5 Best Medical Aids in South Africa Covers Cosmetic Surgery
Do medical aids cover cosmetic surgery in South Africa revealed.
We verified the medical aid plans that cover cosmetic surgery.
This is a complete guide to the best medical aids that cover cosmetic surgery in South Africa.
In this in-depth guide you’ll learn:
- What is cosmetic surgery?
- Which medical aids cover breast reduction?
- Which medical aids cover liposuction in South Africa?
- Are there free plastic surgery options?
So if you’re ready to go “all in” with the best medical aid that covers cosmetic surgery in South Africa, this guide is for you.
Let’s dive right in…
Medical Aids in South Africa Cover Cosmetic Surgery (2023)
- Bonitas Medical Aid – Overall, Best Medical Aid in South Africa that Cover Cosmetic Surgery
- Discovery Medical Aid – Top Extensive Medical Protection in South Africa
- Momentum Health – Broadest Range of Low-Cost Medical Aid Plans
- Fedhealth Medical Scheme – Best Pay-As-You-Go Private Healthcare
- BestMed Medical Aid – Best Customer Service Medical Aid
Introduction to Medical Aid Support & Coverage of Cosmetic Surgery
👉 When someone gets cosmetic surgery, they choose to have an operation or other invasive medical procedure to change their appearance for reasons other than health.
👉 Botox and dermal fillers, which are usually used to relax wrinkles or fill in lines, are examples of non-surgical cosmetic procedures.
👉 In South Africa, it can be harder to find medical aids that cover cosmetic surgery than it is to find regular coverage, because these procedures aren’t always done because someone needs to, but because someone wants to.
👉 Whether or not your health insurance will pay for this kind of surgery depends on your specific situation.
👉 People undergo the following kinds of cosmetic surgery:
➡️ Tummy Tucks
➡️ Eyelid Surgery
➡️ Ear Surgery
👉 Because most medical surgery, treatment and care is so expensive, the majority of people want their medical aid to cover their costs to enable them to finance the medical care that they want.
👉 If cosmetic surgery was required to be covered by health insurance plans, the plans would be unable to remain financially viable if they did so because of the high costs that are frequently associated with these treatments.
👉 Even though the vast majority of medical aid programmes do not cover and will not pay for cosmetic surgery, some might. You will need to do some research in order to find a medical aid company as well as a plan that will cover the operation as well as the treatment that is specific to you.
👉 If you feel that you would benefit from having cosmetic surgery to improve your appearance, or to correct the deformities that are present on your physique or face, whether it was the result of an accident or was something you were born with, you are in for a great deal more of stress and pressure.
👉 A significant number of people in South Africa are interested in acquiring insurance coverage for cosmetic procedures such as liposuction and tummy tucks since plastic surgeons in this country have a great level of expertise in performing these treatments.
👉 You will be faced with a challenging decision if you do not feel that you “need” cosmetic surgery, as well as some challenging implications to deal with.
👉 Some persons hold the view that those who choose to enhance their appearances through the use of cosmetic surgery are vain or suffer from low levels of self-esteem.
👉 Breast implants and breast reduction are two common types of cosmetic surgery that are sought after by women who are looking for financial assistance to cover the costs of the procedure.
👉 If you honestly believe that you would benefit from cosmetic surgery to your face or body, then you will have to learn to deal with the challenges of paying for it.
👉 Deciding to go through with cosmetic surgery is merely the first of several different challenging areas that lie ahead.
👉 Certain consumers are all too aware that certain surgeries are not covered by medical aid programmes since they are regarded as cosmetic rather than functional.
👉 Functional surgeries aim to improve a patient’s health, while cosmetic surgeries concentrate on improving the patient’s appearance. However, some cosmetic operations actually serve a purpose in addition to their aesthetic purpose.
👉 In situations like this, how do various medical aid programmes differentiate between the two?
👉 The Council for Medical Schemes is a governmental agency that was established to provide regulatory oversight of medical schemes.
