Open scheme · Administered by Genesis
Genesis Medical Scheme
Open scheme with a small range of MED options and no broker commission built into contributions.
Genesis at a glance
Genesis sells catastrophic cover and very little else. No gym benefit, no rewards points, no savings account on two of its three options. What you get instead is unrestricted choice of hospital and doctor from R1 680 a month, basic dentistry on every plan, and the strongest reserves of any open scheme in the country.
Genesis contributions for 2026
Effective 1 January 2026. Genesis does not use income bands, so someone earning R15 000 a month pays exactly the same as someone earning R150 000. An adult dependant pays the same as the principal member on every option. A child dependant is registered under the age of 21.
| Option | Type | Main member | Adult | Child | Day-to-day fund |
|---|---|---|---|---|---|
| MED-100 | Hospital plan | R1 680 | R1 680 | R525 | None |
| MED-200 | Enhanced hospital plan | R2 355 | R2 355 | R675 | None |
| MED-200 Plus | Comprehensive | R3 400 | R3 400 | R675 | R10 800 per adult |
The 2026 increase averaged 4.7%, announced on 16 October 2025. Genesis says this is the fourteenth year running it has posted the lowest average increase of any South African open scheme, against competitor increases of 6.8% to 9.9%. Rates for 2027 are usually announced in October and have not been published yet.
What a household pays each month
| Household | MED-100 | MED-200 | MED-200 Plus |
|---|---|---|---|
| Single member | R1 680 | R2 355 | R3 400 |
| Member and partner | R3 360 | R4 710 | R6 800 |
| Member, partner, 1 child | R3 885 | R5 385 | R7 475 |
| Member, partner, 2 children | R4 410 | R6 060 | R8 150 |
| Member, partner, 3 children | R4 935 | R6 735 | R8 825 |
Excludes any late-joiner penalty, which can add up to 75% to an adult contribution. See the joining section below.
The three Genesis options
All three give you the same freedom to use any hospital and any doctor in South Africa. What changes is the rate specialists are paid at, and whether cancer, dialysis and day-to-day care are covered.
MED-100
Entry hospital plan
R1 680 / adult
- Any private hospital
- Basic dentistry included
- Screening tests included
- Specialists at 100% of tariff only
- No cancer or dialysis benefit
- R3 000 co-payment per MRI
MED-200
Enhanced hospital plan
R2 355 / adult
- Specialists at 200% of tariff
- Cancer up to R275 000 a year
- Dialysis up to R300 000 a year
- Scopes and out-of-hospital scans
- No MRI co-payment
- No day-to-day cover
MED-200 Plus
Comprehensive
R3 400 / adult
- Everything on MED-200
- R10 800 day-to-day fund per adult
- GP visits, medicine, spectacles
- Orthodontics and physiotherapy
- Fund is capped, then you self-fund
What each option actually covers
R1 680 per adult, R525 per child. Bare in-hospital cover for people who are healthy, self-fund their doctor visits and want protection against a hospital bill they could not otherwise pay.
- Ward and theatre fees at 100% of the Genesis Scheme Tariff, at any private hospital you choose.
- GPs and specialists in hospital at 100% of Scheme Tariff. This is the plan's weak point: specialists routinely charge two to three times that rate, and the shortfall is yours.
- MRI and CT scans covered in hospital, but with a R3 000 co-payment per scan.
- Internal prosthetics paid at only 50% of cost up to R23 300 a year, so a hip or knee replacement leaves a large gap.
- No cancer benefit, no dialysis benefit, no transplant medicine benefit beyond what the law requires for PMBs.
- No colonoscopy or gastroscopy benefit.
- No out-of-hospital X-rays, scans, medicine, GP visits or optometry at all.
- Basic dentistry and the three screening tests are included, which is unusual at this price.
R2 355 per adult, R675 per child. The extra R675 a month over MED-100 buys the benefits that actually bankrupt people.
- GPs and specialists in hospital at 200% of Scheme Tariff, which closes most of the balance-billing gap MED-100 leaves open.
- Cancer cover of R275 000 per beneficiary a year: oncologist consultations, chemotherapy, radiotherapy, PET and bone scans, pathology, medicine and materials.
- Haemodialysis up to R300 000 a year.
- Organ transplant immuno-suppressant medicine up to R84 000 a year.
- Internal prosthetics at 100% of cost up to R35 000, instead of half the cost.
