This is for all those people currently on medical schemes and enjoying out-of-hospital benefits. It’s important to educate yourself on this stuff, because more often than not, you may find yourself having to pay for scans and checkups out of your own pocket. The costs of your treatment in a medical emergency should be covered  by your medical scheme, but the often high costs of diagnosing your condition in an emergency situation won’t be covered.

All medical schemes in South Africa are obligated, in terms of regulations under the Medical Schemes Act to cover all medical emergencies because they fall under the prescribed minimum benefits (PMB).

However things tend to get a bit muddled, when scheme members who have been in a medical emergencies that turn out to be something less serious discover the hard way that schemes may not cover the costs. Instead the costs are deducted from medical savings and out of pocket – because your condition was less threatening than was feared. That’s normally good news, right?

This becomes a serious issue. Many diagnostic tools, such as a CT scan for example, can cost up to R7,000. Should a patient be rushed to a CT scan in the case of an emergency, only for the results to show that the condition was not in fact an emergency, medical schemes are not liable to cover the costs from the risk benefits.

So, you know. Be advised.

[Source: IOL ]