POLMED

POLMED states that its members have access to 270 Prescribed Minimum Benefit conditions and, in addition, guaranteed treatment and medication for 26 chronic conditions. There is no overall annual limit for PMBs or life-threatening emergencies on either option, and PMB claims accrue towards the out-of-hospital pool first but are not themselves capped by it.

Three things attach to that cover:

• You must register the condition. If a doctor diagnoses a chronic PMB condition, the doctor or pharmacist must call POLMED to verify that you meet the clinical entry criteria. Once registered, medicine and disease management are funded from the correct benefit category and not from your day-to-day pool. Until you register, they come off your day-to-day benefits.
• You must use a designated service provider. Where POLMED has appointed a network provider for a PMB condition and you voluntarily choose someone else, a co-payment of up to 30% may be applied, subject to the PMBs.
• You must reapply before the authorisation expires. The rules require reapplication at least one month before an existing chronic authorisation lapses. Miss it and claims are paid from the acute medicine benefit instead, if any is left. This applies only to authorisations with an expiry date.

What each option covers

Both options fund the statutory Chronic Disease List without limit. The list runs across auto-immune, cardiovascular, endocrine, gastrointestinal, gynaecological, haematological, metabolic, musculoskeletal, neurological, ophthalmic, psychiatric, pulmonary and urological conditions, plus HIV and AIDS, tuberculosis, organ transplantation and treatable cancers as per PMB guidelines. The psychiatric group includes depression, bipolar mood disorder, schizophrenic disorders and post-traumatic stress disorder.

Marine adds an extended, non-PMB chronic list funded from the chronic medication benefit against a family limit of R12 393 for a member alone, R14 854, R17 317, R19 779 and R22 242 as the family grows. That list covers acne, psoriasis, eczema, onychomycosis, ankylosing spondylitis, osteoarthritis, osteoporosis, Paget's disease, psoriatic arthritis, dry eye, allergic rhinitis, GORD, gout prophylaxis, ADHD, PTSD, Alzheimer's disease, trigeminal neuralgia, Meniere's disease, migraine prophylaxis, narcolepsy, Tourette's syndrome, neuromyelitis optica, Huntington's disease and overactive bladder syndrome.

Aquarium has none of this. Its schedule records chronic medication for non-PMB conditions as no benefit. If your condition is on the extended list and you are on Aquarium, you buy the medicine yourself.

On both options POLMED will reimburse medicine intended for an approved chronic condition from the acute benefit for up to four months while you register it as chronic. Non-formulary products attract a 20% co-payment, which can be waived through an exception management process on written motivation from the treating provider.

Almost every out-of-hospital benefit draws from one pool and has its own sublimit inside it. When the pool is empty, the sublimits stop mattering. Benefits are calculated from 1 January to 31 December and are pro-rated from your date of joining, except optical, which runs from the benefit service date and is not pro-rated.

Benefits that carry a single family or beneficiary limit rather than a family-size scale, on Marine: physiotherapy R6 155 a family, psychology and social work R8 256 a family, occupational and speech therapy R3 550 a family, allied and alternative healthcare R3 473 a family, over-the-counter medicine R1 537 a family with a R200 cap per script, specialised dentistry R18 042 a family, basic radiology R8 115 a family, audiology R35 706 a beneficiary. On Aquarium: physiotherapy R2 108 a family for PMBs only, psychology and social work R5 659 a family, over-the-counter medicine R1 132 a family with a R160 cap per script and shared with the acute limit, basic radiology R5 920 a family, audiology R24 456 a beneficiary, and a specialist rand cap of R5 270 a beneficiary.

Emergency room visits are paid from the out-of-hospital pool unless you are admitted to hospital on the same day. That single sentence in both schedules is why a casualty visit that does not end in an admission can eat a large part of a small family's day-to-day money.