- No R3 000 MRI co-payment in hospital.
- Colonoscopy R7 900, gastroscopy R5 300, both together R10 300, limited to two claims a year.
- Out-of-hospital scans at half cost: MRI and CT to R8 400 a year, X-rays and ultrasound to R5 800 a year. The ultrasound benefit may be used for pregnancy scans.
- Epidural pain relief for back and neck conditions at 75% of cost up to R7 500 a year.
- Still no GP visits, medicine or optometry out of hospital.
For most buyers comparing the Genesis range, this is the option that makes sense. It costs 40% more than MED-100 but removes the three biggest holes: cancer, dialysis and specialist shortfalls.
R3 400 per adult, R675 per child. Hospital benefits are identical to MED-200. The extra R1 045 a month buys the Self Managed Fund.
- The SMF gives you R10 800 per adult per year, released quarterly in advance rather than in one lump in January.
- It pays for GP and specialist consultations at 200% of Scheme Tariff, prescribed medicine, spectacles and contact lenses, pathology, physiotherapy and biokinetics, external appliances, and advanced dentistry including orthodontics.
- It behaves like a savings account, not a risk benefit. Once the fund is spent, day-to-day costs come out of your own pocket for the rest of the year.
- At R40 800 a year per adult, the R10 800 fund is roughly 26% of what you pay in. Work out whether you actually spend that much on routine care before choosing it over MED-200.
Genesis options side by side
Tick the box to hide everything the three options have in common, so only the differences are left.
| Benefit | MED-100 | MED-200 | MED-200 Plus |
|---|---|---|---|
| Hospital ward and theatre | 100% Scheme Tariff | 100% Scheme Tariff | 100% Scheme Tariff |
| GP and specialist in hospital | 100% Scheme Tariff | 200% Scheme Tariff | 200% Scheme Tariff |
| Choice of hospital | Any provider | Any provider | Any provider |
| Day-to-day fund | None | None | R10 800 per adult |
| Cancer treatment | No benefit | R275 000 a year | R275 000 a year |
| Haemodialysis | No benefit | R300 000 a year | R300 000 a year |
| Transplant medicine | No benefit | R84 000 a year | R84 000 a year |
| Internal prosthetics | 50% to R23 300 | 100% to R35 000 | 100% to R35 000 |
| MRI and CT in hospital | R3 000 co-payment | Covered in full | Covered in full |
| MRI and CT out of hospital | No benefit | 50%, to R8 400 a year | 50%, to R8 400 a year |
| X-rays and ultrasound out of hospital | No benefit | 50%, to R5 800 a year | 50%, to R5 800 a year |
| Colonoscopy and gastroscopy | No benefit | Covered, 2 a year | Covered, 2 a year |
| Epidural pain relief | No benefit | 75%, to R7 500 a year | 75%, to R7 500 a year |
| Basic dentistry | Included | Included | Included |
| Orthodontics | Excluded | Excluded | From the SMF |
| Spectacles and contact lenses | No benefit | No benefit | From the SMF |
| GP visits out of hospital | No benefit | No benefit | From the SMF |
| Emergency transport (ER24) | 100% of cost | 100% of cost | 100% of cost |
| Cover outside South Africa | Excluded | Excluded | Excluded |
Any hospital, any doctor: what "no networks" really means
Genesis is the clearest example in South Africa of a scheme that competes on freedom rather than price control.
There is no hospital network, no GP network and no specialist network on any of the three options. You can use Netcare, Life Healthcare, Mediclinic, an independent day clinic or a provincial hospital, and you do not need to nominate a GP or get a referral to see a specialist. That is rare. Most schemes at the R1 700 mark restrict you to a named list of hospitals and charge R10 000 or more for using one that is not on it.
The trade-off. Because Genesis does not negotiate network discounts, it controls costs through its Scheme Tariff, a fixed rate the scheme sets itself. Your bill is paid up to 100% of that tariff on MED-100 and 200% on the two MED-200 options. If your surgeon charges 300% of tariff, you pay the difference. So the question with Genesis is never "is this hospital covered", it is always "what does this doctor charge". Ask the surgeon and the anaesthetist for their rate before an elective admission. That one phone call is where the money is.
Designated service providers
ER24, emergencies
Preferred provider for emergency treatment, ambulance transport, evacuation and hospital transfers inside South Africa, paid at 100% of cost. Call 0861 43 63 74.
