Thebemed

Chronic medicine on the Chronic Disease List is unlimited on all four options, which is the strongest thing on the Thebemed benefit schedule and the reason the entry-level pricing is worth a look. It is subject to registration, pre-authorisation, generic substitution, the scheme formulary, internal treatment protocols and renewal of the prescription every six months.

Register by completing the Chronic Medication Benefit Application Form and emailing it to chronic@thebemed.co.za. Thebemed quotes a turnaround of three to five working days. The formulary itself is not published, so ask for it when you register and check whether the medicine you are already on is on it, because generic substitution is compulsory and the difference is yours.

The 2026 brochure lists 34 conditions whose medicine it treats as a Prescribed Minimum Benefit: Addison's disease, ADHD, allergic rhinitis, asthma, bipolar mood disorder, bronchiectasis, cardiac failure, cardiomyopathy, chronic renal disease, chronic obstructive pulmonary disease, coronary artery disease, Crohn's disease, depression, diabetes insipidus, diabetes mellitus type 1 and type 2, dysrhythmias, epilepsy, erythematosus, gastro-oesophageal reflux disease, glaucoma, gout, haemophilia, hyperlipidaemia, hypothyroidism, hypertension, incontinence, multiple sclerosis, osteoarthritis, Parkinson's disease, psoriasis, rheumatoid arthritis, schizophrenia, systemic lupus and ulcerative colitis.

That list is longer than the statutory Chronic Disease List. Several of the entries above, including ADHD, allergic rhinitis, gout, osteoarthritis, reflux disease, incontinence and psoriasis, are not statutory CDL conditions. Treat the brochure list as "conditions Thebemed covers", not as a statement of what the law requires.

Conditions that fall outside that list get nothing on Universal and Universal EDO. On Fantasy the non-CDL benefit is R12 760 a family and R4 650 a beneficiary a year, and on Energy it is R13 320 a family and R4 650 a beneficiary a year. On both, the scheme pays out of the non-CDL pot first and only then draws on the unlimited CDL benefit.

All four options cover Prescribed Minimum Benefits in full as the Act requires. In practice most of the serious benefits on the schedule, including oncology, renal dialysis, organ transplants, maternity, maxillo-facial surgery and drug and alcohol rehabilitation, are described as PMB cover applied through internal protocols rather than as separate rand benefits.

Fantasy is the only option with a Medical Savings Account. R255 a month for a main member, R210 for an adult dependant and R105 for a child, so R3 060, R2 520 and R1 260 over a full year. Join part way through the year and you get a pro-rata share only.

It is not a top-up you choose to use. Several Fantasy benefits are structured to fall through to it automatically once a risk limit is reached, which means the account drains without you deciding anything:

• Acute medicine, once the R6 380 family limit is used up.
• Pharmacy advised therapy, R1 320 of it, before the R535 risk portion applies.
• Casualty visits for anything that is not trauma or an emergency.
• Non-emergency services from any provider who is not on the network.
• Physiotherapy and auxiliary practitioner visits after the first two, capped at R1 425 a family a year.
• Specialised dentistry, capped at R2 600 a family a year.

Add those caps up and the savings account is spoken for several times over on a household with children. For a single member with light claims it does what it is meant to. That is exactly who Thebemed says the plan is for.

All four options cover normal delivery, caesarean section and home delivery by a registered midwife at 100% of negotiated tariff, as a Prescribed Minimum Benefit applied through internal protocols. Elective caesarean surgery performed outside protocol is an explicit exclusion, so the clinical indication has to be there.

Out of hospital, every option gets 2 maternity scans and maternity vitamins to R100 a month for the pregnant beneficiary, on generic substitution and the formulary.

Registering on the Thebe Bambino programme adds a further:

• 1 additional scan, so 3 in total
• 2 additional gynaecology visits per pregnancy
• 3 pre-natal or post-natal midwife consultations

The maternity bag is only issued to mothers who registered on Bambino, and the scheme lists that plainly under exclusions. 3D and 4D scans are excluded on every option. Ante-natal and post-natal exercise classes are excluded except under PMB and except for post-natal nurse visits once you are on the Bambino programme.

