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Thebemed Fantasy Medical Aid Plan

Overall, the Thebemed Fantasy Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and comprehensive cover for a range of treatments to up to 3 Family Members. The Thebemed Fantasy Medical Aid Plan starts from R2,147 ZAR.

👤 Main Member Contribution	R2,147
👥 Adult Dependent Contribution	R1,757
🍼 Child Dependent Contribution	R884
🔁 Gap Cover	None
📉 Annual Limit	Unlimited hospital cover
🏥 Hospital Cover	Unlimited
💙 Screening and Prevention	✅ Yes
💶 Medical Savings Account	✅ Yes
👶 Maternity Benefits	✅ Yes
🏡 Home Care	✅ Yes

Thebemed Fantasy Plan – 6 Key Point Quick Overview

✅ Thebemed Fantasy Plan Overview
✅ Thebemed Fantasy Plan Contributions and Medical Savings Account
✅ Thebemed Fantasy Plan Exclusions and Waiting Periods
✅ Thebemed Fantasy Plan vs Similar Plans from Other Medical Schemes
✅ Our Verdict on the Thebemed Fantasy Plan
✅ Thebemed Fantasy Plan Frequently Asked Questions

Thebemed Fantasy Plan Overview

The Thebemed Fantasy medical aid plan is one of 4, starting from R2,147 and includes comprehensive cover for a range of treatments and procedures in and out-of-hospital, a generous savings account, medical and orthopedic appliances, and more. Gap Cover is unavailable on the Thebemed Fantasy 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 Fantasy Plan Contributions and Medical Savings Account

Fantasy Plan Contributions

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R2,147	R1,757	R884

Fantasy Plan Medical Savings Account

👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
R215 per month	R176 per month	R88 per month
R2,580 per year	R2,112 per year	R1,056 per year

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Thebemed Fantasy Plan Benefits and Cover Comprehensive Breakdown

Thebemed Fantasy Out-of-Hospital Benefits

📌 GP Consultations	The unlimited coverage is provided, but it is managed. Covered up to 100% of the Negotiated Tariff when using a DSP. If a non-DSP is used, a 25% co-payment applies. After the 10th visit, pre-authorization is required. Each beneficiary can nominate two GPs as primary providers. Limited to one out-of-area emergency visit per year. Non-emergency services obtained from non-DSP Networks are paid from the savings account.
📍 Emergency Visits	Covered up to 100% of the Negotiated Tariff. Cover for trauma and emergencies only. Savings cover other events.
🅰️ Acute Medication	Limited to R2,114 per beneficiary per year and R5,814 per family. Covered up to 100% of the Negotiated Tariff at a DSP according to the generic substitute and regulated dispensing fee.
🅱️ Pharmacy Advised Therapy (PAT)	Limited to R193 per script. R850 is paid from the savings benefit. After that, R464 is subject to Risk. Covered up to 100% at cost at a single price exit price and regulated dispensing fee.
🟥 Specialist Consultations	Limited to 5 visits per family per year. Subject to referral by a GP.
🟧 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 R12,156 per family and R4,228 per beneficiary per year. CDL/PMB Chronic Disease List medicine is unlimited and paid from other chronic medicine limits.
🟨 Medical and Orthopaedic Appliances	Combined benefits for in and out-of-hospital. Limited to R6,750 per family per year. Covered up to 100% of the Negotiated Tariff. Subject to pre-approval and GP/Specialist referral. PMBs are based on internal protocols. The following sub-limits will apply: Wheelchairs – One per beneficiary every 3 years. Speech and Hearing Aids – One per beneficiary every 3 years.
🟩 Optometry	Limited to one pair of frames (up to R750) per beneficiary per 2 years. Single and bifocal lenses are covered up to 100% of the Negotiated rate when using a DSP. Contact lenses are limited to R1,230 every 2 years. Contact lenses are not covered if frames are obtained and vice versa.
🟦 Refraction Eye Tests	Limited to one test per beneficiary every 2 years. Covered up to 100% of the Negotiated Tariff. Managed by the PPN.
🟪 Diagnostic Procedures	Covered up to 100% of the Negotiated Tariff at a DSP. PMB is subject to internal protocols. Subject to GP/Specialist referral.
🍎 Auxiliary, Alternative Healthcare, and Physiotherapy Dieticians Occupational Therapists Physiotherapist Speech Therapists Registered Nursing Services Psychology	Limited to R1,050 per family per year collectively. Subject to available funds in the savings account. Covered up to 100% of the Negotiated Tariff. PMBs are subject to internal prostheses.
🦷 Dentistry	–
➡️ Conservative Dentistry	Subject to pre-approval. Covered up to 100% of the Thebemed Dental Rate. Subject to DENIS clinical protocols. The benefit includes the following: Consultations Fillings Extractions Scaling Polishing X-rays
↪️ Specialized Dentistry	Limited to R2,500 per beneficiary and up to R5,000 per family per year. Only covers crowns and orthodontics. Subject to available funds in the savings. Covered up to 100% of the Thebemed Dental Rates. Subject to DENIS clinical protocols.

