FAQs
Frequently Asked Questions
Healthcare
A co-payment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service.
Yes, with the assistance of his/her parents or guardian, provided that the relevant contributions are paid by him/her or on his/her behalf.
Yes, the notice period stipulated in the rules must be complied with.
Yes, until the last day of membership provided contributions are being paid.
Yes, since the employer pays the contributions on behalf of its employees and since the scheme has a contract with the member. The Scheme must give the employer and or/member written notice that if the contributions are not paid up within the stipulated period as per policy rules, membership may be cancelled.
No, contributions to a medical scheme may only be based upon a member’s income and/or his number of dependents.
No, the Act prohibits the payment of bonuses, rebates or re-funding of any portion of contributions other than in respect of savings accounts in certain circumstances.
Only in respect of the cover provided. Different benefit options/plans are priced differently depending on the level of cover afforded. If the rules of the scheme so provide, children may be charged a reduced contribution.
Instead of changing schemes and be faced with waiting periods, a member can either buy up in order to get better benefits or buy down for less contributions.
A healthcare provider or group of providers selected by the scheme as the preferred provider or providers to provide to its members diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions.
General waiting period of up to three months. Condition-specific waiting period of up to 12 months.
Prescribed minimum benefits other than specified in Q28
A child dependant born during the period of membership
A member moving between benefit options unless he has to complete the remaining period of previously imposed waiting periods.
When an individual has to involuntarily transfer to another scheme due to a change of employment.
In instances where an employer changes the medical scheme of his employees with effect from the beginning of the financial year.
It is a penalty by way of additional contributions, imposed on persons joining a scheme late in life i.e. an applicant who is 35 years of age or older who was not a member of one or more medical schemes as from a date preceding 01 April 2001 without a break in coverage exceeding three consecutive months since 01 April 2001.
The Medical Schemes Act makes provision for medical aid schemes to impose twelve (12) months condition-specific waiting period(s) for any pre-existing medical condition(s), such as pregnancy.
How do I know whether or not my scheme has paid and what amount has been paid in respect of a claim?
Payment of claims is regulated by the Act, which includes the dispatch to a member of a statement containing full particulars of the transaction, including the amount charged for every service and the amount of the benefit awarded for each service.
If the account or claim is correct and acceptable for payment, it should be paid within 30 days of receipt of the claim.
It will be different response for different cases. Could be member on chronic but not registered, member went to a specialist and was charged above scheme rates.
Contact the call centre on 011 768 6406 to assist you by requesting the authorisation from the schemes.
Contact the call centre to assist with registrations for different schemes.
There are different reasons as to why this is. Your funds might be exhausted. For further assistance contact the call centre on 011 768 6406.
To the contact centre, where it will be sent to the relevant scheme.
Contact the call centre on 011 768 6406 to check your application status and for any questions regarding your application.
Medical Aid Plans
- Proactively manage medical your expenses/
- Get the best medical care available and enjoy the security of knowing your medical needs catered for.
- Receive immediate medical treatment in an emergency without worrying about the availability of funds. You can undergo surgery and medical treatment when you need it most.
- Enjoy leading a healthy lifestyle that medical aid schemes offer
Insurance
Moso understands insurance can really be a grudge purchase, but by focusing our insurance solutions on value and reliability we make the buying decision more pleasant. We pride ourselves in making you understand what it is that you are purchasing, how well it will work for you, and what should you do when the unfortunate event occurs when it’s time to claim.
Insurance is a way of reducing your potential financial loss or hardship. It can help cover the cost of unexpected events such as theft, illness or property damage. Insurance can also provide your loved ones with a financial payment upon your death.
You pay a fee called a premium, and in exchange, the insurance company agrees to pay you a certain amount of money if the event you are insuring against is covered and happens during the term of the policy.
The details of insurance protection, such as exactly which events are covered and for how much, are defined in your insurance policy. The insurance policy is a contract between you and the insurance company.
Insurance can protect you and your loved ones from financial loss if something unexpected happens. For example:
Auto insurance could pay the cost of repairs to your vehicle if you have an accident.
Life insurance could provide your family with money to support themselves when you die.
Home or Property insurance could pay for the cost to repair your home if there is a fire in your house.