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Thebemed Universal Medical Aid Plan

Overall, the Thebemed Universal Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and preventative care to up to 3 Family Members. The Thebemed Universal Medical Aid Plan starts from R692 ZAR.

🔎 Medical Aid Plan	🥇 Thebemed Universal
👤 Main Member Contribution	R692 – R2,661
👥 Adult Dependent Contribution	R692 – R2,509
🍼 Child Dependent Contribution	R692 – R1,032
🌎 International Cover	None
💵 Prescribed Minimum Benefits (PMB)	✅ Yes
😷 Screening and Prevention	✅ Yes
💶 Medical Savings Account	None
💙 Maternity Benefits	✅ Yes
💜 Pre- and Postnatal Care	✅ Yes

Thebemed Universal Plan – 7 Key Point Quick Overview

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

Thebemed Universal Plan Overview

The Thebemed Universal medical aid plan is one of 4, starting from R692, and is ideal for those seeking cost-effective healthcare using a choice of Designated Service Providers. Furthermore, the Universal plan covers preventative care, chronic conditions, and more. Gap Cover is unavailable on the Thebemed Universal 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 Plan Contributions

💴 Income Bracket	👤 Main Member	👥 Adult Dependent	🍼 Child Dependent
💵 R0 – R500	R692	R692	R692
💶 R501 – R2,500	R1,723	R1,479	R809
💷 R2,501 – R7,500	R1,889	R1,621	R887
💴 R7,501>	R2,661	R2,509	R1,032

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Thebemed Universal Plan Benefits and Cover Comprehensive Breakdown

Thebemed Universal Out-of-Hospital Benefits

🟥 GP Consultations	Unlimited cover is provided when using a DSP. 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.
🟧 Specialist Consultations	Limited to three visits per family per year. Covered up to 100% of the Negotiated Tariff when using a DSP. PMBs are subject to internal protocols.
🟨 Diagnostic Procedures	Unlimited cover provided. Covered up to 100% of the Negotiated Tariff when using a DSP. Pathology and Radiology will be managed per the request form as prescribed by the GP and referring Specialist.
🟩 Pharmacy Advised Therapy (PAT)	Limited to R183 per script. Subject to an overall limit of R594 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.
🟦 Acute Medication	Unlimited cover provided. Covered up to 100% of the Negotiated Tariff when using a DSP. Subject to the generic substitute and scheme formulary.
🟪 Chronic Medication	Unlimited cover provided. Subject to internal protocols. Subject to the Thebemed generic substitute and formulary. PMBs are subject to internal protocol. The benefit is subject to registration of chronic conditions, pre-authorization, internal treatment protocols, and medicine formulary.
🟥 Medical and Orthopaedic Appliances	Combined benefits for in and out-of-hospital. Limited to R5,500 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 R1,255 every 2 years. Contact lenses are not covered if frames are obtained and vice versa.
🟨 Conservative Dentistry	Unlimited cover. Covered up to 100% of the Negotiated Tariff when using a DSP. Subject to DENIS clinical protocols. The benefit includes the following: Check-ups Fillings Extractions Scaling Polishing Plastic Dentures
🟩 Refraction Eye Tests	Limited to one test per beneficiary every 2 years. Covered up to 100% of the Negotiated Tariff. Managed by the PPN.

Thebemed Universal In-Hospital Benefits

🏥 Hospitalization Accommodation Neonatal Intensive Care Medical and Surgical Procedures Medication Consumables Treating Specialist Costs	Unlimited coverage at contracted private facilities and State Hospitals. Covered up to 100% of the Negotiated Tariff when using a DSP. Subject to internal and Department of Health protocols. Subject to Clinical Outcomes and Tariff Negations. Thebemed reserves the right to channel cases to a competitive network. Pre-authorization must be obtained from Associated Providers, or the member must pay for the first three days. Subject to 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.
📌 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.
💊 Take-home Medication	Seven days’ supply per beneficiary per admission.
🧪 Diagnostic Investigations	Covered up to 100% of the Negotiated Tariff when using a DSP. Subject to PMBs and internal protocols. Pathology and radiology are 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. Subject to PMBs and internal protocols. Subject to pre-approval and specialist referral.
💉 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. Accounts will only be paid if the entire course of treatment is completed.
🩸 Blood Transfusions and Blood Replacement Products	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols.
🍎 Auxiliary, Alternative Healthcare, and Physiotherapy Dieticians Occupational Therapists Physiotherapist Speech Therapists	Covered up to 100% of the Negotiated Tariff. Subject to PMBs and internal protocols. A treatment plan and progress report must be submitted to manage clinical outcomes during the event.
🙂 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.
🧠 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 on 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 accessible communication with consultants. Members receive R55 airtime monthly with this benefit.

