What You Should Know

This information may help to answer the most frequently asked questions:

Enquire at AMBITON for more detailed information on late-joiner penalties as well as on waiting periods and exclusions.

2. CHILDREN AND BABIES
A baby should be registered within 30 days of birth. The baby will be covered automatically for the calendar month of his or her birth. To continue cover, contributions for the baby must be paid from the first month following the baby's birth. The baby may be subject to underwriting, if he or she is not registered within the 30-day period

3. THRESHOLDS
There are specific schemes that offer a threshold benefit which enables members to claim for their day-to-day benefits (doctors, dentists etc.), once the savings portion is exhausted. Members will be liable to pay for their daily medical expenses (self payment gap) until a certain limit known as a threshold is reached. On certain scheme options a limit might apply on your day to day benefits once you have reached your threshold benefit. 

Subsequently the scheme will continue to cover the costs of the medical services received at the schemes predetermined rate. You must also keep in mind that not all schemes have an above threshold benefit. Various schemes have a savings plan, once the personal medical savings account is depleted all day-to-day costs will be for the members own accountCertain factors may influence the increase of the self-payment gap and even in some cases make the above threshold benefit almost impossible to reach, for example:

• Over-the-counter medication, without a doctor’s prescription, will be funded from your medical savings subject to availability but this purchase will not accumulate to the threshold. The result may be a potential self-payment gap before the above-threshold benefit is reached.
• Private medical rates, contrary to medical aid rates, will be reimbursed, but only the medical aid rate will accumulate towards the threshold.