All public hospitals
Designated for Prescribed Minimum Benefits. A PMB paid in full with no shortfall has to be treated in a state hospital at the Uniform Patient Fee Schedule rate.
Mental health DSPs
DSPs exist and their claims are paid in full, but Genesis does not publish the list. Phone the scheme before booking.
No pharmacy network
No named pharmacy DSP and no find-a-doctor tool, because there is no network to search.
Benefits in detail
Tap any heading to open it.
Dentistry, included on every plan
This is the one day-to-day benefit that survives on the hospital plans, and it is more generous than most. Every beneficiary on all three options gets the following each year, paid at the lower of cost or Scheme Tariff, from any registered dentist.
| Dental benefit | What you get |
|---|---|
| Oral examinations | 3 per year |
| Scale and polish | 2 per year |
| Fillings | 6 per year |
| Tooth extractions | Covered |
| Root canal treatment | 2 a year, not on wisdom teeth |
| Crowns, bridges or dentures | Up to R5 750 |
| Dental X-rays and Panorex | Up to R750 |
| Dental implant | 1 implant, R10 000 per 3 years |
| Wisdom teeth removed in hospital | Up to R15 000 per case |
Removal of bony impacted wisdom teeth is covered only where pathology and pain are directly linked to those teeth, and is limited to one hospital admission per beneficiary a year. Children under 9 get one lifetime benefit for extractions and fillings under anaesthetic, up to R10 000 per case. Orthodontics is excluded on MED-100 and MED-200, and comes out of the Self Managed Fund on MED-200 Plus.
Screening tests Genesis pays for
Genesis runs no wellness programme and no annual health check. Preventative cover is three tests, paid at 100% of the lower of cost or Scheme Tariff on all three options.
| Test | Who qualifies | How often |
|---|---|---|
| Mammogram | Age 39 and under, if a GP or gynaecologist prescribes it | Once a year |
| Mammogram | Age 40 and over, no prescription needed | Once a year |
| Cervical (PAP) smear | Age 18 and over, if prescribed | Once a year |
| PSA test (prostate) | Age 50 and over | Once a year |
There is no published benefit for flu vaccines, childhood immunisations, HIV tests or a general annual physical.
Chronic medicine and Prescribed Minimum Benefits
Chronic cover on all three options is limited to the conditions on the statutory Chronic Disease List, which holds 26 conditions including asthma, diabetes type 1 and 2, hypertension, epilepsy, HIV, bipolar mood disorder and chronic renal disease. Genesis pays 100% of the cost of formulary medicine, limited to its therapeutic algorithms.
You have to register the condition before the benefit starts. The chronic registration line is 0600 77 45 93. Genesis does not publish its medicine formulary, so ask for it when you register, so you know whether your current prescription is on it or whether you will pay in.
Genesis says plainly on its own site that not every cancer qualifies as a PMB. Worth knowing before you buy MED-100, which has no cancer benefit of its own.
Every published rand limit for 2026
| Benefit | Limit | Applies to |
|---|---|---|
| Cancer treatment | R275 000 a year | MED-200, MED-200 Plus |
| Haemodialysis | R300 000 a year | MED-200, MED-200 Plus |
| Transplant immuno-suppressants | R84 000 a year | MED-200, MED-200 Plus |
| Mental illness out of hospital, non-DSP | R1 350 a visit, R54 000 a year | All options |
| Internal prosthetics | R23 300 a year at 50% | MED-100 |
| Internal prosthetics | R35 000 a year at 100% | MED-200, MED-200 Plus |
| External appliances for fractures | R20 000 a year | All options |
| MRI and CT out of hospital | R8 400 a year at 50% | MED-200, MED-200 Plus |
| X-rays and ultrasound out of hospital | R5 800 a year at 50% | MED-200, MED-200 Plus |
| MRI and CT in hospital co-payment | R3 000 per scan | MED-100 |
| Epidural for back or neck | R7 500 a year at 75% | MED-200, MED-200 Plus |
| Colonoscopy | R7 900 per procedure | MED-200, MED-200 Plus |
| Gastroscopy | R5 300 per procedure | MED-200, MED-200 Plus |
| Both scopes at one sitting | R10 300 per event | MED-200, MED-200 Plus |
| Pathology linked to scopes | R1 750 a year | MED-200, MED-200 Plus |
| Hospice home care | R200 per day | MED-200, MED-200 Plus |
| Crowns, bridges, dentures | R5 750 a year | All options |
| Dental implant | R10 000 per 3 years | All options |
| Wisdom teeth in hospital | R15 000 per case | All options |
| Self Managed Fund | R10 800 per adult a year | MED-200 Plus |
What Genesis does not cover on any option
- Any medical treatment received outside South Africa. There is no travel or international benefit at all.