👉 The border between cosmetic surgery and functional surgery is not as blurry as some people may think it is, according to the Council for Medical Schemes.
👉 In the event that this is the case, the provider will typically provide a comprehensive justification to the scheme. This justification will be reviewed by the plan’s medical advisor, after which a funding decision will be made.
👉 For instance, breast reconstruction surgery can be a component of the treatment for breast cancer, and it can be performed on either the afflicted breast or the healthy breast. Therefore, surgical reconstruction of the breast that was not harmed may be covered, depending on the circumstances of the clinical situation.
READ more about 5 Best Medical Aids under R2000
Is Cosmetic Surgery a Part of Prescribed Minimum Benefits?
👉 Medical schemes are only compelled to cover conditions that fall under the Prescribed Minimum Benefits (PMB) designation, regardless of the member’s scheme or option. This is, however, subject to the use of designated service providers, evidence-based and cost-effective clinical protocols, and lists of medicines as supplied by approved providers.
👉 PMBs, which are mandatory for all schemes, are aimed at saving and prolonging a patient’s life. In this regard, reconstructive surgeries that are linked to PMBs are covered.
👉 Cosmetic surgical procedures that are not listed on, or linkable to, the medical conditions covered by the PMBs, or the chronic disease list, or which do not qualify as an emergency medical condition as defined by the Medical Schemes Act (131 of 199), cannot be made mandatory for schemes to cover.
👉 Three different surgeries that are often excluded from medical aids are breast augmentation, gastric bypass, and gender reassignment surgery.
👉 Breast augmentation and gender reassignment surgeries are not listed as PMB’s, while gastric bypass surgery may or may not fall under the PMB list, depending on the reason for the surgery.
👉 Therefore, schemes can cover them based on their specific rules, applicable to the member’s scheme option. In other words, medical schemes are not compelled to cover these surgeries, but they may choose to cover them.
👉 Generally, a medical aid will pay for plastic surgery only if it’s considered medically necessary.
👉 If however the surgery is deemed necessary to restore normal body function, your medical aid may cover costs in accordance with the scheme rules.
👉 Medical aids cover skin cancers and most often suspicious skin lesions that need to be removed but do not cover (purely) cosmetic plastic surgery.
👉 Some Breast Reduction procedures where reasonable grounds exist for some medical aid cover, a motivation letter – usually accompanied by pictures – will be emailed to your medical aid by the doctor to try to obtain authorisation to proceed with the surgery.
5 of the Best-Known Medical Aids in South Africa & Their Coverage of Cosmetic Surgery
👉 Finding medical aids that cover cosmetic surgery can be very difficult.
👉 Most medical aids will not cover any form of cosmetic surgery; however some may cover reconstructive surgery if it is really necessary.
👉 For example, if you have been in an accident and have been left with a disfigured ear, a scar or any other sort of aesthetic damage, your medical aid may cover the cosmetic surgery needed to repair the damage.
👉 Fedhealth is an example of a medical aid programme that does provide some level of coverage for cosmetic surgery. This particular company offers many medical aid plans, including ones that provide coverage for various kinds of cosmetic surgery. In addition, Fedhealth provides financing for cosmetic surgery that is completely interest-free.
👉 To recap, most medical assistance companies in South Africa do not provide coverage for the various operations included in plastic surgery.
👉 However, if your doctor is able to assist you build a case to demonstrate that a certain surgical operation is essential for your health, then your medical aid will pay for it.
👉 You will not be eligible for coverage if the sole purpose of the plastic surgery was to improve your appearance.
1. Bonitas Medical Aid
👉 Bonitas has served its members for a few decades already, and its rich history is evidence of how the aid supported the South African private healthcare industry.
👉 Its management team consists of several experts who are always searching for new ways to ensure that members get the most affordable, high-quality health care. In the process they aim to keep up with new technology and manage care so that any lifestyle diseases are detected before they become chronic. Better rates with service providers are always negotiated.
