Posted on April 29, 2021 by Staff Writer
Genesis medical scheme has always featured as one of the most affordable private healthcare schemes in South Africa. Since its establishment in 1995, the scheme has managed to build a reputable track record of having intimate understanding of private healthcare.
Getting a medical aid policy is surely the right decision you can make to take care of your health. In recent years, we have seen an impressive increase of people signing up for medical aid in South Africa, in 2019 an average of 22,7% households had a medical policy.
In this publication, we are going to explore both hospital plans and comprehensive medical aid plans offered by Genesis and their respective 2021 rates.
The Scheme plans
Private Choice Option
The Genesis Private Choice hospital plan does not only cover your hospital stay, but also offers basic dentistry care benefits. Among other hospital plans in the market, Genesis Private Choice plan features as one of the best in terms of offering value for money.
As most market options will restrict members to Network Hospitals and Designated Service Providers, the Genesis Private Choice stands out by not restricting its members to any hospital. The scheme gives you the freedom to use any private hospital of your choice and also covers quite a number of specialist treatments from your prefered specialist.
However, there are some conditions like psychiatric treatments that are only covered in full when you use the DSP. For a clearer look into this plan, you will have to download the scheme’s brochure.
There is an annual in-hospital limit of R50 000 per beneficiary of up to 100% of Scheme Tariff for cancer, stroke, motor-neuron disease and organ transplants. However, the Out-of-hospital benefits are limited to Statutory Prescribed Minimum Benefits (PMBs) in public or state hospitals.
The 2021 Private Choice contributions
Main Member R1 340 Adult Dependent R1 340 Child Dependent R440
The Private Benefit Option
Genesis’s Private plan option offers all benefits that you can get from the Private Choice option, the difference is that the Private option tends to offer higher benefit limits, some even at 200% of the scheme tariff.
Even though it is a mere hospital plan, the option does not only cover basic dentistry as an added out of hospital benefit. In Genesis’s Private choice you will also be covered for Plain Radiography (X-rays) and some scans as added benefits. Brochure.
The 2021 Private contributions
Main Member R1 850 Adult Dependent R1 850 Child Dependent R530
Comprehensive medical aid plan; Private Comprehension
Genesis is not only considered the best cover for entry-level health cover but the scheme also caters for high-income earners that need a comprehensive cover for their in-hospital needs and average out-of-hospital coverage.
In all the previous years, Genesis has been offering two options in their comprehensive plans; the Private Plus and the Private Comprehensive. However, at the time of this article we could only get their 2021 comprehensive medical aid plan packed in one package, hence its the only one in review here.
Genesis’s Private Comprehension option is designed to provide you with additional day-to-day cover by way of a Self Managed Fund (SMF). With the SMF, it is as good as providing you with a medical savings account in which your day to day healthcare needs can be covered from.
With Genesis, members are provided with a separate SMF of R8 160 per annum to pay for their day to day health care needs. Each month the scheme is responsible for taking a potion from your monthly contribution into your SMF account.
The Private Comprehension plan covers all the In and Out-of-hospital conditions giving you peace of mind of knowing that your healthcare needs are covered. Among the Out-of-Hospital benefits, policyholders have consultation benefits, medicine needs are covered, plain radiography and pathology benefits are included.
The 2021 Private Comprehension contributions
Main Member R2 640 Adult Dependent R2 640 Child Dependent R530
Basic Dentistry Benefits
In any option from Genesis medical scheme, members get cover for basic, as well as selected enhanced dentistry benefits. These include the following services when obtained from a registered Dental Practitioner:
- Three (3) dental oral examinations
- Six (6) fillings
- Unlimited extractions
- Six (6) plain x-rays for conservative dentistry
- Two (2) root canal treatments
- Crowns, dentures or bridges limited to the lower of cost or Scheme Tariff
- Surgical removal of impacted wisdom teeth
- One (1) scale and polish
- One (1) dental implant limited to R10 000 per three year financial year cycle of membership
Competitive Advantages of the Genesis Medical Scheme
- Genesis is one of the few medical schemes that gives freedom of hospital choice to its members across all plans offered.
- All Genesis plans have an added basic dentistry benefit that is not necessarily paid for from the monthly contributions you make, rather it is paid from the scheme’s pocket.
- Genesis medical scheme has built a good name for themselves by maintaining reliability in claims payments.
Competitive disadvantages of Genesis medical scheme
Although Genesis also has comprehensive medical aid, most of the out-of-hospital benefits are subject to the SMF which is only limited to R8 160. This could be a very small amount for someone with a fragile health who is in constant need of day to day medical care.
Genesis is an ideal medical scheme especially if you want to enjoy the freedom of choosing a hospital of your choice. It doesn’t matter which plan you will choose, it is Genesis’ way of doing things to provide you with that privilege.