- Cosmetic surgery, including obesity surgery and elective procedures not caused by illness, accident or disease.
- Breast reductions and augmentations.
- Treatment relating to impotence.
- Advanced dentistry and orthodontics on MED-100 and MED-200.
- Out-of-hospital GP visits, acute medicine, and chronic medicine outside the CDL, on MED-100 and MED-200.
- Maxillo-facial surgery except after major trauma or an accident, and even then excluding implants, fillings, extractions, root canals, dentures, orthodontics, jaw osteotomies and genioplasty.
- On MED-100, MRI and CT scans for dento-alveolar procedures, migraine, and conservative back or neck treatment.
The full list of exclusions sits in the registered Scheme Rules, which Genesis does not publish on its public site. Ask for a copy before you sign.
Joining Genesis
Waiting periods, penalties and what the application actually involves.
Waiting periods
- General waiting period of up to 3 months. You pay contributions but cannot claim, except for certain PMBs. This applies if you have never belonged to a scheme, or cancelled your last one more than 90 days before applying.
- Condition-specific waiting period of up to 12 months on any pre-existing condition. This applies if you had less than two years of continuous cover.
- With two or more years of unbroken cover and no gap longer than 90 days, only the 3-month general waiting period may be applied.
- Members switching between Genesis options and newborns of existing members are exempt.
Late-joiner penalty, and what it costs
If you are 35 or older when you apply and cannot show unbroken South African medical scheme membership since 1 April 2001, Genesis may add a permanent penalty to your contribution. Only South African scheme membership counts, so cover you held while living overseas does not help you.
| Years without cover after 35 | Maximum penalty | Added to R1 680 |
|---|---|---|
| 1 to 4 years | 5% | R84 a month |
| 5 to 14 years | 25% | R420 a month |
| 15 to 24 years | 50% | R840 a month |
| 25 years or more | 75% | R1 260 a month |
The penalty is permanent and never falls away. Schemes may charge less than the maximum, but never more.
How the application works
- Apply online in three steps from a desktop or laptop, or email a signed, scanned paper form to joinnow@genesismedical.co.za.
- Within 24 to 48 hours Genesis emails you a PDF of everything you submitted. Check it and report corrections.
- Genesis reviews your full medical history. The scheme states that roughly one in five reviews turns up evidence of non-disclosure, and that leaving something out can mean claims are refused or membership cancelled. Disclose everything.
- If waiting periods or exclusions apply you get a counter-offer letter. You have 7 days to sign and return it.
- Membership starts on your requested date if no waiting periods apply.
Claims, authorisations and complaints
- Pre-authorisation. Every hospital admission needs an admission reference number from Genesis on 0860 10 62 05. The number does not guarantee payment if clinical protocols or the Scheme Rules are not met.
- Submitting a claim. Scan and email it to claims@genesismedical.co.za with your membership number clearly shown.
- Turnaround. Claims are processed within 24 hours and paid within 30 days of receipt. Rejection codes appear on your monthly statement.
- Billing errors. Ask the practice to resubmit a corrected claim within 60 days.
- Complaints. Start with the call centre on 0860 10 20 10. Genesis does not publish a formal internal disputes procedure.
- Escalation. If the scheme cannot resolve it, you have a statutory right to complain to the Council for Medical Schemes on 086 112 3267 or information@medicalschemes.co.za, and from there to the CMS Appeal Committee, the Appeal Board and ultimately the High Court.
Genesis contact details
One office, in Cape Town, and no walk-in branches anywhere else. Everything runs by phone, email, the member portal or the app. There is no Saturday service.
Offices and hours
Head office
The Terraces, 4th Floor, Black River Park, Fir Street, Observatory, Cape Town, 7925
Postal address
PO Box 144, Observatory, 7935
Office hours
Monday to Friday, 08:00 to 16:00. Closed weekends and public holidays.