POLMED runs its enhanced benefits through registration. If you are not registered on the relevant programme, you get the ordinary benefit and not the enhanced one. The programmes are:

• Disease Risk Management Programme. Covers respiratory conditions (asthma and COPD), cardiac conditions (hyperlipidaemia, high blood pressure, heart failure, coronary artery disease and dysrhythmia), metabolic conditions (diabetes), spinal conditions (cervical and lumbar) and mental health (depression, bipolar mood disorder, post-traumatic stress disorder and substance abuse). Members are identified from claims data for chronic medicine, consultations and admissions, and contacted to enrol. Those who register receive a Care Plan listing authorised consultations, blood tests and radiology.
• Chronic Medicine Management Programme. The gateway to the chronic medicine benefit on both options. Your doctor or pharmacist registers the condition on 0860 104 111.
• Maternity Programme. Additional antenatal consultations, mental health screening and referral, a dedicated midwife allocation and teleconsultations.
• Oncology Management Programme and HIV Management Programme, the latter on its own line, 0860 100 646.
• Obesity Care Plan. Two GP consultations, specified blood tests, a nutritional assessment, a psychology assessment and a Weight Management Programme Care Plan. Marine only.
• Weight Management Programme. A 12-week exercise programme delivered by the Biokineticist Association of South Africa, including a health risk assessment, group or individual exercise sessions and dietitian and psychologist consultations. One enrolment a beneficiary a year, funded from risk as a separate basket.
• GoSmokeFree Programme. Delivered by a trained nurse through HealthCraft accredited pharmacies, with motivational behaviour change, carbon monoxide readings and relapse follow-ups. One enrolment a beneficiary a year, funded from risk. Nicotine replacement therapy comes from the acute benefit.
• Conservative Back and Neck Rehabilitation Programme. Funded from hospital risk rather than your day-to-day pool, and pre-authorised. POLMED will not fund spinal surgery unless there is evidence that conservative therapy was tried first, PMBs excepted.
• Specialised Dentistry and Prolonged Care for home nursing and home oxygen, both managed care programmes with their own authorisation routes.

Preventative healthcare, identical on both options

This is the strongest part of POLMED and it is the same whichever option you are on. It is funded from risk and does not deplete your out-of-hospital pool. It includes an annual wellness visit under tariff code 55500 covering blood pressure, body mass index, cholesterol, glucose, healthy diet counselling, waist-to-hip ratio and the consultation itself, plus:

• All Department of Health childhood immunisations for children 12 and under, and infant hearing screening up to six weeks of age.
• A Pap smear every third year for women aged 21 to 64, HPV screening every five years from 21, two HPV vaccinations for girls aged 10 to 17, and a mammogram every two years for women aged 40 to 74.
• Prostate cancer screening annually for men aged 50 to 75, and colorectal cancer stool screening every two years between 45 and 75.
• Glaucoma screening every third year, and optical screening for lazy eye and squints for children aged 3 to 5.
• Dental screening, fluoride application annually for children up to 16, caries risk assessment every second year for children up to 14 and for adults from 19, fissure sealants for ages 5 to 25 up to four a year, and polishing and prophylaxis twice a year.
• Annual HIV counselling, rapid testing and post-counselling.
• Annual flu vaccine, pneumococcal vaccine every five years, hepatitis B for all adults, pertussis booster every ten years from age 7, a maternal pertussis booster once per pregnancy, and the COVID-19 vaccine as a PMB.
• Bone densitometry once in a lifetime for members 65 and over, a Hib titer annually from 60, circumcision subject to protocols, contraceptives on a formulary, and Down syndrome screening in the first or second trimester as part of the maternity programme.
• Post-trauma debriefing: four individual or four group sessions a year, for active serving SAPS members only, through the Psycho-Social Network.

Maternity is pre-authorised and subject to treatment protocols on both options. The consultation limit does not accrue towards the out-of-hospital pool, which matters, because it means antenatal care does not eat your day-to-day money.

