Medical schemes have set limitations, co-payments and medical tariffs that dictate what they will pay for and how much they will pay when a medical scheme member is treated in hospital. This policy aims to cover you for the amounts owed to the specialists and hospitals once the medical scheme has settled the accounts and there are still amounts owing.
But these payments are also subject to limits as per the amount shown, per type of cover.
Some of these payments may also be due at time of hospital admission. These amounts would normally be covered by the principal insured but can be claimed back once the medical scheme statement is available and shows the amount paid by the principal insured.