Website and app
www.genesismedical.co.za. The Genesis Medical Scheme app is on the App Store, Google Play and Huawei AppGallery.
Scheme facts and financial strength
Genesis holds roughly nine and a half times the reserves the law requires, and more than two years of contribution income in the bank. On financial strength alone it is the most heavily reserved open scheme in the country. The flip side is size: fewer than 20 000 beneficiaries makes it one of the smallest open schemes registered in South Africa.
| Registered name | Genesis Medical Scheme |
| CMS registration number | 339 |
| Registered | 1995 |
| Scheme type | Open, anyone may join |
| Administration | Self-administered |
| Principal members | 9 224 (31 Dec 2025) |
| Total beneficiaries | 19 362 (31 Dec 2025) |
| Average age of beneficiaries | 39.2 years |
| Pensioner ratio | 11.39% |
| Solvency ratio | 239% (minimum is 25%) |
| Accumulated reserves | R1.19 billion |
| Annual contribution income | R425.5 million |
Who Genesis suits
A good fit for
Healthy adults and young families who can absorb GP and medicine costs themselves. Self-employed people who want the freedom to use any specialist. Higher earners, since flat rates ignore income. Anyone who values unrestricted hospital choice over a rewards programme.
Look elsewhere if
You need regular day-to-day cover. You are managing a chronic condition that is not on the Chronic Disease List. You want a savings account you can spend freely. You travel outside South Africa often. You want a network plan with capped co-payments, or walk-in offices and weekend support.
Questions Genesis members ask
Can I use any hospital on Genesis?
Yes. All three options let you use any private hospital, day clinic or provincial hospital in South Africa. There is no hospital network and no penalty for choosing one hospital over another. You do need a pre-authorisation reference number before you are admitted.
Does Genesis cover doctor visits?
Not on MED-100 or MED-200. Out-of-hospital GP and specialist consultations are for your own account on both plans. Only MED-200 Plus pays for them, from the Self Managed Fund of R10 800 per adult a year.
Why do I still get a bill after a Genesis hospital stay?
Because Genesis pays doctors at a set rate, not whatever they charge. On MED-100 that rate is 100% of Scheme Tariff and on the MED-200 options it is 200%. If your surgeon or anaesthetist charges above it, the difference is yours. Ask each practitioner what percentage of medical aid rate they bill at before an elective admission.
Does Genesis cover cancer treatment?
MED-200 and MED-200 Plus cover cancer up to R275 000 per person a year. MED-100 has no cancer benefit of its own, so cover there is limited to whatever the Prescribed Minimum Benefits require, and Genesis points out that not every cancer qualifies as a PMB.
What is the Self Managed Fund?
It is the day-to-day allowance on MED-200 Plus only, worth R10 800 per adult per year. Genesis releases it quarterly in advance instead of all at once, and you decide what to spend it on: GP visits, medicine, spectacles, physiotherapy, orthodontics and similar. When it runs out you pay for yourself.
Is dentistry included on the Genesis hospital plan?
Yes, and it is the reason many people choose MED-100. All three options include three check-ups, two scale and polish visits, six fillings, two root canals, extractions, crowns or dentures to R5 750, and one implant to R10 000 every three years.
Does Genesis cover me overseas?
No. Treatment received outside South Africa is excluded from the risk benefits on every option, and ER24 emergency transport is limited to within South Africa. Buy separate travel insurance before you fly.
How much does Genesis go up each year?
The 2026 increase averaged 4.7%, effective 1 January 2026. Genesis says this was the fourteenth year in a row it posted the lowest average increase among South African open schemes. Rates for 2027 have not been announced yet.
Will I pay a penalty for joining Genesis late?
Possibly. If you are 35 or older and cannot prove unbroken South African medical scheme cover since April 2001, a late-joiner penalty of between 5% and 75% may be added to your contribution permanently. Only South African scheme membership counts towards the calculation.
Is Genesis financially safe?
On the numbers, exceptionally so. Its solvency ratio was 239% at the end of 2025 against a statutory minimum of 25%, with R1.19 billion in accumulated reserves on R425 million of annual contributions.
Contributions and benefits on this page come from the 2026 Genesis MED-100 and MED-200 benefit brochures and from genesismedical.co.za, last checked on 9 September 2026. Benefits are governed by the registered Scheme Rules. This page is information, not financial advice.