What is a co-payment?
Depending on the plan you’re on or the healthcare provider you use, your medical aid plan may not cover your entire medical expense. In this case, you may be responsible for a co-payment, which is the amount that you must pay from your own pocket for a particular treatment or procedure as determined by your medical aid scheme.
How much this co-payment is depends on your specific circumstances: whether it’s for an in-hospital procedure, or for medication, and then which hospital and specialist you’re using. If you use network providers only, you probably won’t have any co-payments; if you use an out-of-network hospital or specialist, then you may pay a co-payment. Co-payments are either a percentage of the cost of your medical expense or a fixed amount
As part of the rules set out by the Council of Medical Schemes in South Africa, you’re not allowed to be charged a co-payment for a Prescribed Minimum Benefit (PMB), as long as you use the scheme’s Designated Service Providers (DSPs) or use medicine on the scheme’s medicine formulary. However, if you use a different provider other than the DSP, you may be liable to pay a co-payment as part of the scheme’s rules.