every
Managed by Request Form as prescribed Schedule 0, 1 and 2 medicines)
by the GP and referred Specialist) 6 months)
• UNLIMITED, but managed • Limited to R165 / Script
• 100% of Negotiated Tariff at DSP* • UNLIMITED • Subject to Limit of R537 / family / year • UNLIMITED
• After the 10th visit / beneficiary • 100% of Negotiated Tariff at DSP* • 100% Cost at Single Exit Price and • Based on internal protocols
pre-authorisation is required. Regulated Dispensing Fee • Subject to generic substitute and
• Member to choose and consult two • Not chargeable with Acute Script on Schemes Formulary
DSP GPs as primary providers / • PMB* based on internal protocols
Same Day
beneficiary
OPTOMETRY
(Frames, Lenses, Readers, Contact Lenses and Disposable
Contact Lenses. Subject to pre-authorisation)
• 1 Pair of frames limited to R750/beneficiary / 2 years
• Single and Bifocal lenses covered at 100% at DSP*
Negotiated rate
MEDICAL AND • Contact Lenses Limited to R1 185/beneficiary / 2 years
ORTHOPAEDIC APPLIANCES • No benefit for Contact Lenses if Frames are puchased
SPECIALIST (Services In / Out of Hospital.
CONSULTATIONS Subject to Pre-authorisation and
(Subject to referral by GP) GP / Specialist referral.
PMB* based on internal protocols)
• Limited to3 visits / family / year
• 100% of Negotiated Tariff at DSP* • Limited to an overall R5 500
• PMB based on internal protocols / family / year
• 100% Negotiated Tariff CONSERVATIVE REFRACTION TESTS
The following Appliance sub-limits are
applicable:
DENTISTRY
(Check-ups, Fillings and Extractions, Scaling, • 1 Test / beneficiary / 2 years
• Wheelchair: Polishing and Plastic Dentures) • 100% of Negotiated Tariff
One every 3-year cycle / beneficiary • Managed by PPN*
• Speech and Hearing Aid: • UNLIMITED
One every 3-year cycle / beneficiary • 100% of Thebemed Dental Rates
• Based on DENIS* clinical protocols
ACUTE MEDICATION
(Medication, Injection & Material)
• UNLIMITED
• 100% of Negotiated Tariff at DSP*
based on generic substitute and
Schemes formulary
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.IN HOSPITAL BENEFITS
UNIVERSAL 2021
ALL BENEFITS AND SERVICES MUST BE PRE-AUTHORISED PRIOR TO ADMISSION, BY THE RELEVANT MANAGED HEALTHCARE COMPANY ON 0861 84 32 36.
PRE-AUTHORISATION IS NOT A GUARANTEE OF PAYMENT. SCHEME RULES, FORMULARY, INTERNAL PROTOCOLS AND PMB’S WILL BE APPLIED WHERE APPLICABLE.
HOSPITALISATION RENAL DIALYSIS AUXILIARY, ALTERNATIVE
(Including accommodation, neonatal (Including Immune Suppressive Medication)
intensive care, medical and surgical PLANNED HOSPITAL HEALTHCARE AND
procedures, medication, • 100% of Negotiated Tariff PROCEDURES PHYSIOTHERAPIST
consumables and treating • PMB* based on internal
specialist costs) protocols and Treatment Plan • 100% of Negotiated Tariff. PRACTITIONERS
• Subject to PMB’s* • R1 000 Co-payment for the (Includes Dieticians, Occupational Therapists,
• UNLIMITED Physiotherapist and Speech Therapists.
planned procedure:
• At contracted private
Removal of skin lesions . Referred by treating doctor)
facilities and State Hospitals
• R1 500 Co-payment for these • 100% of Negotiated Tariff
• 100% of Negotiated Tariff at DSP*
planned procedures: • PMB* based on internal protocols
• Based on internal and Department
Tonsillectomy, Adenoidectomy, • Treatment Plan and Progress Report
of Health protocols
Vasectomy, Functional endoscopic should be submitted during the hospital
• Based on the Clinical Outcomes
sinus surgery. event to manage the clinical outcome
and Tariff Negotiations
• R3 500 Co-payment for these
• The Scheme has the right to
planned procedures:
channel cases to the most
Back and neck pain without
competitive network
• Associated Providers must contact
BLOOD TRANSFUSIONS neurological symptoms, Arthroscopy,
& BLOOD Colonoscopy, Gastroscopy,
the Scheme for authorisation.