• Three specialist consultations a beneficiary a pregnancy, on both options.
• Ultrasound scans: an annual limit of R6 066 a beneficiary on Marine, limited to two 2D scans a pregnancy, and R4 570 a beneficiary on Aquarium. More than two antenatal scans, and amniocentesis after 32 weeks, need pre-authorisation.
• Home birth is covered to R22 442 a beneficiary a year on Marine and R17 132 on Aquarium.
• The Maternity Programme adds antenatal consultations, mental health screening and referral, a dedicated midwife allocation and teleconsultations on both options.
• A maternal pertussis booster once per pregnancy in the third trimester, and Down syndrome screening in the first or second trimester, both from the preventative benefit.
• Newborns are treated as part of the mother's cost for the first 90 days. Register the baby within 90 days of birth and scheme rule 7.1.2 applies. A separate authorisation is needed if the baby is admitted to hospital. Benefits are also granted if the child is stillborn.

Assisted reproduction is a general exclusion except as prescribed in a public hospital, as defined in the PMBs, and subject to pre-authorisation. Surrogate pregnancy treatment is excluded outright. Reversal of sterilisation is excluded, though the Board may grant it in exceptional circumstances.

Cancer treatment is paid at 100% of the agreed tariff at a network service provider, and it is capped.

Chemotherapy and radiation are limited to the oncology benefit, adherence to the POLMED oncology formulary is required, and medicines must come from the preferred provider network. Treatable cancers are covered as a PMB category on both options, so PMB cover continues where the rand limit does not, but a non-PMB cancer treatment above the limit is yours.

The general exclusions add one that is worth reading before you start treatment: the scheme excludes any new chemotherapeutic drug that has not convincingly demonstrated a survival advantage of more than three months in advanced or metastatic malignancy, unless the managed care organisation pre-authorises it as a cost-effective alternative to standard chemotherapy. Oncology medicine to take out after a hospital stay is not capped at the usual seven days' supply.

The in-hospital and psychotherapy limits are identical on both options. What differs is the money behind out-of-hospital psychology.

• 21 days a beneficiary a year in hospital, or 15 out-of-hospital psychotherapy sessions as a threshold in line with PMB benefits. Beyond that threshold, managed care protocols apply.
• Hospitalisation is limited to a maximum of three days if you are admitted by a GP or a specialist physician rather than a psychiatrist. Additional days must be motivated by the medical practitioner.
• Psychology and social work out of hospital, including marriage counselling, is capped at R8 256 a family on Marine and R5 659 a family on Aquarium, from the out-of-hospital pool. Educational and industrial psychology are excluded on both.
• Social workers and registered counsellors are limited to four consultations in a benefit cycle.
• Four psychosocial consultations for serving members are provided for on Marine, in addition to the four post-trauma debriefing sessions available annually to active serving SAPS members through the Psycho-Social Network.
• Depression, bipolar mood disorder, schizophrenic disorders and post-traumatic stress disorder are all on the PMB Chronic Disease List on both options, so medicine for them is unlimited once registered. PTSD also appears on Marine's extended non-PMB list and in the Disease Risk Management Programme.
• Substance abuse is covered through the Disease Risk Management Programme's mental health stream. Treatment or prevention of alcohol abuse in the acute medicine benefit is excluded except as a PMB.

The mental health programme runs through polpsych@medscheme.co.za. Sleep therapy is a general exclusion. In-hospital allied care specifically excludes rehabilitation, sub-acute, mental health step-down and alcohol rehabilitation facilities on both options.

POLMED splits dentistry into basic and specialised, and the split matters more on Aquarium than anywhere else on the scheme.

Basic dentistry is consultations, fluoride, fissure sealants, non-surgical extractions, cleaning and non-surgical gum treatment, root canal, fillings and plastic dentures. It comes from the out-of-hospital pool, subject to a sublimit of R7 348 to R11 318 by family size on Marine and R5 253 to R7 842 on Aquarium. Routine consultation, scaling and polishing are limited to two check-ups a beneficiary a year on both.

