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Thebemed Energy Medical Aid Plan (🇿🇦 2025*)

Overall, the Thebemed Energy Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and comprehensive cover at network hospitals for its Family Members. The Thebemed Energy Medical Aid Plan starts from R3,205 ZAR.

👤 Main Member Contribution	R3,205
👥 Adult Dependent Contribution	R3,035
🍼 Child Dependent Contribution	R535
🔁 Gap Cover	None
📉 Annual Limit	Unlimited hospital cover
🏥 Hospital Cover	Unlimited
➡️ Screening and Prevention	☑️ Yes
👶 Maternity Benefits	☑️ Yes
💙 Medical Savings Account	None

Thebemed Energy Plan – 7 Key Point Quick Overview

✅ Thebemed Energy Plan Overview
✅ Thebemed Energy Plan Contributions
✅ Thebemed Energy Plan Benefits and Cover Comprehensive Breakdown
✅ Thebemed Energy Plan Exclusions and Waiting Periods
✅ Thebemed Energy Plan vs Similar Plans from Other Medical Schemes
✅ Our Verdict on the Thebemed Energy Plan
✅ Thebemed Energy Plan Frequently Asked Questions

👉🏾 You can download the 2025 Thebemed brochure here.

Thebemed Energy Plan Overview

💙 The Thebemed Energy Medical aid plan is one of 4, starting from R3,205 and includes comprehensive cover at network hospitals, GP and Specialist Consultations, Chronic Medicine, Conservative and Specialised Dentistry, Optometry, and more.

💙 Gap Cover is unavailable on the Thebemed Energy Plan, but the scheme offers 24/7 medical emergency assistance. According to the Trust Index, Thebemed has a trust rating of 2.1.

💙 Thebemed Medical Aid offers the following plans:

Thebemed Energy Plan Contributions

🔎 Income Bracket	👤 Main Member	👥 Main Member + Spouse	💙 Main Member + One Adults + Child	💙 Additional Adult Rate
💶 N/A	R3,205	R6,240	R6,775	R3,035

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Thebemed Energy Plan Benefits and Cover Comprehensive Breakdown