Contraception is funded on all four options: R179 a script a month or R2 150 a year on Universal, Universal EDO and Fantasy, and R215 a script a month or R2 580 a year on Energy, for oral, injectable and patch contraceptives. An IUD is only available on Fantasy and Energy, and the rand amount for it is not published.

Infertility treatment and artificial insemination are limited to Prescribed Minimum Benefits in state hospitals, which in practice means there is no private fertility benefit on any option.

Cancer treatment, meaning radiotherapy, chemotherapy and the related materials, is covered in hospital at 100% of negotiated tariff on all four options. On Universal, Universal EDO and Fantasy it is described as PMB cover applied through internal protocols. On Energy the brochure drops the PMB reference and says only "100% of negotiated tariff, based on internal protocols".

No rand limit is published for oncology on any option, and no separate oncology benefit or oncology programme is described anywhere in the 2026 brochure. That is unusual. Most South African schemes publish an annual oncology limit, often between R250 000 and R500 000, and state what happens above it.

What that means in practice is that your cancer cover is whatever the Prescribed Minimum Benefit regulations require, delivered through Thebemed's treatment protocols and its designated providers. Not every cancer, and not every treatment for a cancer that does qualify, is a PMB. Positron emission tomography scans are an explicit exclusion where applicable, and MRI and CT are capped at 2 scans a beneficiary a year in and out of hospital combined, which is a real constraint during staging and monitoring.

If you are choosing a scheme with cancer risk specifically in mind, ask Thebemed in writing what it funds above PMB level and get the answer before you sign. Do not assume the absence of a limit means the absence of one.

This is the sharpest split in the range.

On Universal, Universal EDO and Fantasy, psychiatric treatment including clinical psychology is PMB conditions only, at 100% of negotiated tariff, on GP or specialist referral and subject to pre-authorisation, a treatment plan and progress reports. In an admission the scheme pays up to 3 days of psychologist therapy sessions, with or without a psychiatrist involved, and beyond that you need fresh authorisation with a treatment plan and progress report. Out of hospital there is almost nothing: Universal and Universal EDO fold psychology into the same 2-visit, R2 000 a family pool that physiotherapy and every other auxiliary discipline share, and Fantasy pays a single psychologist visit to R1 500 a family a year from risk before falling through to savings.

On Energy, mental health carries its own stated limit of R19 160 a family a year for psychiatric treatment in and out of hospital, at 100% of negotiated tariff, with PMB providing 21 days. The same 3-day psychologist rule applies inside an admission. Out-of-hospital psychology otherwise sits inside the R4 440 a family auxiliary pool.

Drug and alcohol rehabilitation is 21 days a beneficiary a year on every option, at a contracted private facility, as a PMB on internal protocols. Read the condition attached to it carefully: the brochure states that the account will only be paid if the full course of treatment has been completed. Leave the programme early and the scheme's stated position is that it does not pay.

Separately from all of this, every option carries unlimited telephonic trauma and short-term counselling at all hours on 0800 229 355, covering relationship, family, health and lifestyle issues, and the Youth Programme funds 2 sessions a year with a registered social worker or psychologist for beneficiaries aged 12 to 21, no referral required, limited to R1 260 a beneficiary. Counselling by registered counsellors and art therapists is excluded except under PMB.

Two different deals here. On Universal and Universal EDO you must use a dentist on the DENIS network. On Fantasy and Energy you may use any registered dentist, paid at the Thebemed Dental Tariff. DENIS managed care protocols apply to every category on every option. Thebemed will confirm a benefit in writing or by telephone before treatment, which is worth doing given how many of these limits are once per tooth or once per cycle.

Specialised dentistry is where the options really separate. Universal and Universal EDO publish no specialised dentistry benefit at all: no crowns, no chrome cobalt frame dentures, nothing beyond periodontics on the Periodontal Programme. Fantasy funds specialised dentistry to R2 600 a family a year, out of your savings account, with one crown per family per year and one partial chrome cobalt frame denture per beneficiary per 5 years. Energy funds crowns and orthodontics together to R2 500 a beneficiary and R5 000 a family a year, one crown a beneficiary a year and once per tooth per 5 years.

