You always have cover for basic medical care

As a member of Remedi Medical Aid Scheme, you always have a basic level of cover, even if you've used up your day-to-day benefits. This is because the Medical Schemes Act states all medical schemes must pay for specific tests and treatment for all conditions on a specific list, no matter what benefit option you're on. We call the conditions and their treatment Prescribed Minimum Benefits (PMBs).

We do not use your day-to-day benefits to pay for Prescribed Minimum Benefits, but there are conditions and limits to cover.

Prescribed Minimum Benefit (PMB) conditions

The Prescribed Minimum Benefits cover basic healthcare members need for:

• Any emergency medical condition (that needs to be treated at once)
• A defined set of 270 conditions
• 26 chronic conditions.

You don't have to be admitted to hospital for your condition to be an emergency. An emergency medical condition is the sudden and unexpected start of a health problem that needs to be treated at once to make sure you don't have permanent damage or to save your life. It is an emergency if not getting treated at once could lead to weakened bodily functions, serious and lasting damage, or even death.

Three conditions for cover

Just because your condition is on the list of Prescribed Minimum Benefits doesn't mean that we cover all the treatment you get for it as a Prescribed Minimum Benefit. For us to pay the full cost of your treatment without you having to pay in, you must meet three conditions.

You must:

1. Be diagnosed with a listed condition

Your condition must be on the general list of Prescribed Minimum Benefits or the Prescribed Minimum Benefit Chronic Disease List if it is a lasting condition. If you have a chronic condition, you must register for the Chronic Illness Benefit for us to pay for your condition as a Prescribed Minimum Benefit. Otherwise, we use your normal day-to-day benefits to pay for treatment.

2. Follow the treatment in the Prescribed Minimum Benefit guidelines

We only pay for specific tests, medicine and other treatment as Prescribed Minimum Benefits. There are also limits to how often we pay for tests and treatment. If you have a condition on the list of Prescribed Minimum Benefits and you and your doctor don't use the basic treatment for it, we cover the treatment from your available benefits.

If you need medicine for your Prescribed Minimum Benefit condition, ask your doctor to prescribe medicine on our list.

3. Use designated service providers, unless you have an emergency medical condition

In a medical emergency where you need to be treated at once, go straight to the nearest hospital. Otherwise, you have to use Remedi's designated service providers. They are healthcare providers (for example, a doctor, pharmacist or hospital) we have an agreement with to treat Prescribed Minimum Benefit conditions. We don't choose the cheapest doctors to be designated service providers. To take care of our members, designated service providers must meet our quality standards so you are guaranteed quality care.