Thebemed Energy Out-of-Hospital Benefits

🟥 GP Consultations	Unlimited access to any GP within the Thebemed network. Covered up to 100% of the Negotiated Tariff. If a non-DSP is used, a 25% co-payment applies.
🟧 Specialist Consultations	Subject to appropriate referral by GP. M = 5 M+2 = 6 M+3+ = 8 Limited to 5 visits/beneficiary/year 2 Additional Pediatricians consultations for children up to 1 year old without a referral
🟨 Chronic Medication	Covers up to 100% of the cost at a single exit price and regulated dispensing fee. Subject to generic and scheme formulary services offered by DSP. Other chronic (non-CDL) medicine is limited to R13,320 per family and R4,650 per beneficiary per year. CDL/PMB Chronic Disease List medicine is unlimited and paid from other chronic medicine limits.
🟩 Pharmacy Advised Therapy (PAT)	Limited to R230 per script. Subject to an overall limit of R1,110 per family per year. Covered up to 100% at cost at a single price exit price and regulated dispensing fee. Over-the-counter (OTC) medication is limited to schedule 0 – 2.
🟦 Physiotherapy	In-hospital physiotherapy is paid for up to 3 days. After that, a treatment plan and progress report is required. Out-of-hospital physiotherapy is limited to R4,070 per family per year. Covered up to 100% of the Negotiated Tariff. PMBs are subject to internal protocols.
🟪 Acute Medication	M = R5 400 M+1 = R 7 380 M+2 = R9 290 M+3+ = R11 780 Per family/year Covered up to 100% of the cost at a single exit price and regulated dispensing fee. Subject to generic and scheme formulary.
🟥 Dental hospital and anaestetics.	After Impacted Teeth • Subject to Pre-authorisation • Based on admission protocols • Extensive conservative treatment for children under the age of 5 years and Impacted teeth
🟧 Basic dentistry out of Hospital	The benefit includes the following: Oral examination – 2 consultations per beneficiary per year (once every 6 months) X-rays: Intra-Oral & Extra-Oral – Extra-oral x-ray: 1 per beneficiary in a 3-year period Extractions Scaling – 2 scaling and polishing treatments per beneficiary per year (once every 6 months). Benefit for fissure sealants: Limited to beneficiaries younger than 16 years of age Benefit for fluoride: Limited to beneficiaries from age 5 and younger than 13 years of age. Plastic Dentures : Pre-Authorisation Required. 1 set of plastic dentures (an upper and a lower) per beneficiary in a 4-year period
🟨 Specialized Dentistry	Limited to R2,500 per beneficiary and up to R5,000 per family per year. Subject to pre-approval. Orthodontic treatment: Only one family member may commence with treatment in a calendar year; Limited to individuals from age 9 and younger than 18 years of age.
🟩 Hospital Anaesthetics	This only applies to impacted teeth. Subject to pre-approval and based on admission protocols.
🟦 Radiology	IN HOSPITAL: Subject to hospitalisation Benefits OUT OF HOSPITAL: Limited to R4 060/family/year
🟪 Pathology	Unlimited cover. Paid up to 100% of the Negotiated Tariff. PMBs are subject to internal protocols.
🟥 Refraction Eye Tests	Limited to one test per beneficiary every 2 years. Covered up to 100% of the Negotiated Tariff. Managed by the PPN.
🟧 Medical and Orthopaedic Appliances	Limited to an overall R8 400/family/year. 100% Negotiated Tariff The following Appliance sub-limits are applicable: • Wheelchair: One every 3-year cycle/Beneficiary/year • Speech and Hearing Aid: One every 3-year cycle/Beneficiary/year
🟨 Optometry	1 composite consultation per beneficiary, at a network provider or R400 per beneficiary for an eye examination, at a nonnetwork provider. Single vision lenses: 100% towards the cost of lenses at network rates and R215 per lens, per beneficiary, out of network. BIFOCAL LENSES : R460 per lens, per beneficiary, out of network. MULTIFOCAL LENSES : R810 per lens, per beneficiary, out of network FRAMES : R985 per beneficiary at a network provider R788 per beneficiary at a non-network provider. CONTACT LENSES: R1935 per beneficiary
🟩 Auxiliary, Alternative Healthcare, and Physiotherapy Dieticians Occupational Therapists Physiotherapist Speech Therapists Registered Nursing Services Psychology	100% of Negotiated Tariff Based on internal protocols. Treatment Plan and Progress Report should be submitted during the hospital event to manage the clinical outcome.
🟦 MRI, PET, and CAT scans	2 MRI or CT scans/beneficiary/year (In or Out of Hospital ) 100% of Negotiated Tariff

Thebemed Energy In-Hospital Benefits

📌 Hospitalization Accommodation Neonatal Intensive Care Medical and Surgical Procedures Medication Consumables Treating Specialist Costs	Covered up to 100% of the Negotiated Tariff. Subject to internal protocols, PMBs, clinical protocols, and Tariff Negotiations. Thebemed can channel cases to the most competitive network.
📍 Diagnostic Procedures	Covered up to 100% of the Negotiated Tariff. PMB is subject to internal protocols. Subject to GP/Specialist referral.
🅰️ MRI, PET, and CAT scans	Limited to 2 MRI/CT scans per beneficiary per year in and out-of-hospital. Covered up to 100% of the Negotiated Tariff.
🅱️ Planned Hospital Procedures	Covered, at 100% Negotiated Tariff R8 000 Co-payment for these planned procedures: Spinal Surgery and Joint Replacements Subject to internal protocols.
📉 Auxiliary, Alternative Healthcare, and Physiotherapy Dieticians Occupational Therapists Physiotherapist Speech Therapists Registered Nursing Services Psychology	Covered up to 100% of the Negotiated Tariff. PMBs are subject to internal prostheses. A treatment plan and progress report must be submitted during the event to manage clinical outcomes.
📈 Take-home Medication	Seven days’ supply per beneficiary per admission.
📊 Renal Dialysis (Includes Immune-Suppressive Medication)	Covered up to 100% of the Negotiated Tariff when using a DSP. PMBs are covered and subject to internal protocols and a treatment plan.
➡️ Hospitalisation Alternatives Step-Down, Sub-acute, and Terminal Care Facilities	Unlimited cover is provided Covered up to 100% of the Negotiated Tariff. PMBs are based on internal protocols
🍼 Maternity	Normal, Caesarean & Home Delivery • 100% of Negotiated Tariff • PMB* based on internal protocols Please refer to the maternity programme on myHealth for additional benefits. • 2 Maternity Sonars • Maternity Vitamins limited to R100 per month/female beneficiary based on generic substitute and Schemes formulary
👶 Thebemed Bambino Program	Requires registration on the program and includes the following: One additional sonar. Two additional gynae visits per pregnancy. Three postnatal midwife consultations. A maternity bag received at 7 months.
💊 Drug and Alcohol Rehabilitation	Limited to 21 days per beneficiary per year. Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols. Subject to the use of a contracted private facility.
🦾 Internal and External Prostheses	Limited to an overall limit of R66,410 per family per year. Covered up to 100% of the Negotiated Tariff.
😊 Maxillo-Facial Surgery	Covered up to 100% of the Negotiated Tariff. PMBs are subject to Department of Health Protocols.
🩸 Blood Transfusions and Blood Replacement Products	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
❤️ Organ Transplants	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
↪️ Oncology	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
🧠 Mental Health Clinical Psychology	Limited to R19,160 per family per year. Covered up to 100% of the Negotiated Tariff. Payment for 3 days of Psychologist therapy sessions is required after pre-approval. Requires a treatment plan and progress report.
🏠 Home-Based Care (As an alternative to hospitalization)	Subject to clinical indication and requires pre-approval.
⚠️ Medical Rescue Ambulance Services Medical Emergency Evacuation Transport to Advisory Services	Covered up to 100% of the Negotiated Tariff at a DSP. Subject to pre-approval.