Thebemed Fantasy In-Hospital Benefits

🏥 Hospitalization Accommodation Neonatal Intensive Care Medical and Surgical Procedures Medication Consumables Treating Specialist Costs	Unlimited cover provided. 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.
🍼 Maternity	The unlimited cover is provided. Covers normal, cesarean, and home delivery. Home delivery must be by a registered midwife. PMBs are covered according to internal protocols. Limited to 2 Maternity Scans. Maternity vitamins are limited to R100 monthly for 9 months, based on generic substitute and scheme 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.
📉 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. PMBs are subject to internal protocols.
📊 Oncology	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
🅰️ Planned Hospital Procedures	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols. An R1,000 co-payment applies to the removal of skin lesions. An R1,500 co-payment applies to the following procedures: Tonsillectomy Adenoidectomy Vasectomy Functional Endoscopic Sinus Surgery An R3,500 co-payment applies to the following procedures: Back and Neck Pain without any neurological symptoms Arthroscopy Colonoscopy Gastroscopy Hysterectomy Laparoscopy Nissen Fundoplication (Reflux Surgery) An R8,000 co-payment applies to Spinal Surgery and Joint Replacements.
🅱️ 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 to manage clinical outcomes during the event.
🟥 Internal and External Prostheses	Limited to an overall limit of R50,000 per family per year. Covered up to 100% of the Negotiated Tariff.
🩸 Blood Transfusions and Blood Replacement Products	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
🩺 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.
🥰 Maxillo-Facial Surgery	Covered up to 100% of the Negotiated Tariff. PMBs are subject to Department of Health Protocols.
❤️ Organ Transplants	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
➡️ 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
↪️ 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 use of a contracted private facility.
🧠 Mental Health Clinical Psychology	Only PMBs are covered. 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.
💙 Health Risk Assessment	Limited to one per beneficiary over 18 years per year.
💜 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.
🔵 Dental Check-up	Limited to one per beneficiary per year.
🟣 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. All benefits are payable at a DSP.
🟩 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	This only applies to oral, injectables, or patches. Limited to R199 per scrip per month or R2,388 per year.
❤️ IUD	Available
🧡 Thebemed Monna	Paid up to 100% of the Negotiated Tariff. Internal protocols will apply.
💛 Men’s Health Consultation	Limited to one per beneficiary over 18 years per year.
💚 Circumcision	Limited to R1,438 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.
❤️ Free Airtime	Members who sign up with Thebemed can be eligible for a free SIM card, providing easy communication with consultants. Members receive R55 airtime monthly with this benefit.

Thebemed Fantasy Chronic Disease Listing

Thebemed Fantasy 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

and many more.

