Genesis Medical Aid

Genesis has been serving the niche private healthcare market since 1995. It is arguably one of the most successful medical aid schemes in its class. In this market affordability, value for money, and financial stability go together.

Tailored plans for targeted markets

Providing access to private health care for those who want it is just what they do. Giving their members the luxury of choosing the doctor they want at the hospital of their choice. This is all part of the preferential offerings to their clients.

This means that their clients are not restricted to a network system of medical service providers or practitioners. They can literally choose whichever hospital and doctor they want.

Additionally, their clients have 24-hour access to emergency care and if they land up in a hospital, they don’t want to be in they have the choice of being transferred to the hospital of their choice.

They provide a suite of three plans to choose from. Each plan is tailored to a specific targeted market. Unlike many other medical aid schemes that offer specialist care such as dentistry as an added extra for which you would need to pay an additional fee, Genesis includes this even in the basic plan. They do have value add-ons for an additional fee, and these are available on each of their packages.

Comprehensive coverage

The list of benefits covered by their in-hospital options is also quite extensive in each of the three plans. Similarly, the auxiliary services, chronic services, and any care required when a patient leaves the hospital.

These are all covered by the scheme which ultimately provides a comprehensive list of service offerings under each plan.

Treatment and stays in the hospital will be paid in full for all prescribed minimum benefits if there is an existing pricing agreement with that hospital. Reimbursement for these treatments in a private hospital will be done at between 100-200% of the scheme price allocation.

Understanding exclusions

Genesis medical aid's list of treatment options and services that are excluded. Each plan also has a list of treatment options and services that are excluded, and it is prudent to ensure that you are familiar with these. This list is available on their website.

Each plan has a comprehensive brochure that is downloadable and packed with useful information for its members.

The brochure also indicates who that plan is most ideal for. This is very helpful for members who may need very specific requirements based on a unique set of circumstances.

The brochure provides detailed information about specialist medical requirements and whether these are covered under a specific plan.

There is an amount indicated against each condition or service offering which gives their clients a sense of costs for specific diagnostic treatments including any imaging requirements that may be required.

All your benefits in one place

Each plan covers a range of benefits for your stay in the hospital, any care you may require once you are discharged from the hospital, and any rehabilitation that may be prescribed to ensure a full recovery.

These plans also cover cosmetic surgery which can be elective and not because of or even related to an existing medical condition. Other specialist treatments of cancers and transplants are subject to additional restrictions depending on the plan.

There are benefits available for palliative care medical mobility aids and specifically defined assessments which may include additional medical care by a medical service provider.

Some plans have an additional benefit that allows clients to self-manage certain benefits and these are prescribed with percentage/weighted limitations allocated. These are all non-hospitalization benefits.

All the benefits allocated are for one benefit cycle/year. Benefits are prorated if a client joins the scheme once a benefit year has already commenced.

What you need to know about claims

Not all claims are covered in full. If the treatment you receive exceeds the scheme’s allowable price range, you will need to cover the difference.

It’s therefore important to ensure that the service provider you choose charges within the rates of the scheme. The alternative is that you can receive the treatment you want from a state facility and still use your medical aid and get the full cost of the treatment paid for.