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Thebemed Health and Wellness Program

☑️ Informs members of potential health risks.
☑️ Supplies a basket of care for those diagnosed with a chronic condition.
☑️ Supports members with motivation, coaching, advice, resources, and tools to help them achieve their goals.

❤️ MyPlan2BWell	Limited to one membership per beneficiary per year for those over 18. Subject to registration online. With MyPlan2BWell, you can: Evaluate your health Choose your objective and sign up for e-coaching Customize your diet Create a fitness plan Follow your progress
🧡 Telephonic Support	Unlimited assistance. Covers trauma and short-term counseling for relationships, family, health, and lifestyle.
💛 HIV Assist	Covered up to 100% of the Negotiated Tariff. Includes pre-and post-exposure prophylaxis. Members must register on the Thebemed HIV/AIDS management program. This benefit also covers the following: Consultations Counseling Medication Pathology Testing
💚 Health Assist	Limited to a referral from a DSP GP or Specialist. Covered up to 100% of the Negotiated Tariff. A DSP pathologist must do the tests.
💙 Youth program	ThebeMed cares about the social ills such as drug and alcohol abuse, teenage pregnancies and induced abortions that impacts the youth in our communities and designed a program that will assist in moderating these challenges. 2 additional sessions for beneficiaries 12-21 beneficiary/year at registered social worker or psychologist. No referral required Limited to R1 260 per beneficiary. 100% of Negotiated Tariff. Contraceptive Benefit Subject to Oral, injectable, patch only contraceptives only Limited to Universal and Fantasy R179 per script per month or R2 150 per annum. Energy Limited to R215/ script/ month or R2 580. Pa IUD(only on Fantasy and Energy)
💜 Flu Vaccines	Limited to one per beneficiary over 12 years per year.
❤️ Blood Sugar/Glucose Test	Limited to one per beneficiary over 15 years per year.
🧡 Colon Cancer Test	Limited to one per beneficiary over 50 years per year.
💛 HIV Wellness Test	Limited to one per beneficiary per year.
💚 Bone Density Scan	Limited to one per beneficiary over 50 per year. Limited to R1,800.
💜 Dietician Consultation	Limited to two consultations for beneficiaries with a BMI of 35+ every 6 months. Limited to R1,200. Only available for beneficiaries 12 years>.
❤️ Biokinetic Consultation	Limited to one per beneficiary per year. Subject to a dietician consultation for beneficiaries with a BMI of 35+. Limited to R300. Only available for beneficiaries 12 years>.
🧡 Youth Assist	Helps young people manage conflict, drug and alcohol abuse, teenage pregnancies, and abortions. Limited to 2 free sessions per beneficiary per year with a social worker or psychologist for beneficiaries 12 to 17 years. Limited to R1,200 per beneficiary. Paid up to 100% of the Negotiated Tariff.
💛 Thebemed Mosadi	Paid up to 100% of the Negotiated Tariff. 1 Pap Smear for Females over 18 years per beneficiary per year. Mammogram for females over 40 years per beneficiary every 2 years. Part of Contraceptive benefits.
💚 Pap Smear	Limited to one per beneficiary over 18 years per year.
💙 Mammogram	Limited to one per beneficiary over 40 years every 2 years.
💜 Contraceptives	Limited to Universal and Fantasy
❤️ IUD	Available
🧡 Thebemed Monna	Paid up to 100% of the Negotiated Tariff. 1 Men’s Health Annual Consultation at DSP Nominated GP (males over 18 years). Circumcision is Limited to R1 680 per Beneficiary. 1 PSA/beneficiary/2 year for beneficiaries over 40 years 100% of Negotiated Tariff Internal protocols applicable.
💛 Men’s Health Consultation	Limited to one per beneficiary over 18 years per year.
💚 Circumcision	Limited to R1,680 per male beneficiary.
💙 PSA	Limited to one per beneficiary over 40 years every 2 years.
💜 Chronic Disease	Subject to registration in the Disease Management program. Subject to Disease Management Protocols. There is a basket of care provided.