Specialised dentistry is periodontal treatment, crowns and bridges, inlays, indirect veneers, orthodontics, partial chrome cobalt frame dentures and maxillofacial surgery. On Marine it carries an annual family limit of R18 042, covers procedures in and out of hospital, includes a second metal denture frame per beneficiary in a five-year period where clinically appropriate, and runs on a five-year cycle for crowns and bridges. On Aquarium there is no general specialised dentistry benefit: it covers PMB events and a short predefined code list only, being surgical extractions requiring bone removal, surgical removal of impacted teeth, root planing for periodontal disease, drainage of an abscess, apicectomy, cyst removal of non-vital pulp, full-mouth clearance under sedation, and general anaesthesia for children under seven or physically or mentally disabled patients.

• All dental procedures performed in hospital require pre-authorisation. All specialised dentistry requires pre-authorisation, and a R500 co-payment applies if you do not get it.
• Only removal of impacted teeth, and extensive dental treatment for children under seven, will be considered for in-hospital treatment at all.
• The dentist's costs for procedures normally done in the rooms come from the out-of-hospital pool even when performed in hospital. Only the hospital and anaesthetist costs come from the in-hospital benefit.
• Aquarium members pay a 30% co-payment for using a dentist outside the DENIS network. Marine members do not.
• Excluded on both: gold inlays in dentures, soft and metal bases added to new or full dentures including laboratory costs, invisible retainers, bleaching of living teeth, oral hygiene education and plaque control instruction, delivery fees from the dental laboratory, mouthguards for sport, and fixed orthodontics for anyone over 18 subject to the Index of Complexity, Outcome and Need. Orthognathic surgery is PMB only, and the temporomandibular joint benefit is limited to non-surgical intervention.

Optical runs through the PPN network on a 24-month cycle counted from the date of claiming, not the calendar year, and it is not pro-rated. Each beneficiary gets either spectacles or contact lenses, not both, in a cycle. Every claim for lenses or frames must carry the lens prescription.

The network composite consultation covers the refraction, a glaucoma screening, visual field screening and identity authentication, at 100% of cost. The eye examination is once every two years per beneficiary unless prior approval is obtained for a clinical indication. Contact lens re-examinations can be claimed at six-monthly intervals, and no contact lens benefit is granted if the beneficiary already took spectacles in the same two-year cycle. Aquarium adds screening for amblyopia and strabismus in children aged 3 to 5, limited to PMBs. Contact lens preparations are an excluded acute medicine category on both options.

A multifocal lens is worth R900 on Marine and R460 on Aquarium, which is close to half. Combined with a frame allowance of R835 against R1 686, an Aquarium member buying spectacles is looking at roughly R1 295 of scheme money against R2 586 on Marine, before the two-year wait starts again.

These are stand-alone benefits, so in appropriate cases the medical appliance limit does not accrue towards the out-of-hospital pool. Pre-authorisation is required for the listed appliances, quotations are required, and all maintenance costs are a scheme exclusion, as are repairs, parts and accessories.

Battery replacement for a cardiac resynchronisation therapy pacemaker and for an implantable cardiac defibrillator is covered every five years on Marine. Urine catheters and consumables on both options are subject to a cost-effective quote and clinical protocols. Where a benefit is marked as not listed above, the Aquarium schedule simply does not carry the line; PMB entitlement may still apply and that is a question for the scheme, in writing, before the procedure.

Two things POLMED handles that no open scheme has to.

Injury on duty

Injuries on duty are regulated by the Compensation for Occupational Injuries and Diseases Act, not by the scheme rules. Report the injury to your commander immediately or before reporting off duty, however minor it appears. If you cannot, a colleague must do it for you. The commander completes a WCL 2 within 24 hours, the treating practitioner completes part B and attaches it to the medical account, and the employer submits the report to Head Office within 14 working days of the injury.

The supporting file must reach Head Office within three months of the injury and includes the SAPS 114, the injured member's supplementary statement, the WCL 4 for an ordinary injury, WCL 303 for PTSD or WCL 22 for COVID-19, the on-duty statement from the commander, the first report statement, witness statements, a copy of the pocketbook or diary entry, and where relevant the call-up instruction for a course, a sport championship or a physical fitness test.

PTSD claims run on their own forms, WCL 1 or 2, WCL 3, WCL 303 and WCL 304, and require a detailed psychiatrist report with a brief psychiatrist rating scale, an impairment rating scale and a global assessment of functioning score.