Thebemed Fantasy Plan Exclusions and Waiting Periods

Fantasy Plan Exclusions

The Thebemed Fantasy 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.

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Fantasy 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 Fantasy 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.

Thebemed Fantasy Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Thebemed Fantasy	🥈 Sizwe Hosmed Silver Hospital	🥉 CompCare SELFNET
👤 Main Member Contribution	R2,147		R2,291
👥 Adult Dependent Contribution	R1,757		R2,291
🍼 Child Dependent Contribution	R884		R810
📉 Annual Limit	Unlimited hospital cover	Unlimited Hospital Cover	Unlimited
➡️ Hospital Cover	Unlimited	Unlimited for PMBs	Unlimited

Our Verdict on the Thebemed Fantasy Plan

The Thebemed Fantasy medical aid plan is a comprehensive healthcare plan that provides members with a wide range of benefits and features to help them manage their healthcare needs. The plan is designed to provide members access to quality healthcare services, including hospitalization, chronic medication, and day-to-day medical expenses. One of the key features of the Thebemed Fantasy medical aid plan is that it provides comprehensive hospitalization benefits. Members are covered for in-hospital treatment, surgery, medication, and specialized treatments such as organ transplants and dialysis.

This benefit provides members with peace of mind knowing that they have access to quality medical care should they need it. In addition to hospitalization benefits, the Thebemed Fantasy medical aid plan also provides members with chronic medication benefits. This benefit covers the cost of medication for chronic conditions such as diabetes, hypertension, and asthma. Another feature of the Thebemed Fantasy medical aid plan is that it covers day-to-day medical expenses. This includes visits to general practitioners and specialists and prescribed medication and pathology tests.

While the Thebemed Fantasy medical aid plan offers comprehensive benefits, some drawbacks exist. The first is that the plan may be expensive for some members, particularly those on a tight budget.

The plan’s comprehensive benefits may be attractive, but the cost may be prohibitive for some individuals and families.

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Thebemed Fantasy Plan Frequently Asked Questions

What is the Thebemed Fantasy medical aid plan?

Thebemed Fantasy is a comprehensive medical aid plan that is suitable for individuals and couples with healthy lifestyles. The plan has unlimited private hospital coverage and includes a generous Medical Savings Account (MSA).

What benefits does the Thebemed Fantasy plan provide?

The Thebemed Fantasy plan provides members with hospitalization benefits, chronic medication coverage, and day-to-day medical expense coverage.

Does the Thebemed Fantasy plan cover organ transplants?

Yes, the plan covers organ transplants up to 100% of the Negotiated Tariff. However, PMBs are based on the protocols from the Department of Health.

Does the Thebemed Fantasy plan cover dialysis?

Yes, the plan covers dialysis up to 100% of the Negotiated Tariff. However, only PMBs are covered under this benefit.

Is the Thebemed Fantasy plan affordable?

Yes, Thebemed Fantasy is affordable and starts from R2,174 for the Main Member, R1,757 per adult, and R884 per child dependent.

Can families enroll in the Thebemed Fantasy plan?

Yes, the plan is available for individuals and families, especially those with active and healthy lifestyles who do not require extensive medical coverage.

What is the waiting period for the Thebemed Fantasy plan?

The waiting period ranges from three to twelve months.

How can I find healthcare providers who accept Thebemed Fantasy plan?

You can consult the Thebemed website for a list of providers or view your membership documents.

How do I file a claim with the Thebemed Fantasy plan?

To file a claim, you can complete the necessary form that can be downloaded from the Thebemed website, provide the necessary documents, and submit it to the scheme.

Can I change my coverage under the Thebemed Fantasy Plan?

Yes, you can change your coverage under the plan. However, some terms and conditions apply, and you might be subject to waiting periods and limitations.

Does the Thebemed Fantasy plan have any limitations on coverage?

There are some limitations on the cover depending on the procedure and treatment required, scheme protocols, and other conditions.

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.