Medical aid benefit exhausted: what to ask your scheme
Your medical scheme says the benefit your claim would have been paid from is used up. What that means, and the questions to put to the scheme in writing.
The scheme says the benefit this claim would have been paid from is used up.
The wording to look for
- “your day-to-day benefit is exhausted”
- “savings account is depleted”
- “limit has been reached”
Questions to put to your scheme in writing
- On what date was the benefit exhausted?
- Please provide the statement of account supporting that date.
- Which claims were paid from that benefit during this benefit year?
- Does the scheme fund this service from the risk benefit where it is a Prescribed Minimum Benefit, and was that considered?
- Please confirm the annual amount of that benefit for my option and family size this year.
Only you can answer these
- Whether any claim on that statement is one you do not recognise.
- Whether the service was for a condition registered with the scheme.
Paste your rejection notice and build the letter. It is read on your own device and never uploaded.
See every reason a South African medical scheme gives.
Pryse is not a law firm and does not act for you. Nothing here is a determination of your rights or legal advice, and no registered scheme rule is quoted. The questions ask your scheme to provide its own.