Benefits are payable within the prescribed 24 months or until the condition stabilises. Reopening a finalised claim requires the medical service provider to submit a request for reopening on their letterhead through Comp Easy or at a Labour Centre.

Motor vehicle accidents and third-party claims

POLMED's recoveries department at Medscheme is notified whenever you or a dependant is in an accident and will contact you. If you intend to claim against the Road Accident Fund or any third party you must supply a summary of how the accident happened, the third party's contact details, the name of your attorney if you have appointed one, the vehicle registration numbers and the police station where the accident was reported.

You will be required to sign POLMED's consent and indemnity forms including a Member Undertaking to include the scheme's liability in the third-party claim and to pay back the scheme's portion on a successful recovery. The guide states directly that failing to lodge a claim, to keep POLMED informed, or to pay back money recovered in a third-party claim breaches both your membership agreement and your employment contract with SAPS, and that you may be held personally liable. The recoveries line is 0800 117 222.

The general exclusions run to 37 numbered items on both options, with due regard to PMBs. The ones members actually run into:

• Anything outside South Africa. "The Scheme does not grant benefits for services rendered outside the borders of the RSA." Travel insurance is your responsibility, on both options. There is no travel benefit, no evacuation benefit and no emergency cover abroad.
• Services not aimed at treating an actual or supposed illness. Ageing is specifically not treated as an illness.
• Cosmetic operations and procedures where no pathological substance proves the necessity, and anything not life-saving, life-sustaining or life-supporting.
• Sleep therapy. Sex change operations. Reversal of sterilisation, subject to Board discretion. Any treatment resulting from a surrogate pregnancy.
• Artificial insemination, except as prescribed in a public hospital, as defined in the PMBs, and pre-authorised.
• Charges for appointments you fail to keep.
• Accommodation in old-age homes, institutions providing general care for the aged or chronically ill, spas, health resorts or rest resorts, and holidays for recuperative purposes.
• Reports, investigations or tests for insurance, university or school admission, fitness tests, medical court reports, employment, emigration and immigration. Also aptitude tests, IQ tests, school readiness, questionnaires, and assessment of learning or behavioural problems.
• Obesity treatment, though the Scheme may approve morbid obesity treatment on prior motivation.
• Repair, maintenance, parts and accessories for appliances and prostheses.
• Cosmetics and sunblock, though sunblock may be considered for albinism.
• Non-clinically essential or non-emergency ambulance transport. Beneficiaries' travelling costs.
• All clinical trials. Any health benefit not on the prescribed list, including new interventions where long-term safety and cost to benefit cannot be supported.
• Compensation for pain and suffering, loss of income, funeral expenses or damages.
• Accounts from providers not registered with a recognised professional body, and services from institutions not registered under any law.

Separately, a long list of acute medicine categories is excluded: slimming preparations, household remedies, emollients, food and nutrition products, soaps and cleansers, cosmetics, contact lens preparations, sunscreens, medicated shampoo, veterinary products, geriatric vitamins, tonics and stimulants, unregistered supplements, homeopathic remedies and natural oils, diagnostic agents, thermometers and hearing aid batteries, bandages and dressings, incontinence products other than stoma-related supplies, growth hormones, treatment of impotence or sexual dysfunction, female infertility treatment, androgens and anabolic steroids, all newly registered medication, and medicines where the cost to benefit ratio cannot be justified.

Membership is for serving members of the South African Police Service and their registered dependants. There is no public route in. A new member application needs the membership application form, a letter of appointment or SAP96, a copy of your identity document, proof of income in the form of a salary advice, three months of bank statements or a stamped letter from the bank confirming your banking details, and a membership certificate from your previous medical aid if you had one.

Who can be registered as a dependant

Applications go to polmedmembership@medscheme.co.za, fax 0861 888 110, post to Private Bag X16, Arcadia 0007, or by hand at any POLMED regional walk-in branch. Any change affecting your membership status must be reported within 30 days.

This is the rule that costs people their medical cover, and it is stated in one line in the membership section.