👉 The company’s financial status is stable, its key indicators of fiscal health are strong, and it has ample funds in reserve.
Who Manages Bonitas Medical Aid?
👉 Bonitas is run by an efficient experienced management team and an independent Board of Trustees that is made up of professionals from the legal, health, financial, and business sectors. None of them is members of the fund too.
👉 Bonitas offers a wide variety of plans so that any family can find one that fits the needs of family members.
👉 The plans are easy to understand and use while assisting the members to get the most out of their benefits. None of these plans’ benefits does include cosmetic surgery though.
👉 The Edge category gives access to day-to-day benefits including unlimited GP consultations, layers of virtual care, dental and optical consultations, a private hospital network and more. Options include BonStart and BonStart Plus, both designed for young, economically active people, living in the larger metros, and looking to expand their families.
👉 The Traditional plans give an overall day-to-day limit with sub-limits for GP and specialist consultations, acute and over-the-counter medicine, X-rays and blood tests and other out-of-hospital medical expenses. Options include a Standard, Standard Select, Primary, and Primary Select plan, with the network options all using a network of quality providers that offers day-to-day benefits and hospital cover.
👉 A series of Saving plans give members a set amount that they can use for out-of-hospital costs like doctor visits, optometry, and dentistry. They also cover members in the hospital and give them extra benefits for maternity, wellness, and preventative care. Options are called BonFit Select, BonSave, BonComplete, BonClassic and BonComprehensive. The latter offers ample savings, an above-threshold benefit and extensive hospital cover.
👉 The series of Hospital Plans cover members for emergency and planned procedures in hospital and they get access to some additional benefits for wellness and preventative care. Plans are called Hospital Standard, BonEssential, and BonEssential Select, which uses a quality provider network that offers comprehensive hospital benefits and some value-added benefits.
Cosmetic Surgery Benefits under Bonitas Medical Aid
👉 Bonitas Medical Scheme did pay for medically backed breast reduction surgery within their protocols of the surgery being medically necessary, but apparently that has changed, and no cosmetic surgery is currently covered by the medical aid.
👉 Regardless of the member’s scheme or option, Bonitas is only required to cover conditions that fall under the Prescribed Minimum Benefits (PMB) designation. This is conditional on the use of designated service providers, evidence-based and cost-effective clinical protocols, and medication lists provided by approved providers.
👉 PMBs are designed to save and prolong a patient’s life. Reconstructive surgeries related to PMBs are covered in this regard.
How Much Are Bonitas Medical Aid Monthly Premiums?
👉 Bonitas monthly contributions start at R 2 033 for a Principal Member, R 1 555 for a spouse/adult dependant and R 596 per child (max 3) on the BonEssential Hospital Plan and go up to R 8 217 for a main member, R7 749 for additional adult, and R 1 672 for a child for the BonComprehensive plan that offers abundant savings, an above threshold benefit and extensive hospital cover.
What Is the Waiting Period for Bonitas Medical Aid Benefits?
👉 The minimum general waiting period for Bonitas medical aid is three months for all benefits. Some plans, however, have a waiting period of 12 months, especially regarding a pre-existing condition.
How to Claim for Breast Reduction Benefits from Bonitas
👉 You can send in your claim in the following ways:
➡️ Email your claims to [email protected].
➡️ Post your claims to Bonitas Claims Department, PO Box 74, Vereeniging, 1930.
➡️ Submit your claims in person at one of the walk-in centres.
👉 Follow these simple steps to get your claims paid quickly:
➡️ Ensure your banking details are correct for refunds by electronic transfer (EFT) into your bank account
➡️ Make sure that your account and receipt show your name and initials, membership number, treatment date, the name of the patient as shown on your membership card, amount charged and ICD-10 code.