Orthodontics exists only on Energy. It is granted once per beneficiary per lifetime, only for people from age 9 and younger than 18, and only one family member may start treatment in a calendar year. Cases are assessed on pre-authorisation using an orthodontic needs analysis, and the benefit depends on the outcome of that analysis. If you have two children who need braces, one of them waits a year.

Osseo-integrated tooth implants are excluded on every option. So is any dental exclusion listed in the scheme's Dental Benefit Exclusions Summary, a document Thebemed says is available on request but does not publish.

Eye tests, spectacles and contact lenses are available once every 2 years on every option, measured from the date of your previous claim rather than by calendar year. Clinical protocols apply. The network is run by PPN, and the gap between network and non-network rates is large enough to matter.

There is no contact lens benefit at all if you buy spectacles in the same cycle. You choose one or the other. Contact lens preparations and solutions are an explicit exclusion, as is refractive surgery. Optical authorisation runs through PPN on 086 110 3529.

One conflict worth knowing about: the Universal brochure gives the non-network frame and contact lens amount as R1 495 while the Universal EDO brochure gives R764 for frames. Both plans are otherwise identical. Confirm which applies before you buy out of network.

Health Assist is the wellness programme and it runs across all four options. Unlike most scheme wellness programmes it is not a rewards scheme, there are no points and no partner discounts. It is a list of tests the scheme pays for, plus a disease management basket for anyone newly diagnosed with a chronic condition.

HIV Assist covers consultations, counselling, medication and pathology tests at 100% of negotiated tariff subject to PMBs, and pre-exposure prophylaxis is explicitly included, which is not standard at this price point. Members are encouraged to register on the HIV and AIDS management programme.

MyPlan2BWell is the online side of it: rate your health, choose a goal, register for e-coaching, personalise a meal plan, design a fitness plan and track results. One membership a beneficiary a year for anyone over 18, subject to online registration at thebemed.co.za/myhealth.

Note that this whole programme is delivered at DSPs, and biokinetics is excluded everywhere except under the Health Assist benefit or an authorised back treatment protocol.

Two co-payments apply on top of all of this: R8 000 on planned spinal surgery and joint replacements on every option, and R1 000 for using a hospital outside the DSP list on Universal and Universal EDO.

The exclusion list runs to 53 numbered items. Everything on it is excluded except where the law requires it as a Prescribed Minimum Benefit. The ones most likely to catch a buyer out:

• Any medical expense incurred outside the borders of South Africa. There is no travel benefit, no evacuation benefit and no international cover on any option. If you leave the country, you are uninsured for health.
• Services rendered during any waiting period imposed on you or a dependant.
• Cosmetic surgery, including blepharoplasty, rhinoplasty, otoplasty, genioplasty and tattoo removal. Blepharoplasty is allowed only where it causes demonstrated functional visual impairment and is pre-authorised.
• Obesity treatment including liposuction, tummy tucks and bariatric surgery. Cosmetic breast reduction and reconstruction, refractive surgery and human growth hormones.
• Infertility treatment and artificial insemination, except at PMB level in state hospitals.
• Osseo-integrated tooth implants, and everything on the unpublished Dental Benefit Exclusions Summary.
• 3D and 4D maternity scans. Elective caesarean surgery performed out of protocol.
• MRI scans ordered by a general practitioner, unless there is no reasonable access to a specialist. X-rays performed by chiropractors. Chiropractic and podiatry benefits in hospital.
• Positron emission tomography scans where applicable, CT colonography for screening, and MDCT coronary angiography for screening.
• Nutritional and food supplements, patented baby foods, vitamins except prenatally, for children under 12 and for people on the HIV programme, acne treatment including Roaccutane, toning and slimming products, medicated soaps and shampoos, aphrodisiacs and anabolic steroids.
• Acupuncture, reflexology and aromatherapy. Osteopathy, registered counsellors, phytotherapy and therapeutic massage therapy.
• Blood pressure monitors, stethoscopes, beds and mattresses, arch supports, chair seats, humidifiers, electronic toothbrushes and pain relieving machines including TENS and APS.
• Sleep therapy, uvulopalatopharyngoplasty, gender re-alignment, epilation, facet joint injections and percutaneous radiofrequency ablations.
• Insulin pumps except for children aged 7 or younger with frequent documented events of hypoglycaemia and hyperglycaemia.
• Organ and bone marrow donations to anyone who is not a member or dependant of the scheme.
• Examinations for insurance, visas, employment and school camps. Appointments not kept. Fees for writing prescriptions. Visiting a provider solely to obtain a sick certificate without treatment.
• Convalescent and recuperative homes and frail care for the aged and chronically ill, based on managed care protocols.
• The maternity bag, for any mother who did not register on the Bambino programme.

