medical scheme
Mastering your medical scheme’s self-payment rules
If you rarely access your above-threshold benefits, you may be overinsured and may be able to find better value on a different option
Members signing up for top-of-the-range medical scheme options often mistakenly believe that all their claims, bar those of a stated rand amount in the “self-payment gap”, will be covered. But you may find the self-payment gap is higher than the amount you expect to pay because of health-care choices you make and the fine print in the rules of the scheme. And even once you have breached the self-payment gap and think you are in the clear with your claims, you may find the same rules apply to your above-threshold benefit, resulting in you having to dig into your pocket again.
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