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Reminder: rehealth.co.za helps you get the most out of your medical aid. It's free, it's instant. No registration or pesky sales calls.
Today we discuss:
- Who pays for ER visits?
- "Free money" for day-to-day expenses
- Why is it so difficult to get into medical school?
Please share!
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Reminder: rehealth.co.za helps you get the most out of your medical aid. It's free, it's instant. No registration or pesky sales calls.
Today we discuss:
- Who pays for ER visits?
- "Free money" for day-to-day expenses
- Why is it so difficult to get into medical school?
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ποΈ Eve's notes...
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I want to talk about two polar opposite things today. First, a rejected claim is not the final word. If you submit a claim which you think should be paid by your scheme and they reject it, follow up. Youβll be amazed how often a simple email or change of billing code will get that claim paid. I see it all the time. And if it still continues to be rejected and you are adamant that it should be paid, complain to the Council of Medical Schemes.
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Here is the polar opposite stance: please do not complain when a claim that you are clearly not entitled to gets rejected. I see this all the time too. The narrative is always some version of βI pay Rxx every month, and now I have this one claim and they refuse to cover it. What a scam!β Medical aids need to look after the best interest of all their members, which means that they have carefully designed actuarial models where the premium you pay matches the claim risk for specific benefits. By law, no plan can be βunprofitableβ. If your premium excludes a certain benefit, it really does exclude it, and your premium reflects this. Case closed.
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Balancing the two - claims wrongly rejected and claims justly not covered - is tricky, and often it seems the schemes feed on our inability to tell the difference, and hope we just give up. Of course, my goal is to help you be wiser about your benefits and options π.
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Stay healthy! Stay wise and thanks for reading.
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PS: Send me your medical aid/insurance questions and experiences. I canβt give individual advice but I can maybe give you insight into benefits and legislation. eved@rehealth.co.za or hit reply to this email.
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πΏπ¦ First, let's save some money...
There's little I like more than a good deal and I want to collect as many health and wellness special offers for you as possible. Watch this space.
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ποΈ There's no lack of specials in November...but I am still inclined to wait to the actual Black Friday (Nov 28) to lock in the real discounts. It's exactly 3 weeks away.
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π°Woolies has a new rewards program, that gives you more personalised vouchers, cash back and rewards for goals. You can opt to focus on wellness-related deals, if you wish. Download the app to sign up.
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πͺ Discovery Members. If you register for Personal Pathways on the app, do your wellness assessment and activate activity tracking in 2025, you will be given R1,000 per adult for day-to-day expenses immediately in January 2026. (See more "free money" opportunities below.)
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πΏπ¦ Medical Aid and other cover 101:
Useful and relevant information about medical aid, gap covers, hospital insurance and even pet cover. Goal: to help you know the rules, so you don't overpay.
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Who pays for an ER visit?
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Many medical aids suggest you need to pay out of pocket for ER visits, but that's not true. Emergencies are always paid for by the scheme. You can see how your plan says it pays for ER visits by looking at the in-of-hospital benefit for your plan on rehealth.co.za.
Ways ER visits can be paid:
- from risk (i.e. by the scheme),
- from specific benefit (see ER benefit on rehealth, under "in-hospital benefits"),
- from day-to-day funds,
- by your gap cover,
- by your hospital insurance
- or out-of-pocket.
Examples: If you go to ER ...
π₯ ... and then get admitted to hospital, scheme pays for the ER.
π₯ ... for anything that is a medical emergency (life threatening or not), scheme pays. (Official definition: A medical emergency is a sudden and unexpected event that requires immediate medical or surgical treatment to protect your health. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place your life at risk.) This includes fractured legs, wounds, severe allergic reaction, head trauma, dental trauma etc.
π₯ ... with something that appears to be a PMB emergency, but doctors need to run tests to confirm whether this is accurate, everything up to the diagnosis should be paid for by the scheme. (Eg. a possibly burst appendix)
π₯ ... with symptoms that are not a medical emergency (eg. high fever) then the scheme will probably pay for the visit out of any available benefit, or your day-to-day funds. If there are none, you will need to pay out of pocket.
Note that most gap insurers have plans that cover some ER visits that are not paid for by scheme.
Hospital insurance products (not medical aids) also often have an ER benefit.
If your medical aid rejects an ER claim that you think it should pay, resubmit it citing the reasons why you think it should be paid. This tip often works. π
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Yep, it's more "free" money ....
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Many schemes are incentivising members to lead healthier lifestyles (or to at least be aware of their health risks) by giving "free money" in exchange for tests and assessments. You can see if your plan has any such incentive on rehealth.co.za, under the "Cost Table" for any plan. (We're busy adding the 2026 incentives ).
Bonitas: Their Benefit Booster gives families up to R5,000 in a fund to spend on out-of-pocket expenses. It really is a great incentive, and it's easy to get.