Thebemed Universal Chronic Disease Listing

Thebemed Universal 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.

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Thebemed Universal Plan Exclusions and Waiting Periods

Universal Plan Exclusions

The Thebemed Universal 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.

Universal 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 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.

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Thebemed Universal Plan vs Similar Plans from Other Medical Schemes

🔎 Medical Aid Plan	🥇 Thebemed Universal	🥈 Momentum Ingwe Plan	🥉 Makoti Medical Scheme Primary Option
👤 Main Member Contribution	R692 – R2,661	R541
👥 Adult Dependent Contribution	R692 – R2,509	R541
🍼 Child Dependent Contribution	R692 – R1,032	R466
🌎 International Cover	None	Up to R9.01 million	None
💵 Prescribed Minimum Benefits (PMB)	✅ Yes	✅ Yes	✅ Yes
😷 Screening and Prevention	✅ Yes	✅ Yes	✅ Yes
💶 Medical Savings Account	None	None	None
💙 Maternity Benefits	✅ Yes	✅ Yes	✅ Yes
💜 Pre- and Postnatal Care	✅ Yes	None	None

Our Verdict on the Thebemed Universal Plan

The Thebemed Universal Plan is a comprehensive medical aid plan that offers a range of benefits and services to individuals and families in South Africa. This plan is designed to cover a wide range of healthcare needs and is known for its affordability and ease of use. One of the key advantages of the Thebemed Universal Plan is its comprehensive cover. In addition, the plan offers a range of benefits, including hospital cover, chronic medication benefits, and wellness programs. Furthermore, this cover is designed to help members manage their healthcare needs and access the care they need when they need it. Another advantage of the Thebemed Universal Plan is its affordability. It is priced competitively and is designed to offer value for money to members, making it an attractive option for individuals and families who are looking for comprehensive healthcare coverage at an affordable price.

The Thebemed Universal Plan also offers a range of digital tools and services designed to enhance the customer experience. In addition, members can access their benefits and manage their healthcare needs through the scheme’s website or mobile app. This makes it easy for members to manage their healthcare needs on the go and access the care they need when they need it. Despite its many advantages, there are some drawbacks to the Thebemed Universal Plan. One of the main drawbacks is that the plan may not be suitable for individuals with very specific healthcare needs.

For example, individuals who require very specialized medical care may need to look for a plan that offers more extensive coverage for their specific needs. However, while the plan has some drawbacks, such as its suitability for specific healthcare needs, the overall benefits and value for money make it an attractive option for many people.

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Thebemed Universal Plan Frequently Asked Questions

What is the Thebemed Universal plan, and how does it differ from other Thebemed medical aid plans?

The Thebemed Universal plan is a comprehensive medical aid plan that offers a range of benefits, including hospital cover, chronic medication benefits, and wellness programs. Thebemed differs from other plans because of its cost-effective yet extensive cover, starting from R635 per month.

What benefits are covered by the Thebemed Universal plan?

The Thebemed Universal plan offers a range of benefits, including comprehensive hospital cover, chronic medication benefits, wellness programs, and access to network doctors. Members of the plan also have access to a range of digital tools and services designed to enhance the customer experience.

How do I join the Thebemed Universal plan, and what information do I need to provide?

To join Thebemed Universal plan, you can download the application form from their website or request it from their customer support team. The application form will require you to provide personal details such as your name, contact information, and medical history. You may also be required to provide details about your current medical aid plan and the benefits you are currently receiving.

What is the pricing structure for the Thebemed Universal plan?

The pricing structure for the Thebemed Universal plan varies depending on the income level of the Main Member and the number of dependents.

What wellness programs are included in the Thebemed Universal plan?

Thebemed Universal plan offers a range of wellness programs designed to help members manage their health and well-being. These programs include access to health coaches, nutritionists, fitness experts, and other professionals who can provide guidance and support on various health and wellness topics.

What is the waiting period for the Thebemed Universal plan, and how does it apply to new members?

The waiting period for the Thebemed Universal plan is typically three months for general healthcare benefits and 12 months for pre-existing medical conditions. This waiting period applies to new members joining the plan for the first time.

What network doctors are included in Thebemed Universal plan, and how do I find one in my area?

Thebemed Universal plan offers access to a network of doctors and healthcare providers throughout South Africa. Members can use the scheme’s website or mobile app to find network doctors in their area and book appointments online.

What is the cover for chronic medication with the Thebemed Universal plan?

Thebemed Universal plan offers comprehensive coverage for chronic medication, including prescription and other treatments. However, members must meet specific criteria to qualify for this cover, such as having a specific medical condition or meeting certain diagnostic criteria.

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.