One of the concerns many people have when considering cataract surgery is whether their medical aid will cover the costs. The good news is that, in most cases, medical aid schemes in South Africa do offer some form of coverage for cataract surgery. Here’s how it typically works:
Cataracts are a Prescribed Minimum Benefit
According to healthcare regulations in South Africa, the treatment for cataracts falls under Prescribed Minimum Benefits (PMBs). This means that all registered medical aid plans are legally obliged to cover the costs of diagnosing, treating, and caring for cataracts, making it more accessible for patients in need.
Pre-Authorisation is Required
It’s standard procedure for your ophthalmologist’s practice to request pre-authorisation from your medical aid before the surgery is scheduled. This ensures that both you and your healthcare provider are clear about what the medical aid covers and what if anything, will be your financial responsibility.
Hospital Plans Cover It Too
Even if you are on a hospital plan, you’re in you should be covered. Because cataract surgery is typically performed in a hospital theatre, these plans usually cover the procedure as well. However, it’s advisable to check with your medical aid provider for the specifics of what is covered under your hospital plan.
Conclusion
While medical aid coverage can vary, the regulations surrounding Prescribed Minimum Benefits make it likely that your medical aid will cover cataract surgery. Always remember to get pre-authorisation and consult with your medical aid to understand your coverage fully.
Disclaimer: This article is for informational purposes only and should not be considered medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your ophthalmologist or other qualified health professional with any questions or concerns you may have about your eyesight. The most reliable advice is obtained through a consultation and inspection from a medical specialist