Hysterectomy, Laparoscopy, Nissen
Failure to do so will result in REPLACEMENT Fundoplication (Reflux Surgery)
payment for only the first 3 days
• Subject to internal protocols
PRODUCTS • R8 000 Co-payment for these
• 100% of Negotiated Tariff planned procedures:
• PMB* based on internal protocols Spinal Surgery and Joint replacements. MATERNITY
(Home Delivery: By Registered Midwife)
• Subject to PMB’s and internal • UNLIMITED
protocols • Normal, Caesarean & Home
Delivery
• 100% of Negotiated Tariff
• PMB* based on internal protocols
DIAGNOSTIC • 2 Maternity Sonars
INVESTIGATIONS • Maternity Vitamins. Limited to R100
(Pathology and Radiology / month / female beneficiary based
Subject to GP / Specialist referral) on generic substitute and Schemes
DRUG & ALCOHOL formulary
• 100% of Negotiated Tariff
• PMB* based on internal protocols REHABILITATION
(Account will only be paid if the full course
of treatment is completed) TAKE HOME With registration on the Thebe
MRI / PET / CAT SCANS • Limited to 21 days / beneficiary /year MEDICATION Bambino Programme
(Subject to Pre-authorisation and • 100% of Negotiated Tariff • 1 Additional Sonar
Specialist referral) • 7 Days supply / beneficiary / hospital stay
• PMB* based on internal protocols • 2 Additional gynae visits / pregnancy
• 2 MRI or CT Scans / beneficiary / • Subject to Contracted Private Facility • 3 Post Natal Midwife Consultations
year (In/Out of Hospital) • Maternity Bag at 7 months - Mother and
• 100% of Negotiated Tariff baby essentials to get you started on your
• PMB* based on internal protocols journey to motherhood
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR.IN HOSPITAL BENEFITS UNIVERSAL EDO
UNIVERSAL 2021 (Efficiency Discount Option)
The Universal Efficiency-discounted option (EDO) is a sub-op-
tion of the Universal plan. An EDO option is designed around
members’ willingness to limit their choice of provider(s) in a
restricted network.
MENTAL HEALTH ALTERNATIVES Members selecting Universal EDO agree to pay lower
(Psychiatric Treatment including TO HOSPITALISATION contributions (relative to the Universal plan) in return for
Clinical Psychology. (Subject to Pre-authorisation &
Appropriate referral by Case Management.) having their choice of hospitals and doctors restricted when
DSP* GP/ Specialist. Subject to • UNLIMITED they are treated for all medical treatment.
Pre-authorisation for In and Out of • At Step Down, Sub-acute &
Hospital, Treatment Plan Submission & Terminal Care Facilities
Progress Report) • 100% of Negotiated Tariff. The main Universal plan’s DSP* network list is broader with a
• PMB Conditions Only • PMB* based on internal protocols national footprint compared to the Universal EDO.
• 100% of Negotiated Tariff
• Payment up to 3 days for
Psychologist charging therapy UNIVERSAL EDO PLAN
sessions with or without a
Psychiatrist in the same admission, CONTRIBUTION RATES
thereafter pre-authorisation
required with treatment plan and
progress report. PER MEMBER
MEDICAL RESCUE PER MONTH
(Ambulance, Medical Emergency
Evacuation Transport to Advisory Services)
• 100% of Negotiated Tariff at DSP* UNIVERSAL
• Subject to Pre-authorisation EDO
INCOME
0 - R500 R456
INTERNAL & R501 - R2 500 R1 129
EXTERNAL PROSTHESIS R2 501- R7 500 R1 243
(Subject to PMB Conditions only) R7 501+ R1 438
• Limited to an overall R50 000 / MAXILLOFACIAL
family / year SURGERY 0 - R500 R456
Prosthesis sub-limits are applicable:
• 100% of Negotiated Tariff R501 - R2 500 R1 004
• Vascular: R20 000 + +
• Joint replacement R35 000
• PMB* based on Department of R2 501- R7 500 R1 105
Health protocols
• Functional: R20 000 R7 501+ R1 235
• Major Musculoskeletal: R15 000
• 100% of Negotiated Tariff and
based on internal protocols 0 - R500 R456
* R501 - R2 500 R561
+ R2 501- R7 500 R617
R7 501+ R675
ALL BENEFITS WILL BE PRO-RATED FOR MEMBERS ADMITTED DURING THE BENEFIT YEAR. ALL COSTS PAYABLE AT 100% OF NEGOTIATED TARIFF.
