Genesis Medical Scheme And Insurance

By | January 22, 2019

Genesis Medical Scheme And Insurance Benefit Overview

Whether you are looking for a hospital plan or a comprehensive medical aid plan, our range of options will cater for your unique needs at the best possible value for money.

All our plans provide cover for hospitalisation and related accounts at any private hospital in South Africa*, as well as additional medical aid benefits at very competitive and affordable rates. In particular, families with children benefit from our low cost child contributions.

Terms and conditions apply as set out in the Scheme Rules.

No matter which hospital plan or full cover medical aid benefit option you select, you will enjoy comprehensive cover together with the following unique and incredible benefits:

Hospitalisation and related accounts

Hospital and related accounts (e.g. theatre costs, x-rays, pathology, physiotherapy, blood transfusion, medicines, etc.) will be covered at 100% of Medical Aid Rates for a general ward or intensive and high care wards of a private or provincial hospital, day clinic or the recovery room charges of an unattached operating theatre.*

Whilst in hospital, the Scheme will reimburse general practitioners and specialists at cost up to 100% of Medical Aid Rate on the Private Choice option.

On the Private, Private Plus and Private Comprehensive options, general practitioners and specialists will be reimbursed at cost up to 200% of Medical Aid Rate.


Basic dentistry benefits

All Genesis members enjoy cover for basic, as well as some enhanced dentistry benefits. This unique benefit includes the following services when obtained from a registered Dental Practitioner:

  • Three (3) dental oral examinations
  • Six (6) fillings
  • Unlimited extractions
  • Six (6) plain x-rays for conservative dentistry
  • Two (2) root canal treatments
  • Crowns, dentures or bridges limited to the lower of cost or Medical Aid Rate, further limited to R3 700
  • Surgical removal of impacted wisdom teeth

Flexibility and Freedom of Choice

All Genesis members have the luxury to choose their preferred hospital,  doctor or medical specialist*, along with a choice of funding model.  Members are neither forced to seek treatment in network hospitals, nor are they forced to make use of network medical practitioners.

Emergency medical evacuation

Genesis members have access to the ER24 Emergency Contact Centre for the management of any medical emergency, such as emergency pre-hospital treatment, evacuation and transport (including inter-hospital transfers) within the Republic of South Africa, when using ER24, as well as a 24/7 medical helpline service for medical related enquiries.(*)  Statutory prescribed minimum benefits (PMBs) in private hospitals are covered as per the Scheme Rules; in public or state hospitals, benefits are covered as prescribed by law.

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