Medical Aid for Those Who Can’t Afford Medical Aid

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Even if you think that you cannot afford medical aid, you might just be surprised to find out that you could find good medical cover that you can afford with Thebe Med Medical Aid Scheme.

ThebeMed is a unique medical aid scheme providing affordable, quality healthcare to members earning between R 2,000 and R 6,000 per month.

Once you earn more than R5 000 the options are not so “affordable” anymore as all the options are income-based.

ThebeMed provides a variety of benefit options and a selection of service providers suited to meet the specific needs of their individual members.

  • Comprehensive private hospital cover
  • Extensive out of hospital benefits
  • Affordable premiums

Simple Approach of ThebeMed Medical Aid Scheme

The scheme has adopted an approach that will enable the fund to be simple and easy-to-use when medically necessary. 

On both the Energy and Universal options, there is extensive day-to-day medical cover, and to streamline the whole process, the General Practitioner (GP) is the Key Role Player. 

The GP is seen as the gatekeeper and must determine whether further treatment is needed. Referalls to specialists and radiologists must be made by your GP, otherwise the costs will not be paid in full. 

[tip title=”moneysmart tip”]When in doubt, always go back to your GP.[/tip] 

The Plans

There are 2 plans, namely the Energy Plan and the Universal Plan.

Both are very similar, providing private hospital cover as well as comprehensive day-to-day medical benefits through a network of providers.

On the Universal plan, the benefits are a little bit more restrictive and limited than on the Energy Plan.

With the Universal Plan, you don’t have any choice in the DSP (Designated Service Provider), but on the Energy plan members will be able to select a network option that will best suit their needs in terms of choice of provider and affordability.

You can choose between paying more (and having more choice in terms of the number of doctors you may visit) or paying less and staying with one doctor.

The member’s contribution would be charged according to Network selection.

  • Core Members are only allowed to consult 1 Primary Care Provider in the Core Network. Failing to do so will result in no payment.
  • Medium Members have a choice of up to 3 Primary Care Providers in the Medium Network. Failing to do so will result in a 25% co-payment.
  • Open Members are allowed to consult any Primary Care Provider in or out of the Network. 

Unique Benefits of ThebeMed Medical Aid Scheme

Some of the unique benefits offered by ThebeMed Medical Aid Scheme are listed below:

Member Support Services

A programme has been developed to help members improve their state of health, develop coping skills and for members to accept responsibility for their own wellness.

Some of the benefits include :

  • Confidential counselling advice line
  • Short-term counselling
  • Marital and relationship difficulties
  • Personal and work related stress 

Maternity Benefits/BAMBINO Programme

This programme includes the following:

  • 2 antenatal visits (Universal)
  • 2 sonars (Universal) OR 3 sonars (Energy)  
  • Maternity hamper

Home Delivery

  • By a registered midwife
  • Limited to R6 000 per pregnancy 

The Premiums

Please note: All benefits will be pro-rated for members admitted during the benefit year. All costs payable at 100% of negotiated rates.

UNIVERSAL PLAN

COMBINED
INCOME
MAIN
MEMBER
ADULT
DEPENDENT
CHILD DEPENDENT
0 – 2500 R578 R514 R287
2501 – 5000 R605 R537 R300
5001 – 7500 R717 R616 R336
7501 + R1008 R952 R392

ENERGY PLAN

INCOME
GROUP

NETWORK

CORE

MEDIUM

OPEN

SINGLE M+1* SINGLE M+1* SINGLE M+1*
0 – 4000 R945 R1638 R1181 R2048 R1330 R2305
4001 – 7500 R1464 R2094 R1626 R2326 R1912 R2733
7501 – 10k R2310 R3118 R2497 R3371 R2996 R4045
10 001
+
R2587 R3358 R2722 R3533 R3403 R4417

* M+1 refers to principal member plus 1 dependent 

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For more information visit http://www.thebemed.co.za/ or call them on 0861 84 32 36.

For any medical aid queries or advice, please feel free to contact Nelda at nelda@medicalbenefits.co.za or call (021) 975-8324.

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About Author

Nelda Celliers is a medical aid advisor based in Cape Town. She has a Higher Certificate in Insurance through the Insurance Institute of South Africa. Nelda obtained her licenses from the Financial Services Board and Council for Medical Schemes to operate her own medical aid practice, Medical Benefit Advisors.