* Maximum 2 children per family chargedmyHealth Health and Wellness Management Programme
INFORMS MEMBERS OF POTENTIAL HEALTH RISKS POWERED BY
SUPPLIES A BASKET OF CARE FOR THOSE DIAGNOSED WITH A CHRONIC CONDITION.
wellness
SUPPORTS MEMBERS WITH MOTIVATION, COACHING, ADVICE, RESOURCES AND TOOLS
TO HELP THEM ACHIEVE THEIR GOALS.
MYPLAN2BWELL HEALTH ASSIST
www.thebemed.co.za/myhealth Limited to referral from DSP* GP & Specialist THEBEMED MOSADI
100% of Negotiated Tariff. All benefits payable at DSP*
• Rate your health (Test to be done at DSP Pathologist)
• Choose your goal & register for e-coaching • 100% of Negotiated Tariff at DSP*
• Personalise your meal • 1 Health Risk Assessment Test (over 18yrs) / • 1 Pap Smear / beneficiary / year (females over 18 years)
beneficiary / year. Available at DSP* Pharmacy • 1 Mammogramme / beneficiary every 2 years
• Design your fitness plan
without a DSP* GP referral
• Track your results (females over 40 yrs)
• 1 Flu Vaccine (over 12 yrs) / beneficiary / year
• 1 Membership / beneficiary / year for beneficiaries • 1 Blood Sugar/Glucose Test (over 15 yrs) / • Contraceptives - Oral, injectable and patch only
over 18 years beneficiary / year • Limited to R180 (Energy) and R150 (Fantasy and
• Subject to online registration • 1 Colon Cancer Test (over 50 yrs) / Universal) / script / month
beneficiary / year
• 1 HIV Wellness Test / beneficiary / year
• 1 Bone Density Scan (over 50 yrs) / beneficiary / year.
Limited to R1 800
• 1 Dental Checkup / beneficiary / year
• 2 Dietician Consultations for BMI 35+ /
beneficiary / 6 months. Limited to R1 200 (over 12 yrs) THEBEMED MONNA
TELEPHONIC SUPPORT • 1 Biokinetic Consultation / beneficiary / year All benefits payable at DSP*
08002BWELL (0800 229 355) Subject to Dietician Consultations for BMI
35+ and Limited to R300 (over 12 yrs) • 100% of Negotiated Tariff at DSP*
Trauma & Short Term (Relationship, Family, • 1 Mens Health Consultation (males over 18 yrs)
Health, Lifestyle) Counselling • Circumcision - Limited to R1 300 / beneficiary
24 hours a day / 7 days a week Mon - Frid: 08h00 to 16h00 • 1 PSA (males over 40 yrs) / beneficiary / 2 years
• UNLIMITED • Internal protocols applicable
YOUTH ASSIST
HIV ASSIST Designed to help the youth deal with conflict, drug and CHRONIC DISEASE FREE AIRTIME
alcohol abuse, teenage pregnancies and abortions. Subject to Registration on the
Includes Consultations, Counselling, Medication Sign up with Thebemed
and Pathology Test. Members encouraged to register on the • 2 Free sessions at registered social worker or Disease Management and receive a FREE SIM
HIV/AIDS Management Programme psychologist for beneficiaries 2-17 years / beneficiary Programme CARD. This provides
/ year • Subject to Disease easy communication with
• 100% of Negotiated Tariff. Subject to PMB’s • Limited to R1 200 / beneficiary
• Pre-exposure prophylaxis included Management protocols consultants and you receive
• 100% of Negotiated Tariff • Basket of Care R55 airtime monthly.
EDUCATE IDENTIFY DIAGNOSE TREAT SUPPORT
For detailed information contact Momentum Wellness on 08002BWELL (0800 229 355)Available
in all official
South African
languages
Hello Doctor lets you talk to a doctor
on your phone, any�me, anywhere.
Just request a call, or send your ques�on via text
Download the app Log in via our website Dial *120*1019#
GET IT ON
www.hellodoctor.co.za from your phone and follow the prompts
to request a call.
Works on all phones
• Expert advice from qualified doctors FREE for ThebeMed Medical Aid Scheme members.
• Send a Call Back request from the Hello Doctor App, and a doctor will call you back within an hour.
• Check your symptoms on the App to get an idea of what's wrong.
