Riskfin

28/08/2026

As Women’s Month comes to a close, the CMS continues to encourage informed healthcare decisions by raising awareness of women’s health issues across every stage of life.

From reproductive health and pregnancy to motherhood and menopause, women face evolving health needs over time. The CMScripts featured below provide practical information on these key areas and outline the Prescribed Minimum Benefits (PMBs) that medical scheme members are entitled to access.

Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause painful periods, chronic pelvic pain and, in some cases, difficulties with fertility. The diagnosis, treatment, and care costs of endometriosis included under DTP code 434M must be paid under the PMB Regulations, regardless of the member’s plan benefits.

Read more about endometriosis and the healthcare support available to help women manage symptoms and improve their quality of life here.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries. Many ovarian cysts are harmless and disappear on their own, but some may cause pain, abnormal bleeding or complications that require treatment. In 2020, it was estimated that almost 7% of women in the world developed an ovarian cyst at some point in their lives.

The diagnosis and management of ovarian cysts may involve consultations, investigations, medication or surgery, depending on the individual’s condition and healthcare needs.

Find out more about ovarian cysts and PMB cover here.

Pregnancy Benefits

Pregnancy is a significant and often life-changing experience, but navigating medical scheme benefits during this time can sometimes be challenging. While many members expect all pregnancy-related care to be covered as a PMB, the extent of cover may depend on individual circumstances and scheme rules.

Learn more about what is covered, what is not covered, and how you can avoid unexpected costs during pregnancy and childbirth here.

Vertical transmission

Although significant progress has been made in the prevention and treatment of HIV, it remains a major health concern in South Africa, particularly for women and children.

Vertical transmission, which is the passing of HIV from an HIV-positive mother to her baby during pregnancy, childbirth or breastfeeding, is still the primary way young children acquire the virus. However, early diagnosis, access to quality healthcare and adherence to antiretroviral treatment (ART) can reduce the risk of transmission and improve health outcomes for both mother and child.

Gain a better understanding of vertical transmission of HIV and the benefits available here.

Menopause

Menopause is a natural stage of ageing that marks the end of a woman’s menstrual cycles. It can bring physical and emotional changes, including hot flushes, sleep difficulties, mood changes and other symptoms that may affect daily life.

Understanding these changes and discussing symptoms with a healthcare professional can help women make informed decisions about their health and treatment options.

Learn more about menopause and the healthcare considerations associated with it here.



Women’s health needs can change throughout life, but having the right information can make it easier to recognise when care is needed and understand the benefits available through your medical scheme. The CMS encourages you to continue the conversation by sharing reliable health information and empowering the women in your life to make informed decisions about their health and wellbeing.

25/08/2026

Choosing a Medical Aid Scheme

Review Scheme Materials and Changes
Always read the information your scheme sends about benefit changes for the next year.
If unsure, contact the scheme for explanations about changes, limits, and benefits.
Selecting an Option
Choose a benefit option based on your healthcare needs and what you can afford.
You may use a broker, but it is not compulsory. If you do, ensure they are accredited by the Council for Medical Schemes (CMS).
Provider Networks and Rules
Schemes may have preferred or network providers. Know who these are before making appointments.
Check how close Designated Service Providers (DSPs) are to your home or work.
Using non-DSPs voluntarily may result in co-payments, except in emergencies.
Prescribed Minimum Benefits (PMBs)
No restrictions, co-payments, or exclusions for PMBs if using DSPs.
PMBs must be funded even if annual or savings limits are depleted; they cannot be paid from your savings account.
Benefit Limits and Sub-limits
Most options have overall annual limits and sub-limits for specific services (e.g., scans, prostheses, oncology).
Understand both the overall and sub-limits, and the rules that apply to them.
Scheme Rates and Co-payments
Bills are often paid at the scheme rate, which may not cover the full amount charged by providers.
If you choose not to use a preferred/network provider, you may face co-payments or limited coverage.
Medicine Formularies and Protocols
Schemes may have a list of approved medicines (formulary). Using medicines not on the list may require co-payments.
If formulary medicines are ineffective or cause harm, the scheme must fund alternatives without penalty.
Managed care protocols must be evidence-based and consider cost-effectiveness.
Medical Savings Accounts (MSA)
Only up to 25% of your contribution can go to an MSA, used for day-to-day claims.
If your MSA is depleted, you are responsible for further costs until any above-threshold benefit applies.
PMBs cannot be paid from your MSA.
Exclusions and Waiting Periods
Some treatments may be excluded by scheme rules (e.g., cosmetic surgery, treatments not available in South Africa).
Waiting periods may apply when switching schemes to prevent 'scheme hopping.'
Trade-off Between Cost and Cover
More comprehensive cover usually means higher contributions.
If you choose less cover, consider setting aside your own savings for future needs.
There is cross-subsidization: healthy members subsidize those who claim more.
Customer Support
Contact details for general enquiries and complaints are provided by the CMS.
Example Implementation:

Before changing your medical scheme, list your healthcare needs and compare them to the benefit options and limits of each scheme.
Check the list of DSPs and ensure they are accessible to you.
Review the scheme's formulary to see if your regular medicines are covered.
If using a broker, verify their CMS accreditation.
Keep the CMS contact details handy for any disputes or complaints.