Hello Doctor

This benefit lets you talk to a doctor on your phone, anytime, anywhere available in all official South African languages.

Thebemed Energy Chronic Disease Listing

💙 Thebemed Energy covers the following chronic conditions:

✅ Addison’s Disease
✅ ADHD
✅ Allergic Rhinitis
✅ Asthma
✅ Bipolar Mood Disorder
✅ Bronchiectasis
✅ Cardiac Failure
✅ Cardiomyopathy
✅ Chronic Renal Disease
✅ Chronic Obstructive
✅ Pulmonary Disease
✅ Coronary Artery Disease
✅ Crohn’s Disease
✅ Depression
✅ Diabetes Insipidus

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Thebemed Energy Plan Exclusions and Waiting Periods

Energy Plan Exclusions

💙 The Thebemed Energy Plan’s exclusions include, but are not limited to, the following:

☑️ Treatment or operations for cosmetic purposes such as Blepharoplasties, Genioplasties, Rhinoplasties, Otoplasties, removal of tattoos, Labial frenectomies for patients over the age of 8 years old, etc., are not covered by Thebemed.
☑️ Treatment for obesity, including Liposuction, tummy tuck, Bariatric Surgery, etc., is not covered by Thebemed.
☑️ Cosmetic breast reduction and reconstruction, refractive surgery, and human growth hormones are not covered by Thebemed.
☑️ Treatment for infertility or artificial insemination is limited to Prescribed Minimum Benefits in State Hospitals.
☑️ Thebemed does not cover holidays for recuperative purposes.
☑️ Services rendered by persons not registered with a recognized body in South Africa constituted in terms of any law are not covered by Thebemed.
☑️ Purchase of medicines and proprietary preparations such as bandages and aids, nutritional/food supplements including patented baby foods and special formulae, acne treatment including Roaccutane and Diane, toning and slimming products, domestic and biochemical remedies, vitamins except when prescribed for prenatal conditions, children under 12 years, including people living with HIV/AIDS and registered on the program, aphrodisiacs, all soaps and shampoo (medicated or otherwise), anabolic steroids, contact lenses preparations, medicines and preparations advertised to the public and readily available without prescription are not covered by Thebemed.
☑️ Examinations for insurance, visas, employment, school camps, and similar purposes are not covered by Thebemed.
☑️ Services rendered during any waiting periods imposed on the member or any dependent joining the scheme are not covered by Thebemed.
☑️ Travel costs other than in an ambulance for emergency service to the hospital only are not covered by Thebemed.
☑️ Appointments are not kept, and Thebemed does not cover fees for writing prescriptions.

Energy Plan Waiting Periods

💙 When joining a medical plan for the first time, new members may not comprehend why they must wait before they can file a claim. Waiting periods are reasonable, given that a medical scheme operates a pool of funds to cover claims for all members.

💙 Moreover, a single claim can cost tens or even hundreds of thousands of rand. Waiting periods exist primarily to prevent people from joining a medical plan only when they require expensive medical care and then quitting, which would significantly deplete the pool of funds available for all members’ needs.