• Get daily tips from a doctor to stay healthy.
ABBREVIATIONS CHRONIC DISEASE LISTING
Chronic medication for the following disease listing is considered as Prescribed
BHF - Board of Healthcare Funders Minimum Benefits (PMBs)*.
BMI - Body Mass Index
DSP - Designated Service Provider • Addison’s Disease • Epilepsy
NON-DSP - Service Providers that fall outside of the DSP List • ADHD • Gastro-oesophageal reflux disease
CO-PAYMENT - Payment that needs to be made to service providers that • Allergic Rhinitis • Glaucoma
are not on the DSP* list, including certain planned hospital • Asthma • Gout
procedures and services to specialists not referred • Bipolar Mood Disorder • Haemophilia
• Bronchiectasis • Hyperlipidaemia
CDL - Chronic Disease List
• Cardiac Failure • Hypothyroidism
DENIS - Dental Information Systems
• Cardiomyopathy • Incontinence
GP - General Practitioner • Chronic Renal Disease • Multiple Sclerosis
ICD10 - International Statistical Classification of Disease and • Chronic Obstructive • Osteoarthritis
Related Health Problems Pulmonary Disease • Parkinson’s Disease
PMB - Prescribed Minimum Benefits • Coronary Artery Disease • Psoriasis
PPN - Preferred Provider Negotiators • Crohn’s Disease • Rheumatoid Arthritis
SEP - Single Exit Price • Depression • Schizophrenia
THEBE BAMBINO - Thebemed’s Maternity Programme • Diabetes Insipidus • Systemic Lupus
PROGRAMME • Diabetes Mellitus Type I Erythematosus
VCT - Voluntary Counselling and Treatment • Diabetes Mellitus Type II • Ulcerative ColitisEXCLUSIONS & LIMITATIONS
The scheme will pay in full, without co-payment or use of deductibles, the diagnosis, treatment and 19. X-rays performed by anyone other than a registered Radiologist, Radiographer, Registered
care costs of the prescribed minimum benefits as per regulation 8 of the Act. Furthermore, where a Radiographer Assistant or Dentist
protocol or a formulary drug preferred by the scheme has been ineffective or would cause harm to 20. Benefits in respect of the cost of medical expenses incurred whilst overseas are subject to
a beneficiary, the scheme will fund the cost of the appropriate substitution treatment without a approval by the Board of Trustees, if approved, cover will be at the applicable South African tariff
penalty to the beneficiary, the scheme will fund the cost of the appropriate substitution treatment 21. Complications arising from procedures or / and condition which is a scheme exclusion
without a penalty to the beneficiary as required by regulation 15H and 15I of the Act. 22. Revision of scars Keloid removal except for burns and functional impairment
23. All expenses incurred due to elective Caesarean surgery are not covered by the Scheme
Expenses incurred with any of the following will not be paid by the scheme, except where included 24. Purchase or hire of medical, surgical or other appliances or devices not provided for in the rules
as Prescribed Minimum Benefits: or protocols or not scientifically proven. Including appliances to treat headaches, autopsies, back
rests and chair seats, beds and mattresses, blood pressure monitors, elctroninc tooth brushes,
1. Treatment or operations for cosmetic purposes including Blepharoplasties, Genioplasties, humidifiers, pain relieving machines (e.g. TENS and APS),
Rhinoplasties, Otoplasties, removal of tattoos, Labial frenectomies for patients over the age of 25. Erythropoeitin unless pre-authorised
8 years old, etc. 26. Gender re-alignment
2. Treatment for obesity including Liposuction, tummy tuck, Bariatric Surgery, etc. 27. Uvulopalatopharingoplasty
3. Cosmetic breast reduction and reconstruction, refractive surgery and human growth hormones 28. Hyperbaric oxygen treatment except for Prescribed Minimum Benefits
4. Treatment for infertility or artificial insermination limited to Prescribed Minimum Benefits in State 29. Organ donations to anyone other than a member or dependent of the scheme
Hospitals 30. Exclusions listed under “Dental Benefit Exclusions Summary”, available on request from Scheme
5. Holidays for recuperative purposes 31. Positron Emission Tomography (PET) scans where applicable
6. Services rendered by persons not registered with a recognised body in South Africa constituted 32. Alternative Health Practitioners (Osteopathy; Registered Counsellors; Reflexology; Phytotherapy;
in terms of any law Therapeutic massage therapy)
7. Purchase of medicines and proprietary preparations, including but limited to: 33. 3D and 4D Maternity scans