Thebemed states that where a protocol or formulary drug it prefers has been ineffective or would cause harm, it will fund an appropriate substitute without penalty, as regulations 15H and 15I require.

The 2026 brochure says only this: "In terms of the Medical Schemes Act, medical schemes may apply waiting periods and/or late joiner penalties to new members joining the Scheme. If we do apply a late joiner penalty to your membership, we will let you know before we activate your cover."

The scheme does not publish the length of its general or condition-specific waiting periods anywhere. Not in the brochure, not in the website terms, not in any document in its public library. The registered Scheme Rules would carry them, and those are not published online either.

What the Medical Schemes Act allows an open scheme to impose is:

• A general waiting period of up to 3 months, during which you pay but cannot claim, except for Prescribed Minimum Benefits in some circumstances.
• A condition-specific waiting period of up to 12 months on any condition you already have.
• Where you have had two or more years of continuous cover with another scheme and no break longer than 90 days, only the 3-month general waiting period may be applied.

Broker sites quote 3 months and 12 months for Thebemed, which are the statutory maxima rather than anything the scheme has confirmed. Ask Thebemed in writing what it will apply to you and to each dependant before you accept the membership, and keep the answer. Services rendered during a waiting period are an explicit exclusion, so this is not a theoretical question.

If you are over 35 when you apply and you were without medical scheme cover after the age of 35, Thebemed applies a permanent multiplier to your contribution. The bands are the statutory maxima and the scheme publishes them in full.

Creditable coverage, meaning any verifiable period of South African medical scheme membership, is subtracted from your age when the penalty is worked out. Membership you held as a child dependant does not count, and neither does cover that ended two or more years or more before you applied.

Rand amounts are rounded to the nearest rand and are shown against the top band of Universal EDO and against Energy. The penalty applies to the relevant contribution for whichever option and band you join on. It is permanent and it does not fall away with time. Thebemed says it will tell you before it activates your cover, so read the offer letter.

Thebemed does not publish a joining process, an application checklist or a current application form. There is no online application, no list of required documents and no stated turnaround anywhere on the public site. This is a genuine gap and it is unusual for an open scheme.

What is known:

• Individual applicants are directed to phone the call centre on 0861 84 32 36 or to send "Hi" on WhatsApp to the same number.
• Members who join through an employer go through their employer's assigned Medical Scheme Coordinator. Thebemed publishes a full employer and paypoint table with each coordinator's direct mobile number on its Contact Us page, which is more transparency about named staff than most schemes offer.
• All benefits are pro-rated for members admitted during the benefit year, so joining in July gives you half a year of family limits, not a full one.
• Only 2 child dependants are charged. Any further children are covered without an extra contribution.
• You nominate your DSP GPs at the start of the benefit year, and Thebemed states that members are not allowed to change networks during the year.
• No resignation or cancellation notice period is published. The Act's default is one calendar month in writing, but confirm it against the registered rules.