Bonitas Contact Details
34 Melrose Blvd, Birnam
Phone for General Queries: 0860002108
Email: [email protected]
Email: [email protected]
READ more about Bonitas vs BestMed Medical Scheme
2. Discovery Medical Aid
👉 Discovery Health Medical Scheme (DHMS) is often described as the largest registered open medical scheme in South Africa. It is called an open medical scheme because anyone can join, as long as they follow the rules of the Scheme.
👉 The Discovery Health Medical Scheme gives more than 20 health plan options, each with unlimited private hospital coverage and a variety of benefits to fit individuals’ needs and budgets.
👉 Discovery claims that its contributions are on average much cheaper than what other South African medical schemes charge for the same level of coverage and its wellness programme called Vitality, allows members to join and get rewards for living a healthier life.
Who Manages Discovery Medical Aid?
👉 The Discovery Health Medical Scheme is owned by its members, and it is run by an independent Board of Trustees. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
👉 The Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes.
Discovery Medical Aid Option Plans
👉 Discovery option plans range from comprehensive private healthcare coverage to basic plans where members get cost-effective private healthcare coverage through a set network of providers.
👉 The following health plan options are available:
👉 The Executive Plan and Comprehensive series offer customers the most extensive cover for in-hospital and day-to-day benefits, as well as extended chronic medicine cover and an unlimited Above Threshold Benefit.
👉 The Priority Series offer cost-effective in-hospital cover, essential chronic medicine cover and day-to-day benefits with a limited Above Threshold Benefit.
👉 A Saver Series provides economical in-hospital cover, essential chronic medicine cover and day-to-day benefits through a Medical Savings Account and the value-for-money Core Series provide unlimited private hospital cover and essential cover for chronic medicine but with no day-to-day cover.
👉 The Smart Series of plans provide the most cost-effective in-hospital cover, essential chronic medicine cover plus limited day-to-day cover for providers in a specified network and the Keycare Series is a very basic series of plans that offer affordable medical cover from providers in a specified network for both in-hospital and out-of-hospital treatment.
Cosmetic Surgery Benefits under Discovery Medical Aid Option Plans
👉 Discovery Medical Health Scheme (DMHS) does not fund breast augmentation surgery if it is requested for purely cosmetic reasons but may provide funding for breast reduction surgery under certain circumstances to members of the Executive plan and Comprehensive plan.
👉 This funding is only available for candidates with a diagnosis of gigantomastia, and is subject to a limit of R50,000.
👉 Discovery also funds breast reconstruction surgery for members with breast cancer post-mastectomy across all plan types.
👉 Breast reconstruction surgery for non-oncology cases is funded on a discretionary basis from the Reconstructive Surgery Benefit, subject to a R50,000 per-member benefit limit, only on Executive or Comprehensive plans.
👉 Discovery also funds gastric bypass surgery for members on Executive and Comprehensive plans, from the Specialised Medicine and Technology benefit, but with a 20% co-payment and an overall limit of R200 000 per person per annum.
👉 Gender reassignment surgery is a general scheme exclusion, but Discovery does provide funding for gender reassignment surgery as part of a pilot programme for Executive and Comprehensive plan members with a diagnosis of gender dysphoria. Candidate members must however be 18 years or older and have belonged to the specified plans for a minimum of at least three years. A co-payment of 20% is payable and the overall limit R200 000.
How Much Are Discovery Medical Aid Monthly Premiums?
👉 Monthly premiums start from R930 per member for the Keycare Series with medical cover for both in-hospital and out-of-hospital treatment by providers in a specified network and goes up to R8 298 per member for the Executive Plan with extensive cover for in-hospital and day-to-day benefits, extended chronic medicine cover, and unlimited Above Threshold Benefit.
What Is the Waiting Period for Discovery Medical Aid’s Benefits?
👉 Discovery Health Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim for Discovery Medical Aid Benefits
👉 You can submit a claim fast and easy in the following ways:
➡️ Scan and upload your claims on the website.
➡️ Scan and email your claims to [email protected].
➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
➡️ You can also submit your claims by post.
Discovery Medical Aid Contact Details
PO Box 784262,
Phone: 0860 99 88 77
READ more about Discovery Health versus Momentum Medical Scheme compared and revealed.
3. Momentum Health
👉 Momentum Medical Scheme is a non-profit open medical scheme registered under the Medical Schemes Act 131 of 1998, as amended.
👉 Momentum has a reputation as one of the top open medical schemes in South Africa and is run by one of country’s largest and most trustworthy healthcare solutions companies.
Who Manages Momentum Health?
👉 Momentum Health Solutions is a wholly-owned subsidiary of Momentum Metropolitan Life Limited.
👉 Its Board of Trustees is elected annually at an Annual General Meeting and the board includes several individuals with substantial experience and skills in a variety of legal, medical, and accounting fields.
👉 Momentum Medical Scheme provides a wide range of medical insurance plans and benefits, including 6 medical aid plans. Members can choose between the following options:
👉 Evolve Option – cover hospitalisation from the Evolve Network of private hospitals with no overall annual limit, and access to 2 virtual doctors’ consultations and any additional day-to-day benefits subject to HealthSaver+.
👉 Custom Option – gives comprehensive hospital and chronic cover from any or associated providers.
👉 Incentive Option – extensive hospital and chronic cover from any or associated providers. Day-to-day expenses are covered by a dedicated medical savings account funded by 10% of monthly contributions
👉 Extender Option – extensive hospital cover and additional chronic cover from any or associated providers. 25% of contributions go to a dedicated medical savings account from which day-to-day expenses are paid.
👉 Summit Option – unlimited private hospital cover from any provider. A chronic cover is available for an additional 36 conditions and day-to-day benefits up to R29 700 per beneficiary per year are covered.
👉 The Ingwe Option gives affordable and accessible entry-level medical cover for treatment from any hospital, the Ingwe network of private hospitals, or State hospitals.
Cosmetic Surgery Benefits under Momentum Health’s Option Plans
👉 Momentum Health is only obliged to cover conditions that fall under the Prescribed Minimum Benefits (PMB) designation, regardless of the member’s scheme or option. This is conditional on the use of designated service providers, evidence-based and cost-effective clinical protocols, and medication lists provided by approved providers.
👉 Reconstructive surgeries related to PMBs are covered in this regard.
How Much Are Momentum Health Monthly Premiums?
👉 Momentum monthly premiums start at R1 539 for the main member on the Evolve Option and go up to R12 345 for the main member on the Summit Option.
What Is the Waiting Period for Momentum Health’s Benefits?
👉 The general waiting period is 3 months, but since pregnancy is considered a pre-existing condition, it is excluded from all benefits for the first 12 months of scheme membership.
How to Claim Momentum Health Benefits
👉 You can submit a claim in several ways:
➡️ Use the Momentum App
➡️ Use the web chat facility in the bottom left corner.
➡️ Send an email to [email protected] or send normal mail to PO Box 2338, Durban, 4000
👉 To make sure your claim is processed quickly and accurately, including the following information:
➡️ Membership number.
➡️ Principal member’s surname, initials, and first name.
➡️ Patient’s surname, initials, and first name.
➡️ Date of treatment.
➡️ Amount charged.
➡️ ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
➡️ Service provider’s name and practice number.
➡️ Proof of payment if you’ve paid the claim out of your own pocket.
Momentum Health Contact Details
201 Umhlanga Ridge Blvd
PO Box 2338
READ more about Fedhealth versus Momentum Medical Scheme compared and revealed.
4. Fedhealth Medical Scheme
👉 Fedhealth has been in operation in South Africa since 1936. Over the years, they were committed to their task of providing affordable but quality health care to members of all ages and income groups.
👉 Fedhealth gives its members the option to access to manage their medical care to a large extent.
👉 The fund had a Global Credit Rating of AA- for 14 years in a row, and the scheme has well over the required 25% reserves.