• Bandages and aids 34. MRI scans ordered by a general practitioner, unless there is no reasonable access to a specialist
• Nutritional / food supplements including patented baby foods and special formulae 35. X-rays performed by chiropractors
• Acne treatment including Roaccutane and Diane, refer to Scheme 36. Chiropractor and Podiatry benefits in hospital
• Contraceptives available from state institutions 37. Sleep therapy
• Toning and slimming products 38. Bilateral gynaecomastia
• Domestic and biochemical remedies 39. Stethoscopes and sphygmomanometers (blood pressure monitors)
• Vitamins except when prescribed for prenatal conditions, children under 12 years. 40. CT colonography (virtual colonoscopy) for screening
Including people living with HIV/AIDS and registered on the programme 41. MDCT Coronary Angiography for screening
• Aphrodisiacs 42. Epilation – treatment for hair removal
• All soaps and shampoo (medicated or otherwise) 43. Facet joint injections and percutaneous radiofrequency ablations
• Anabolic steroids 44. Organs and haemopoietic stem cell (bone marrow) donations to any person other than to a
• Contact lenses preparations member or dependent of a member on this Fund
• Medicines and preparations advertised to the public and readily available without prescription, 45. Counselling by Registered Councillors and/or Art Therapist. Subject to Prescribed Minimum
except where indicated in relevant benefit option Benefits
8. Examinations for insurance, visas, employment, school camps and similar purposes 46. Allergy screening panels and/or desensitisation
9. Services rendered during any waiting periods that are imposed on the member or any 47. Arch supports and chair seats
dependant joining the scheme 48. Beds and mattresses
10. Travel costs other than in an ambulance for emergency service to hospital only 49. Insulin pumps except for children 7 years or younger with frequent documented events of hypo
11. Appointments not kept and fees for writing prescriptions and hyperglycemia
12. Telephonic consultations including after-hours consultations / fees except in emergency situations 50. Blepharoplasties unless causing demonstrated functional visual impairment and pre-authorised
13. Non-PMB claims resulting from war, invasion, act of foreign enemy, hostilities, warlike 51. Persons attending on behalf of another registered beneficiary or main member at a registered
operations (whether war be declared or not) civil war, rebellion, revolution, insurrection, healthcare services provider
military or usurped power, wherever a member has been participating 52. Visiting a healthcare service provider with the sole purpose of obtaining a sick certificate without
14. Convalescent or recuperative homes or clinics for the aged and chronically ill including frail care any treatment received
15. Loss of libido, including Viagra and Caverject 53. Maternity Bag is not available for mothers after birth, that did not register on the Bambino
16. Acupuncture, reflexology and aromatherapy Programme
17. Ante- and Postnatal exercise, except under Prescribed minimum Benefits and Post-natal visits at 54. Biokinetics in and out of hospital, except under Health Assist benefit and protocol rule or when
registered nurse once registered on the Bambino Programme authorised under the Back treatment protocol
18. Osseo-integrated tooth implantsThebemed is Live PREFERRED SERVICE PROVIDERS
on WhatsApp.
Emergency Service for Netcare 911:
082 911 and 0860 638 2273
BENEFITS
Optical authorisation for PPN:
0861 10 35 29
CONFIRM BENEFITS CLAIMS GET PRE-AUTH
Dental authorisation for DENIS:
0860 10 49 33
SEND A CLAIM GET A DOCUMENT
COMPLAINTS
complaints@thebemed.co.za
THEBEMED TIP OFF FRAUD LINE
0861 666 996
Thebemed Medical Aid Scheme
Ground Floor, Old Trafford 4, Isle of Houghton,
Corner Boundary & Carse O’Gowrie Roads,
Houghton, Johannesburg
PO Box 4709, Johannesburg, 2000
Website: www.thebemed.co.za
Call Centre: 0861 84 32 36
Momentum Health
Meersig Building, 269 West Ave, Centurion 0163
Thebemed is administered by Momentum TYB.
General Disclaimer
This brochure is a marke�ng aid. The registered Scheme Rules will always take precedence and available on request.
Note that ThebeMed may specify certain principles rela�ng to the use of your benefits.
In terms of the Medical Schemes Act, medical schemes may apply wai�ng periods and/or late joiner penal�es to new members joining the Scheme. If we do apply a late joiner
penalty to your membership, we will let you know before we ac�vate your cover.You can also read