• Pre-authorisation is required for every hospital admission, all planned procedures, MRI, CT and PET scans on specialist referral, chronic medicine registration, GP visits beyond the tenth, psychologist sessions beyond the third day of an admission, plastic dentures, medical rescue, home based care, and drug and alcohol rehabilitation. Call 0861 84 32 36 or email hospauth@thebemed.co.za, with specialised radiology going to specauth@thebemed.co.za.
• Pre-authorisation is not a guarantee of payment. Thebemed states this in bold at the head of every in-hospital benefit page. Scheme rules, the formulary, internal protocols and PMB rules are all still applied after the fact.
• Claims go to claims@thebemed.co.za, through the Member Zone at thebemed.momentumtyb.co.za, or through WhatsApp on 0861 84 32 36, which handles benefit confirmations, claim submissions, statements, documents and pre-authorisations.
• The claims submission deadline is not published. The Medical Schemes Act sets a statutory limit of four months from the date of service, after which a scheme is not obliged to pay. Thebemed does not state it anywhere, so work to four months.
• Complaints go to complaints@thebemed.co.za or the call centre. Fraud, waste and abuse go to the independent hotline on 0800 00 04 36 or thebemed@tip-offs.com, which accepts anonymous reports.
• Thebemed publishes no internal dispute or appeal procedure, no response timeframes and no disputes committee process. If the complaints email does not resolve it, you have no published next step inside the scheme.
• Escalation to the Council for Medical Schemes. You have a statutory right to complain to the CMS on 0861 123 267 or complaints@medicalschemes.co.za, and from there to the CMS Appeal Committee, the Appeal Board and ultimately the High Court. These contacts come from the Council itself. Thebemed does not publish them in its brochure or on its website, which is a disclosure gap worth knowing about before you need it.

One thing only: the hospital list. Universal covers Mediclinic, Life Healthcare, Netcare, the National Hospital Network and Lenmed. Universal EDO covers Life Healthcare, Mediclinic and Netcare, and Thebemed says in its own brochure that the Universal list is broader with a national footprint. Every other benefit is identical, from the unlimited GP visits to the 4 specialist visits a family to the DENIS dental network. EDO costs between R140 and R1 010 a month less for a main member depending on the band. Both charge R1 000 if you use a hospital outside the list.

Universal EDO at R680 a month for a main member, but only in the lowest income band. In that band the adult dependant and the child also cost R680 each, so a couple with two children pays R2 720. In the top band the same plan is R2 145 for a main member. Since Thebemed has not published what the income band thresholds actually measure, confirm which band you fall into before you treat R680 as your price.

Two, on Universal, Universal EDO and Fantasy. Each beneficiary nominates up to two DSP GPs at the start of the benefit year and uses them all year. Visits to them are unlimited, with pre-authorisation required from the eleventh, plus two out-of-area visits a year for when you are travelling. Energy is different: you can use any GP in the Thebemed network without nominating one, with one out-of-area visit a year. On every option, choosing a GP who is not on the network costs you a 25% co-payment on that visit.

Fewer than most buyers expect. Universal and Universal EDO cover 4 visits per family per year. Fantasy covers 5 per family per year. On a family of four that is roughly one specialist visit each, and a GP referral is required. Children up to 12 may see a paediatrician without a referral and a child under 1 gets one extra paediatrician visit, but both come out of the same family limit. Energy's specialist benefit is printed two contradictory ways in the same brochure, as 5 to 8 visits scaled by family size and as 5 visits per beneficiary, so get it confirmed in writing.

Three likely reasons. First, if the procedure was planned spinal surgery or a joint replacement there is an R8 000 co-payment on every option, including Energy. Second, if the hospital was not on your option's DSP list, Universal and Universal EDO charge R1 000. Third, Thebemed pays 100% of its own negotiated tariff, so a practitioner who charges above that rate leaves you the difference. Ask the surgeon and the anaesthetist what they bill at, and ask the scheme whether they are contracted, before an elective admission.

For conditions on its list, yes, and unlimited, on all four options. You have to register the condition, get pre-authorisation, accept generic substitution and the scheme formulary, and renew the prescription every six months. Register at chronic@thebemed.co.za, with a stated turnaround of three to five working days. For conditions that are not on the list, Universal and Universal EDO pay nothing, Fantasy pays up to R12 760 a family and R4 650 a beneficiary a year, and Energy pays up to R13 320 a family and R4 650 a beneficiary. The formulary itself is not published, so ask for it before you join.