👉 Fedhealth is also known for its unique benefits paid from Risk, which help members get more value from their regular benefits.
Who Manages Fedhealth Medical Scheme?
👉 Fedhealth is still run by its members for its members and is always searching for new ideas to meet the needs of members who strive to take care of their health in a changing world.
👉 The medical aid plans offered by Fedhealth are made to fit members’ budget, needs, and stage of life. They can choose from a variety of options, including coverage if they’ve never had medical aid before, the innovative flexiFED options that let you make your own aid, and the maxiFED options that offer the most comprehensive medical aid coverage.
👉 The options range from the myFED option with affordable (salary-banded) cover for lower income, previously uncovered employees, flexiFED Savvy options for the young, healthy and newly employed, flexiFED 1, an affordable hospital plan with savings pocket to help cover unexpected day-to-day medical bills to flexiFED 2, flexiFED 3, and flexiFED 4, all family hospital plan options with generous benefits.
Cosmetic Surgery Benefits under Fedhealth Medical Scheme’s Option Plans
👉 Fedhealth is one of only a few medical aid programmes that does provide some level of coverage for cosmetic surgery, or alternatively financing that are completely interest-free for cosmetic surgery.
👉 Other procedures like breast augmentation, gastric bypass, and gender reassignment surgery, are currently exclusions and will not be funded by Fedhealth.
👉 Although these procedures are generally regarded as cosmetic surgery, the scheme evaluates each request individually to determine whether it is purely a cosmetic request or if there is a functional reason for the request.
👉 If a procedure may prevent downstream costs for the scheme and improve the health and quality of life of the member, there may be more justification to fund a procedure.
How Much Are Fedhealth Medical Scheme Monthly Premiums?
👉 The monthly premiums for the salary-banded myFED option is from R 1 275 per month for the main member. The maxima PLUS extensive medical cover will cost from 13 122 per month per the main member.
What Is the Waiting Period for Fedhealth Benefits?
👉 The general waiting period for FedHealth benefits is usually three months, depending on the medical aid scheme you join. The waiting period for pre-existing conditions is 12 months.
How to Claim for Benefits from Fedhealth Medical Scheme
👉 Members can submit claims using one of the following:
➡️ In the Fedhealth Family Room,
➡️ Through a WhatsApp service
➡️ On the Fedhealth Member Phone App
➡️ You may also email, fax or post the claims to email: [email protected], fax: (011) 671 3842 or post to Private Bag X3045, Randburg, 2125.
Fedhealth Medical Scheme Contact Details
Flora Centre Shop 21 and 22
Corner Conrad street and Ontdekkers Rd
Phone: 0861 116 016
READ more about the 5 Best Medical Aids for Pensioners and People over 65
5. BestMed Medical Aid
👉 BestMed claims to be South Africa’s largest self-administered scheme and the country’s fourth-largest open medical scheme.
👉 BestMed has offered members access to an extensive network of healthcare providers, value for money, and wellness benefits for many years, with single-digit increases for 5 years in a row and 13 structured plans for every stage of life and budget.
👉 The aid gives access to networks of specialists and hospitals all over South Africa, including more than 4,300 family doctors and all its option plans provide great benefits for preventive health care, like female contraceptives, pneumonia and flu vaccines and more.
Who Manages BestMed Medical Aid?
👉 The Executive Leadership of BestMed is supported by teams of Member Elected Trustees and Board Appointed Trustees.
👉 BestMed customers can choose between Hospital Plans, Network Plans, Savings Plans, and Comprehensive Plans.
👉 Hospital Plans include the Beat 1 Network Plan that covers you at a range of network hospitals for planned and unplanned hospital stays, no matter what age you are.
👉 The BestMed Network Plans include the Rhythm 1 Network Plan and Rhythm 2 Network Plan, both offering unlimited in-hospital cover with either limited essential day-to-today benefits or comprehensive savings for consultations with designated healthcare providers.