Continuation of membership under scheme rule 6.3.1 is available in five situations only:

• Retirement (rule 6.3.1.1)
• Medically boarded (rule 6.3.1.2)
• Severance package (rule 6.3.1.4)
• Employment under section 7 or 17C coming to an end
• Death of the principal member, for any dependant active at the time (rule 6.5.1)

You must inform the scheme in writing within 90 days, with the reason and the date of your last day of service. The application for continuation membership needs a copy of your identity document, proof of monthly pension if you retired or were boarded, proof of the basic monthly salary you received in your last month of service if you took a severance package, a service certificate and a letter from the Medical Board at SAPS Head Office, and a recent bank statement or a stamped letter from the bank.

Where the principal member dies, surviving dependants need the continuation membership form completed by the remaining spouse or partner, the death certificate, identity documents or birth certificates for minor children, the marriage or customary union certificate, proof of pension from the GEPF, and a recent bank statement or stamped bank letter. Widows and orphans cannot register new dependants. If both parents die, the youngest child becomes the principal member, and you must supply the details of the guardian of any minor orphans.

Not published. The 2026 Benefits and Contributions Guide contains no general waiting period, no condition-specific waiting period and no late-joiner penalty, on either option, anywhere in its 86 pages. The membership section asks for a membership certificate from your previous medical aid if you had one, which is how a scheme establishes prior cover for waiting period purposes, but the consequence is never stated.

The Medical Schemes Act allows a restricted scheme to apply a general waiting period of up to three months and a condition-specific waiting period of up to twelve months on a pre-existing condition, and to apply a permanent late-joiner penalty of up to 75% of the contribution to a member over 35 who has not had continuous cover. Whether POLMED applies any of it, and on what terms, is in the registered Scheme Rules, which the guide says prevail in all instances and which are published in full on polmed.co.za. Ask in writing before you sign, and keep the answer.

What the guide does say is that benefits are pro-rated. Annual maximum benefits run 1 January to 31 December and are apportioned from your date of admission to the scheme to the end of that budget year. The exception is optical, which is calculated from the benefit service date and is not pro-rated.

• Pre-authorisation is compulsory for all hospital and day clinic admissions, all procedures and treatments listed in the benefit table, all MRI and CT scans, all specialised dentistry, all dental procedures in hospital, all dialysis, refractive surgery, prostheses, specialised medication and the listed medical appliances. Call 0860 765 633, or your admitting doctor calls 0860 104 111. Failing to authorise an admission costs R5 000.
• What to have ready when you call: membership number, date of admission or procedure, patient name, hospital name, type of procedure or operation with the diagnosis, RPL code and ICD-10 code from the doctor, and the admitting doctor's name and practice number.
• In an emergency the scheme must be notified within 48 hours or on the first working day after admission. For emergency medical services the window is 72 hours from the incident, and an unauthorised service provider costs 40% of the claim.
• Claims must be submitted within 120 days of the service date. After that they are rejected as stale and you pay. Copies of accounts are accepted.
• Submitting claims: polmedcurrentclaims@medscheme.co.za, fax 011 758 7660, post to POLMED, Private Bag X16, Arcadia 0007, or hand them in at a regional walk-in branch. A claim needs the provider's name and practice number, the referring doctor's practice number for a specialist claim, the group practice number and the name of the practitioner who did the work, your membership number, the scheme name and option, the main member's initials and surname, the patient's name and dependant code, the patient's date of birth, the date of service, the account number, the tariff, NAPPI or procedure codes, the ICD-10 codes and the cost of each item. Medicine claims also need the name, quantity, dosage and net amount payable.
• Member refunds need proof of payment together with the provider's account showing a zero balance. Keep your banking details current with the scheme.
• Take-out medicine after a hospital stay is limited to seven days' supply or the equivalent rand value per beneficiary per admission, except for anticoagulants after surgery and oncology medicine.
• Private and semi-private rooms are excluded unless motivated and approved before admission on the basis of clinical need.