Discovery: They have "Personal Pathways" for which you have to register on the app. You will then be given personalised incentives (eg. get a mammogram) or 5-10 week challenges. Every time you check a goal/challenge, you get money into a fund. Every adult, on every plan, can get at least R1,000 into the fund, and it can go as high as R16,000 (but that's after jumping through a lot of hoops, and only on the higher plans). If you register this year, you will get an immediate R1,000 per adult (on any plan) on 1 January 2026 (see above, under "Saving Money").
Fedhealth: D2D benefit unlocks generous benefits (R3,000-R4,5000 per year) for out of hospital expenses if you complete a wellness assessment and register n the app.
Profmed: If you complete a preventative screening, you unlock R2,750 per year for day-to-day expenses.
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We've loaded the 2 new Bonitas plans (BonCore and BonPrime) and the 2 new Discovery Plans (Classic Smart Saver and Essential Smart Saver) on the rehealth.co.za site. (All the old plans for Bonitas and Discovery have also been updated with 2026 benefits).
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Speaking of Bonitas, last week I mentioned the "capturing" of the scheme by some of the execs (first published in Business Day), and this week the Council of Medical Schemes has said they are taking these allegations seriously and have opened an investigation. #Get The Popcorn
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Looks like the medical aid credits are going away, at some point in the next few years.
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Don't forget, rehealth,co.za allows you to check all your plan benefits here, and you can also compare any two plans side by side.
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πΏπ¦ Everyday health and wellness:
You might have 99 problems - until you have a health problem. Then you'll have just one problem. We help you look after yourself π
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Bright idea: let's train more doctors
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I recently heard of a star medical student who could not get into medical school in South Africa, and had to go study in Mauritius. Another story was how a new graduate couldn't specialise in orthopaedic surgery, because only 1 or 2 positions per province are available a year, and because he was Indian he was bottom of the pile.
I don't understand why it's so difficult to get into medical school. We have a lot of young brilliant minds in the country, but even straight-A students struggle. And in any case: straight-As do not guarantee success in medical school (or as a doctor), and non straight-As do not mean that a student would fail in medicine.
I propose that we accept all students who are eager to study medicine, and who have some decent grades, into first year of medical school, and then we let the cookie crumble. Those who make it through the first year, great. Those who don't can change careers, or downgrade to other medical fields.
It's madness that we are turning bright students away when we have such a shortage of doctors in the country (and the world).
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Other news:
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β οΈThere is an increase of Typhoid cases in the country. Lots of denials all around, but to be safe boil your tap water before drinking it.
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β οΈThere are also increased cases of rabies. Stay alert and vaccinate your pets.
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π End of year gets hectic and stressful. If you or someone you know needs mental health intervention, know that medical aid pays for up to 15 out of hospital consults with a psychologist, or up to 21 days in a mental health facility. By law. Even on hospital plans. More info here.
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Know of a South African service / product / facility that I should feature here? Let me know by hitting reply to this email!
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πΏπ¦ Weekend loading...
An important part of staying healthy is taking time out to relax, and smell the roses. Go hang out with a book, a podcast, your dog or your friends. Climb a mountain, eat a salad. Smile. This section is all about helping you get into that mood.
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Watch: Diagnoses (Netflix)
Diagnosis follows patients on their journeys toward finding a diagnosis, and potentially a cure, for their mysterious illnesses. By combining the power of global crowdsourcing, social media, and established medical expertise, each case is untangled with illuminating new insights that had previously eluded doctors. (Fun fact: the last episode has a condition that I suffer with (Waldenstrom). )
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Read: A builderβs guide to living a long and healthy life
I'm not going to lie...this is a long, detailed read, but it is full of valuable insight into how to adjust your lifestyle to improve chances of a long and healthy life. Justin Mares breaks down everything, from what clothing to wear, what food to eat, what products to use etc. Very US centric, but the message is clear and applies to all of us. I've bookmarked it to reference over the next months. Find the full article here. β
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Watch: How to control your Cortisol
It's a long, complex episode, but it's very helpful if applicable to you. Getting your cortisol rhythm right can be transformative for your health and performance. Huberman explains how to properly set your cortisol rhythm, which can significantly increase your daytime energy, focus, mood, and stress resilience, while also improving your sleep quality.
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π Next week...
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Thank you for reading! I appreciate your attention :-). Next week I am planning to tackle the following topics (but send me suggestions or questions!).
- When medical aids get sued...we discuss some recent cases
- Who pays for MRIs and CT Scans, and when?
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See you then!
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PS. If you find value in this newsletter, please forward to a friend! I'll be so happy to see it spread through more medical aid members. Strength in numbers!
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Important side note: I am not a broker or financial advisor, so cannot give individual advice. All info is my own interpretation of how the medical aid etc world works. Always speak to a broker or your insurer before making any decisions about your health cover
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