Fantasy
About this plan
The Fantasy plan offers comprehensive coverage for a variety of in and out-of-hospital treatments and procedures, a generous savings account, medical and orthopedic appliances, and other benefits.
Principal Member
From
R2,545
per month
Adult Dependant
From
R2,080
per month
Child Dependant
From
R1,045
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Fantasy
Thebemed Fantasy Medical Aid Plan ( 🇿🇦 2026*)
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 for its Family Members. The Thebemed Fantasy Medical Aid Plan starts from R2,545 ZAR.| 👤 Main Member Contribution | R2,545 |
| 👥 Adult Dependent Contribution | R2,080 |
| 🍼 Child Dependent Contribution | R1,045 |
| 🔁 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 R2,545 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 Energy Medical Aid Plan
- ✅ Thebemed Fantasy Medical Aid Plan
- ✅ Thebemed Universal Medical Aid Plan
- ✅ Thebemed Universal EDO Medical Aid Plan
Thebemed Fantasy Plan Contributions and Medical Savings Account
Fantasy Plan Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R2,545 | R2,080 | R1,045 |
Fantasy Plan Medical Savings Account
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R255 per month | R210 per month | R105 per month |
| R2,290 per year | R1,870 per year | R940 per year |
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. After the 10th visit pre-authorisation is required. Member to choose and consult two DSP GP as primary provider /beneficiary. Based on internal protocols. 2 Out of Area Visits per beneficiary per year Non-emergency services obtained from a Non-DSP Network provider is subject to Savings |
| 📍 Emergency Visits | Covered up to 100% of the Negotiated Tariff. Cover for trauma and emergencies only. Savings cover other events. |
| 🅰️ Acute Medication | Limited to and R6,380 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 R220 per script. R1320 is paid from the savings benefit. After that, R535 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. 1 Additional Paediatrician consultations for children up to 1 year old without a referral |
| 🟧 Chronic Medication | 100% of Cost at Single Exit Price & Regulated Dispensing Fee. Subject to Generic & Scheme Formulary Services provided by DSP* OTHER CHRONIC (NON-CDL) MEDICINE Limited to R12 760 per family and R4 650 per beneficiary per year CDL/PMB CHRONIC DISEASE LIST MEDICINE UNLIMITED Payable first from Other Chronic Medicine. |
| 🟨 Medical and Orthopaedic Appliances | Limited to an overall R7 090 per family per 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 | Eye Tests, Spectacles or contact lenses are available once every 2 years (based on the date of your previous claim) Benefits are subject to clinical protocols. Frames (up to R910 Network and non network R728 per beneficiary ) per beneficiary per 2 years. Single, bifocal and Multifocal lenses are covered up to 100% of the Negotiated rate when using a DSP and R215 for single lenses out of network and R460 for Bifocal and Multifocal lenses out of network. Contact lenses are limited to R1,450 every 2 years. Contact lenses are not covered if frames are obtained and vice versa. |
| 🟦 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 425 per family per year Subject to Savings PMB* Based on internal protocols |
| 🦷 Dentistry | - |
| ➡️ Conservative or Basic 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 R2,600 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. 7 days’ supply per beneficiary/ per hospital stay on take home medication. |
| 🍼 Maternity | • Normal, Caesarean & Home Delivery • 100% of Negotiated Tariff • PMB* based on internal protocols Please refer to the maternity program on myHealth for additional benefits. |
| 📉 Diagnostic Procedures | Covered up to 100% of the Negotiated Tariff. PMB is subject to internal protocols. Subject to GP/Specialist referral. Allergy tests |
| 📈 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, at 100% Negotiated Tariff Subject to internal protocols. R8 000 Co-payment for these planned procedures: • 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 R58,155 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. |
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 R1,260 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 R179 per scrip per month or R2 150 per annum |
| ❤️ 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 R1,760 per male beneficiary. |
| 💚 PSA | Limited to one per beneficiary over 40 years every 2 years. |
| 💙 Chronic Disease | Subject to registration on the Disease Management program. Subject to Disease Management Protocols. There is a basket of care provided. |
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
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.
👉🏾 Read: 5 Best Gap Cover Options for Under R1500
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.
Thebemed Fantasy Plan vs Similar Plans from Other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Thebemed Fantasy (2026) | 🥈 Sizwe Hosmed Copper Medical aid plan (2026) | 🥉 CompCare SelfCare (2026) |
| 👤 Main Member Contribution | R2,545 | R3,625 | R2,566 |
| 👥 Adult Dependent Contribution | R2,080 | R3,625 | R2,566 |
| 🍼 Child Dependent Contribution | R1 045 | R1,255 | R898 |
| 📉 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.
💙It 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.
You might also like the following plans of Thebemed Medical Aid:
- Thebemed Energy Medical Aid Plan
- Thebemed Universal Medical Aid Plan
- Thebemed Universal EDO Medical Aid Plan