Ex gratia, when the benefits run out

The Board may, at its absolute discretion and on written request, authorise an ex gratia payment on proof that undue hardship would otherwise be imposed. It is not a benefit extension. The cut-off for applications is the end of April of the following year. Ex gratia does not cover scheme exclusions, stale claims older than 120 days, co-payments, amounts under R1 000, or costs relating to out-of-hospital benefits. On Aquarium, approval is subject to income band. The form must be signed by both member and doctor with a motivation from the treating doctor, with outstanding claims attached, and goes to polmedexgratia@medscheme.co.za.

POLMED runs a two-stage process and then hands over to the regulator.

1. Lodge the complaint or appeal with POLMED. The form is on the POLMED website under the Dispute Resolution process. Send it to polmedappeals@medscheme.co.za, fax 0860 104 114, call 0860 765 633, post to Private Bag X16, Arcadia 0007, or hand it in at your regional walk-in branch.
2. Wait for the outcome. The scheme states the dispute will be processed within a minimum of five working days, depending on the complexity of the enquiry, and that the outcome will be communicated to you. Note the wording: five working days is the floor, not a deadline.
3. Escalate to the Council for Medical Schemes if your query is unresolved or you remain dissatisfied with the outcome or the service. The CMS complaint form is on the Council's website. Phone 0861 123 267 or 012 431 0500, fax 086 673 2466, email complaints@medicalschemes.co.za, or post to Council for Medical Schemes, Private Bag X34, Hatfield 0028.

The Council will notify POLMED of the complaint. POLMED then engages the administrator to investigate and gives the Council feedback within the Council's timeline, and the Council informs you of the outcome.

Suspected fraud goes elsewhere: the POLMED Fraud Hotline on 0800 11 28 11, SMS 33490 or email information@whistleblowing.co.za. That service is run by an independent company, Tip-offs Anonymous, and you may remain anonymous. You can also email fraud@medscheme.co.za.

No. POLMED is a restricted scheme registered under the Medical Schemes Act for employees of the South African Police Service and their registered dependants. A new member application requires a letter of appointment or a SAP96. There is no route in for the general public, and no broker can sell it to you. Dependants of a serving member qualify, and dependants of a member who retires, is medically boarded, takes a severance package, whose section 7 or 17C employment ends, or who dies while a member, can continue under the continuation rules.

Subtract the member portion table from the full unsubsidised table and the answer is a flat rand amount rather than a percentage. On Marine, SAPS pays R2 691 a month for a principal member, R2 691 for an adult dependant and about R1 345 for each child, in every income band from R0 to R58 150 and above. On Aquarium it is about R1 364, rising to R1 417 in the top three bands, and roughly R680 to R707 a child. Because the subsidy is flat and contributions rise with income, SAPS carries 84% of a Marine contribution at the bottom of the scale and 62% at the top. Across the scheme the employer accounts for about 72% of contribution income.

Because POLMED runs benefits and contributions on different calendars. The benefit schedules take effect on 1 January 2026, so the new limits applied from New Year. The contributions run from 1 April 2026 to 31 March 2027, so from January to March you were paying the 2025 rates against the 2026 limits. The same happens every year. The guide publishes both tables side by side, the old one and the new one, which is why members often quote the wrong figure.

Aquarium at R127 a month for a principal member earning R8 043 or less, R54 for a child. A member, spouse and two children in that band pay R362 a month between them. What R127 buys is the statutory Prescribed Minimum Benefits, unlimited, plus a day-to-day pool of R8 696 for a single member, four GP visits a year at a nominated network GP, and the full preventative healthcare benefit. What it does not buy is any chronic medicine for a non-PMB condition, any allied healthcare, any refractive surgery, physiotherapy or occupational therapy beyond PMBs, or admission to a hospital outside the POLMED network without a 30% co-payment.

Only if nobody on your membership claims. In the top income band the saving is R1 037 a month for a single member and R3 056 for a family of four, which is real money. What you give up is the open hospital network, an unlimited non-PMB hospital benefit, roughly half your day-to-day pool, more than half your GP visits, all non-PMB chronic medicine, physiotherapy and occupational therapy outside PMBs, allied healthcare entirely, out-of-hospital radiology outside PMBs, specialised dentistry, maxillofacial cover and refractive surgery. POLMED itself writes in the Aquarium schedule that the option "is not intended for members who require medical assistance on a regular basis, or who are concerned about having extensive access to health benefits". Take that at face value.