No rand limit is published on any option. Radiotherapy, chemotherapy and related materials are covered in hospital at 100% of negotiated tariff, described as Prescribed Minimum Benefit cover applied through internal protocols on Universal, Universal EDO and Fantasy, and as internal protocol cover on Energy. There is no oncology programme, no stated annual maximum and no statement of what happens above one. MRI and CT are limited to 2 scans a beneficiary a year in and out of hospital combined, and PET scans are excluded where applicable. If cancer risk is why you are buying, ask the scheme in writing what it funds above PMB level.

Only Energy, beyond Prescribed Minimum Benefits. Energy carries a limit of R19 160 a family a year for psychiatric treatment in and out of hospital. Universal, Universal EDO and Fantasy cover PMB conditions only, with up to 3 days of psychologist sessions inside an admission before fresh authorisation is needed. Out of hospital, Universal and Universal EDO fold psychology into a 2-visit, R2 000 a family pool shared with physiotherapy and every other auxiliary discipline, and Fantasy pays one psychologist visit to R1 500 a family from risk. All four options include unlimited telephonic counselling on 0800 229 355.

Only on Fantasy. It is R255 a month for a main member, R210 for an adult and R105 for a child, so R3 060, R2 520 and R1 260 a year, roughly 10% of the contribution. Universal, Universal EDO and Energy have none. On those three, day-to-day care is funded out of risk instead, which is why the acute medicine benefit on Universal and Universal EDO is unlimited rather than capped. Thebemed's stated design intent is to avoid members running out of benefits before year end.

On Fantasy and Energy, yes, any registered dentist, paid at the Thebemed Dental Tariff. On Universal and Universal EDO you must use a dentist on the DENIS network. Energy has the strongest dental benefit in the range: two check-ups and two scale and polish treatments a year rather than one of each, fluoride for children aged 5 to 12, and the only orthodontic benefit Thebemed sells. Orthodontics is once per beneficiary per lifetime, ages 9 to 17 only, and only one family member may start treatment in a calendar year.

No. Medical expenses incurred outside the borders of South Africa are an explicit exclusion on every Thebemed option. There is no travel benefit, no international emergency cover and no evacuation benefit. Buy separate travel insurance before you fly, and understand that this applies to work trips and cross-border road travel as much as to holidays.

About 8.8%, though the scheme does not publish a headline figure. Comparing the 2025 and 2026 brochures line by line gives between 8.6% and 8.9% on the main member rate of every option: Universal from R755 to R820 in the lowest band and from R2 900 to R3 155 in the top band, Universal EDO from R625 to R680 and from R1 970 to R2 145, Fantasy from R2 340 to R2 545, and Energy from R3 205 to R3 490. Rates for 2027 had not been published as at 9 September 2026.

On the current numbers, yes. Solvency was 41.32% at 31 December 2025 against a statutory minimum of 25%, with R237.0 million in members' funds on R503.8 million of insurance revenue and an 11.2% investment return. The book is unusually young, with an average beneficiary age of 29.1 and a pensioner ratio of 0.37%, which keeps claims down. The context is that the scheme was under curatorship from August 2019 until May 2022 precisely because it could not hold the 25% floor. It is a small scheme with 26 436 beneficiaries, so weigh that against the price.

Start at complaints@thebemed.co.za or the call centre on 0861 84 32 36. Thebemed publishes no internal disputes committee, no appeal ladder and no response timeframes, so if that does not resolve it you have no published next step inside the scheme. You then have a statutory right to complain to the Council for Medical Schemes on 0861 123 267 or complaints@medicalschemes.co.za, and from there to the CMS Appeal Committee, the Appeal Board and ultimately the High Court. Those CMS contacts come from the Council, not from Thebemed. Fraud and abuse go to the anonymous hotline on 0800 00 04 36 or thebemed@tip-offs.com.