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Thebemed Universal EDO Medical Aid Plan

Overall, the Thebemed Universal EDO Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to up to 3 Family Members. The Thebemed Universal EDO Medical Aid Plan starts from R574 ZAR.

🔎 Medical Aid Plan	🥇 Thebemed Universal EDO
👤 Main Member Contribution	R574 – R1,808
👥 Adult Dependent Contribution	R574 – R1,553
🍼 Child Dependent Contribution	R574 – R848
🏥 Hospital Cover	Unlimited
📉 Annual Limit	Unlimited hospital cover
📈 Prescribed Minimum Benefits	✅ Yes
📊 Screening and Prevention	✅ Yes
💚 Chronic Conditions	✅ Yes
🤓 Optometry Benefit	None

Thebemed Universal EDO Plan – 7 Key Point Quick Overview

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

Thebemed Universal EDO Plan Overview

The Thebemed Universal EDO medical aid plan is one of 4, starting from R574. Universal Efficiency Discount Option (EDO) is designed for members who need affordable healthcare while using restricted hospital and doctor networks for medical procedures and treatment. Gap Cover is unavailable on the Thebemed Universal EDO 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 Universal EDO Plan Contributions

💴 Income Bracket	👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
💵 R0 – R500	R574	R574	R574
💶 R501 – R2,500	R1,420	R1,262	R706
💷 R2,501 – R7,500	R1,578	R1,403	R784
💴 R7,501>	R1,808	R1,553	R848

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Thebemed Universal EDO Plan Benefits and Cover Comprehensive Breakdown

Thebemed Universal EDO In-Hospital Benefits

🧠 Mental Health / Clinical Psychology	Only covers PMB conditions. Covered up to 100% of the Negotiated Tariff. Payment for 3 days of Psychologist therapy sessions is required after pre-approval. Appropriate referral by a DSP GP or specialist is required. Pre-approval is required for in and out-of-hospital cover. Requires a treatment plan and progress report.
➡️ 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
🦾 Internal and External Prostheses	Limited to an overall limit of R52,300 per family per year. Covered up to 100% of the Negotiated Tariff. Subject to PMB conditions only and based on internal protocols.
🏡 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.
🥰 Maxillo-Facial Surgery	Covered up to 100% of the Negotiated Tariff. PMBs are subject to Department of Health Protocols.

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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 R166 per scrip per month.
🟥 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 Universal EDO Chronic Disease Listing

Thebemed Universal EDO covers the following chronic conditions:

✅ Addison’s Disease
✅ ADHD
✅ Allergic Rhinitis
✅ Asthma
✅ Bipolar Mood Disorder
✅ Bronchiectasis
✅ Cardiac Failure
✅ Cardiomyopathy
✅ Chronic Renal Disease
✅ Chronic Obstructive

and many more.

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Thebemed Universal EDO Plan Exclusions and Waiting Periods

Universal EDO Plan Exclusions

The Thebemed Universal EDO 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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Universal EDO 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 Universal EDO 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 Universal EDO Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Thebemed Universal EDO	🥈 Fedhealth FlexiFED 1 (Elect)	🥉 KeyCare Start Regional
👤 Main Member Contribution	R574 – R1,808	R1,716	R1,239 – R3,247
👥 Adult Dependent Contribution	R574 – R1,553	R1,341	R1,239 – R3,247
🍼 Child Dependent Contribution	R574 – R848	R625	R755 – R883
🏥 Hospital Cover	Unlimited	Unlimited	Network Hospital in the member’s region only – Unlimited
📉 Annual Limit	Unlimited hospital cover	Unlimited Hospital Cover	Unlimited Hospital Cover
📈 Prescribed Minimum Benefits	✅ Yes	✅ Yes	✅ Yes
📊 Screening and Prevention	✅ Yes	✅ Yes	✅ Yes
💚 Chronic Conditions	✅ Yes	✅ Yes	✅ Yes
🤓 Optometry Benefit	None	None	✅ Yes

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Our Verdict on the Thebemed Universal EDO Plan

In conclusion, the Universal Efficiency-discounted option (EDO) is a cost-saving sub-option of the Universal plan that restricts members’ choice of hospitals and doctors in return for lower contributions. While the EDO option has a more limited network than the main Universal plan, it offers benefits such as 100% cover of negotiated tariffs for psychiatric treatment, medical rescue, maxillofacial surgery, and internal and external prostheses. However, the EDO plan is subject to pre-authorization for in and out-of-hospital treatment, treatment plan submission, and progress reports. Additionally, the EDO plan charges a maximum of two children per family and an overall cap of R52,300 for prostheses.

Furthermore, costs are payable at 100% of the negotiated tariff. Overall, the Universal EDO plan is suitable for individuals and small families who do not require comprehensive or extensive healthcare.

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Thebemed Universal EDO Plan Frequently Asked Questions

What is the Thebemed Universal EDO plan?

The Thebemed Universal EDO plan is a sub-option of the Universal plan that offers cost-saving benefits in return for a restricted network of hospitals and doctors.

How does the Universal EDO plan save costs?

Members of the Universal EDO plan agree to limit their choice of providers in a restricted network in return for lower contributions relative to the main Universal plan.

What is the difference between the Universal plan and the Universal EDO plan?

The main difference is that the Universal plan has a broader network with a national footprint compared to the Universal EDO plan.

What benefits are included in the Universal EDO plan?

The Universal EDO plan covers psychiatric treatment, medical rescue, maxillofacial surgery, and internal and external prostheses subject to pre-authorization for in and out-of-hospital treatment.

What is the cover for psychiatric treatment under the Universal EDO plan?

The Universal EDO plan offers 100% coverage of negotiated tariffs for psychiatric treatment, including clinical psychology.

Is there a limit to the number of children covered under the Universal EDO plan?

Yes, the Universal EDO plan charges a maximum of two children per family.

Is there a limit to the amount of coverage for prostheses under the Universal EDO plan?

Yes, the Universal EDO plan is limited to an overall R52,300 per family per year for internal and external prostheses subject to PMB conditions only.

What happens if a member is admitted during the benefit year?

All benefits are pro-rated for members admitted during the benefit year, and costs are payable at 100% of the negotiated tariff.

Is home-based care covered under the Universal EDO plan?

Yes, the Universal 2023 home-based care option is available instead of hospitalization, subject to clinical indication and pre-authorization.

What is pre-authorization, and how does it work under the Universal EDO plan?

Pre-authorization is when a member obtains approval from Thebemed before receiving medical treatment. Under the Universal EDO plan, pre-authorization is required for in and out-of-hospital treatment, treatment plan submission, and progress reports.

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.