It ends. The membership rules state that a member who resigns from SAPS, irrespective of the number of years in service, does not qualify to remain a POLMED member. Continuation membership is available only on retirement, medical boarding, a severance package, the end of section 7 or 17C employment, or death of the principal member. In any of those cases you must tell POLMED in writing within 90 days, giving the reason and your last day of service, and supply the continuation form, your identity document, proof of pension or of your last basic monthly salary, a service certificate, a letter from the SAPS Medical Board and your banking details.

Because the admission was not pre-authorised. It is the single largest penalty on the scheme and it applies on both options, at any hospital, including the open network on Marine. Authorisation must be obtained before the event, by you on 0860 765 633 or by your admitting doctor on 0860 104 111. In a genuine emergency you have 48 hours, or the first working day after admission, to notify the scheme. Separate penalties exist for other failures: 40% of the claim for an unauthorised emergency service provider, up to R1 000 for an unauthorised MRI or CT, R500 for unauthorised specialised dentistry and R2 000 for a day procedure done outside a specified facility.

Effectively yes, with two exceptions a year. Every member and dependant nominates a primary network GP and the principal member nominates a second one. You are each allowed two visits a year to a non-nominated GP for an emergency or when out of town. Beyond that, on Aquarium a 30% co-payment applies to every non-nominated visit, and on Marine the visit is funded at the non-network rate rather than the agreed tariff. The GP also controls your access to specialists: without a referral authorisation, obtained before the consultation, POLMED imposes a co-payment of up to R1 000 on Marine or up to 30% on Aquarium, payable by you directly to the specialist and not refundable.

Gynaecologists, psychiatrists, oncologists, ophthalmologists and nephrologists for chronic dialysis need no referral, and neither do dental specialists, pathology, radiology or supplementary and allied health services on Marine. Separately, the scheme allows two specialist visits per beneficiary per year without a referral on both options, specifically to cater for people who clinically need an annual or twice-yearly specialist review. Beyond that, referral by your nominated network GP is required or the co-payment applies.

No, on either option. Both schedules state that the Scheme does not grant benefits for services rendered outside the borders of South Africa, and that it remains the member's responsibility to acquire insurance cover when travelling. There is no travel benefit, no evacuation benefit and no emergency cover abroad anywhere in the 2026 guide. What POLMED will do is release an advance supply of chronic medicine for a trip if you submit your flight itinerary, a valid prescription, your departure and return dates and the collection date at the pharmacy, and only within the current benefit year.

Apply for ex gratia. The Board may authorise a payment at its absolute discretion on written request, on proof that undue hardship would otherwise be imposed. The form goes to polmedexgratia@medscheme.co.za, signed by both you and your doctor, with a motivation from the treating doctor and the outstanding claims attached. The cut-off is the end of April of the following year. Ex gratia will not cover scheme exclusions, claims older than 120 days, co-payments, amounts under R1 000 or out-of-hospital benefit costs, and on Aquarium approval is subject to income band. If your condition is a Prescribed Minimum Benefit, you should not need ex gratia at all: PMBs have no annual limit on either option.

Lodge the dispute with POLMED first, using the form on the POLMED website under the Dispute Resolution process, sent to polmedappeals@medscheme.co.za, faxed to 0860 104 114, posted to Private Bag X16, Arcadia 0007, or handed in at a walk-in branch. The scheme says a dispute is processed within a minimum of five working days depending on complexity. If it is unresolved or you remain dissatisfied with the outcome or the service, take it to the Council for Medical Schemes on 0861 123 267 or 012 431 0500, complaints@medicalschemes.co.za, or Private Bag X34, Hatfield 0028. The Council notifies POLMED, POLMED investigates with the administrator and reports back within the Council's timeline, and the Council tells you the outcome.