💙 Therefore, a waiting period is defined during which members may not be eligible to file a claim, despite making monthly contributions. The following can be noted regarding Thebemed’s waiting periods on the Energy Plan:

☑️ Except for people who have never paid into a medical scheme before or who have had a break in membership of more than 90 days, waiting periods do not apply to life-threatening emergencies or prescribed minimum benefits (PMBs).
☑️ In some instances, a new member who joins the plan with a particular pre-existing health condition may be ineligible to file a claim for treatment related to that condition for up to a year.
☑️ If a member has belonged to a different medical plan for less than or up to 24 months, they may be subject to a condition-specific waiting period, including for pregnancy, upon joining a new plan.

💙 If the previous membership lasted longer than 24 months and there was no break of at least 90 days, a three-month general waiting period may apply. Since pregnancy is a PMB, the same rules regarding waiting periods apply.

Medical Aid Comparison : Thebemed Energy Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Thebemed Energy	🥈 Suremed Health Explorer	🥉 KeyHealth Origin
👤 Main Member Contribution	R3 205	R1,545 – R3,860	R2,451
👥 Adult Dependent Contribution	R3 035	R1,370 – R3,860	R1,746
🍼 Child Dependent Contribution	R535	R715 – R1,200	R799
➡️ Hospital Cover	Unlimited	Unlimited	Unlimited
↪️ Oncology Cover (Maximum ZAR)	Covered up to 100% of the Negotiated Tariff	Unlimited for PMBs at a Preferred Provider	Covered up to 100% of the medical scheme tariff. Covered up to R197,500 per family per year.

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Our Verdict on the Thebemed Energy Plan

💙 Thebemed Energy is a comprehensive medical aid plan offering its members a range of benefits and features. One of the key features of Thebemed Energy is its focus on preventative care.

💙 The plan offers various preventative services, such as annual health screenings, vaccinations, and wellness programs, to help members stay healthy and prevent the onset of chronic diseases. The plan also offers a range of hospitalization and chronic care management benefits. Members have access to a network of hospitals and healthcare providers and cover for in-hospital procedures and treatments.

💙 In addition, the plan also provides cover for chronic conditions, including medication and ongoing management. Another important feature of Thebemed Energy is its affordability.

💙 The plan offers a range of options to suit different budgets and healthcare needs, making it accessible to a wide range of individuals and families. However, one potential drawback of Thebemed Energy is its limited network of healthcare providers.

💙 While the plan does offer access to a network of hospitals and healthcare providers, the network may not be as extensive as other medical aid plans, which could limit members’ choices and options for healthcare.

💙 However, while the plan may have some limitations regarding its network of healthcare providers, its focus on preventative care and chronic care management makes it a valuable option for individuals and families looking for quality healthcare coverage.

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Thebemed Energy Plan Frequently Asked Questions

What is Thebemed Energy?

Thebemed Energy is a medical aid plan providing its members comprehensive healthcare coverage and benefits. It offers a range of preventative care, hospitalization, and chronic care management services and access to a network of hospitals and healthcare providers.

How do I join Thebemed Energy?

To join Thebemed Energy, you can visit their website and complete the online application form or contact their customer service center for assistance.

What healthcare services are covered under Thebemed Energy?

Thebemed Energy covers a range of healthcare services, including preventative care, hospitalization, chronic care management, medication, and more.

What is the cost of Thebemed Energy?

The cost of Thebemed Energy depends on the Main Member’s income bracket and how many dependents they have. The monthly contribution for only the main member starts from R3,205.

Does Thebemed Energy have a network of healthcare providers?

Yes, Thebemed Energy has a network of hospitals and healthcare providers that members can access for healthcare services. However, the network may be limited compared to other medical aid plans.

Can I choose my own healthcare provider with Thebemed Energy?

While Thebemed Energy has a network of healthcare providers, members can choose their own provider if they are not in the network. However, this may result in higher out-of-pocket costs for the member.

Does Thebemed Energy cover pre-existing conditions?

Yes, Thebemed Energy covers pre-existing conditions, subject to waiting periods and other terms and conditions. You can review the plan documents or contact customer service for more information.

What is the claims process for Thebemed?

To claim Thebemed, you can submit your claim online, via email, fax, or post. However, you must provide supporting documentation, such as medical invoices and receipts, to support your claim.

Can I change my cover level with Thebemed?

Yes, you may be able to change your cover level with Thebemed, depending on your circumstances and the terms of your plan.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.