l Going to See a Healthcare Provider

SAB Medical Aid strives to contain medical costs to optimise your benefits. We recognise the important role that Healthcare Providers play in maintaining your health and wellbeing.

Claims will be paid directly to the Health Care Provider or the member where applicable.

Cover for Specialists and General Practitioners

Specialist and GP consultations are paid from your Out-of-hospital benefit, subject to the applicable consultation and visit limits. Up to 80% of the contracted/Scheme Rate or the claimed amount, (whichever is less), is covered when visiting a specialist with a GP referral. 

For members who are on the Comprehensive Option, the balance of the claim is paid from the available funds in your Medical Savings Account (MSA) or claimed through deduction from your salary or debited from your bank account if you are a self-paying member. If you are on the Essential Option, your claim is subject to applicable limits and the 20% balance is claimed back through deduction from your salary or debited from your bank account if you are a self-paying member.

Dentistry Cover

Basic dental care is covered from your Dentistry Benefit. On the Comprehensive Option, basic dentistry is covered from your Day-to-day limit and advanced dental care is covered from your Advanced Dental Benefit limit. On the Essential Option the dental limit is calculated according to the number of dependants on your membership. Advanced dental care is not covered on the Essential Option.

Dentistry claims are covered at 80% at the Scheme Rate or the claimed amount, whichever is less, with the exception of oral and maxillofacial surgery claims, which are covered at 100% of the Scheme Rate on both Options. Osseo-integrated implants and orthognathic surgery claims are covered up to 100% of the Scheme Rate from the Advanced Dental Benefit on the Comprehensive Option only.

If you are on the Comprehensive Option the balance of the claim is paid from the available funds in your Medical Savings Account (MSA), or we will deduct from your salary or debit from your bank account if you are a self-paying member. If you are on the Essential Option, the 20% balance is deducted from your salary or debited from your bank account if you are a self-paying member.

Hospital Admission

Cover for hospital admissions depends on your Option.

For more information about your hospital cover, please refer to your Benefit Guide.

Click here for your guide to visiting your doctor.

Click here for your guide to visiting a hospital.