👉 BestMed Savings Plans include the Beat 2 Savings Plan, Beat 2 Network Savings Plan, Beat 3 Savings Plan and Beat 3 Network Savings Plan – all with extensive hospital cover at private hospitals and a savings account out of which general day-to-day expenses are paid.
👉 The Network Savings Plans are associated with certain Network hospitals and providers.
👉 These plans provide excellent hospital benefits with extensive day-to-day cover, out-of-hospital benefits, chronic benefits and medical savings accounts for extra payment flexibility.
Cosmetic Surgery Benefits under BestMed Medical Aid’s Option Plans
👉 BestMed Medical Aid is obliged to cover conditions listed under the Prescribed Minimum Benefits (PMB) description, regardless of the member’s scheme or option.
👉 This is subject to the use of designated service providers, evidence-based and cost-effective clinical protocols, and medication lists provided by approved service providers. Reconstructive surgeries related to PMBs are covered in this regard.
How Much Are BestMed Medical Aid Monthly Premiums?
👉 At the time of writing, monthly premiums for the cheapest BestMed Beat1 Network Hospital Plan started at R1 710 for a member, with an additional R1 329 for an adult dependant and R720 for a child dependant, to a maximum of 3 child dependants. Additional children join at no additional cost.
👉 The most expensive plan at the time was the Pace4 Comprehensive Plan, with monthly contributions of R9 411 per member and R9 411 per adult dependant. For a child dependant, the extra contribution was R2 205, up to 3 child dependants with additional children added as beneficiaries of the scheme at no extra cost.
What Is the Waiting Period for BestMed Medical Aid’s Benefits?
👉 There can be a general waiting period of three months or a specific waiting period of 12 months for a certain condition.
👉 Bestmed Medical Scheme will sometimes only pay a claim if it is a PMB. This can happen if you are in a waiting period or if you are getting treatment for a condition that your plan doesn’t cover.
How to Claim Benefits from BestMed Medical Aid
👉 If your healthcare provider does not submit claims to BestMed, one must submit the original claim directly to the fund administrators.
👉 You can claim by means of the BestMed App, or by scanning and emailing your claim to them.
👉 Details that should appear on all claim documents include:
➡️ Member’s name and contact details
➡️ BestMed membership number
➡️ Patient’s details
➡️ Service provider’s name, contact details and practice number
➡️ Details of treatment, including applicable tariff and ICD-10 codes
➡️ Whether payment should be done to the service provider or the member
👉 You will receive an email confirmation when your claim is received and indexed.
BestMed Medical Aid Contact Details
Bestmed Medical Scheme, Glenfield Office Park, 361 Oberon Avenue, Faerie Glen, Pretoria
PO Box 2297
Phone: +27 (0)86 000 2378
You might also like to read more about Genesis Medical Aid
Frequently Asked Questions
Are There Medical Aids That Cover Cosmetic Surgery?
Yes, there are medical aids that cover cosmetic surgery, but only if it’s considered medically necessary.
Are cosmetic surgical procedures covered by medical schemes?
No medical scheme mandates coverage for cosmetic surgical procedures not listed under Prescribed Minimum Benefits (PMBs), chronic disease lists or emergency conditions.
Which surgeries are often excluded from medical aid coverage?
Medical aids often refuse coverage for breast augmentation, gastric bypass and gender reassignment surgeries.
Will medical aids cover plastic surgery if it’s medically necessary?
Medical aid plans generally only cover plastic surgery if it’s deemed medically necessary or necessary to restore normal body functions in accordance with their rules and policies.
Do medical aids cover cosmetic plastic surgery?
No, medical aids typically do not cover cosmetic plastic surgery performed for aesthetic reasons only.
Will medical aids cover the removal of skin cancers or suspicious skin lesions?
Yes, medical aids typically cover removal of skin cancers or suspicious skin lesions that require treatment as these procedures are medically necessary and fall under its coverage.