23/08/2026

Medical aid? How does it work?

Think of your medical aid as having two separate wallets
🏥 Wallet 1: Hospital Benefits (Big Expenses)
This pays for major medical events such as:
• Hospital admissions
• Operations
• Maternity confinement
• Cancer treatment
• Emergency treatment
• Specialist procedures in hospital
Most South African medical aids provide a separate hospital benefit that is not linked to your savings account. Hospital cover is usually subject to:
• Pre-authorisation
• Network hospitals or doctors
• Scheme rules and co-payments where applicable
For example:
✅ You are admitted to hospital for an appendectomy costing R80,000.
➡️ The medical aid pays from the hospital benefit. ➡️ Your savings account is generally not touched (unless there is a co-payment or excluded item).
💰 Wallet 2: Day-to-Day Benefits (Everyday Healthcare)
This is used for routine medical expenses such as:
• GP visits
• Dentists
• Optometrists
• Medication from the pharmacy
• Blood tests
• X-rays
• Physiotherapy
On a savings plan, part of your monthly contribution is placed into a Medical Savings Account (MSA) which you use throughout the year for these expenses. Many savings plans allocate between 10% and 25% of your contribution to savings.
For example:
✅ You visit the GP and the account is R600.
➡️ The R600 comes from your savings account. ➡️ Your savings balance decreases by R600.
What happens when the savings run out?
This depends on the plan.
Example 1: Savings-only plan
If your savings are finished:
❌ You pay future GP visits and medication from your own pocket.
Example 2: Savings + insured day-to-day benefits
Many modern plans (such as certain Medihelp plans) provide additional insured day-to-day benefits after savings have been exhausted.
In this case:
✅ Savings runs out in August.
✅ The scheme may still pay for certain GP visits, medicine, radiology, dentistry or other specified benefits from an insured benefit pool, depending on the plan.
A practical example
Let's say your medical aid contribution is R5,000 per month and the plan has a 15% savings component.
• Monthly contribution: R5,000
• Savings allocation: R750 per month
• Annual savings available: R9,000
During the year:
Expense Paid From
GP visit Savings
Antibiotics Savings
Dentist Savings
Eye test Savings
Hospital admission Hospital benefit
Operation Hospital benefit
So even if you have used all your savings, your hospital cover usually remains available for approved hospital events.

19/08/2026

Funeral cover explained:

Funeral cover is an insurance policy that pays out a cash amount when a person covered by the policy dies. The money is intended to help pay for funeral expenses such as the coffin, burial or cremation, catering, transport, and other funeral-related costs.

How it works
You pay a monthly premium.
The people listed on the policy are covered.
If one of the covered people passes away, a claim is submitted.
The insurer pays a lump sum to the beneficiary or family to assist with funeral costs.
Example

If you have funeral cover of R30,000 and your spouse passes away, the insurer pays R30,000 (assuming the claim is valid and all policy conditions are met). The family can then use the money for funeral expenses.

Funeral Cover vs Life Cover
Funeral Cover: Pays a smaller amount quickly to cover funeral expenses.
Life Cover: Usually pays a larger amount to help beneficiaries with long-term expenses such as bond repayments, education, and household income needs.
Important things to remember
Most policies have waiting periods for natural death claims.
Premiums must be kept up to date.
You can often cover family members on the same policy.
The amount of cover should be enough to meet your family's expected funeral costs.

"Funeral cover is there to make sure your family does not have to find money for a funeral when a loved one passes away. You pay a small premium every month, and when a valid claim is submitted, the policy pays out a cash amount to help cover funeral expenses." Contact us to find out about our product offering.

14/08/2026

Breast health starts with knowing your own body. Taking a few minutes each month to perform a breast self-examination helps you become familiar with what feels normal, making it easier to notice changes that should be discussed with your doctor.

Look out for signs like a new lump, changes in the size or shape of the breast, skin dimpling, ni**le discharge, persistent pain, or changes around the ni**le. While these changes are often caused by conditions other than cancer, they should always be assessed by a healthcare professional.

Routine mammograms remain one of the most effective ways to detect breast cancer early, often before symptoms develop. Profmed’s Preventative Care Benefit includes annual mammograms for women aged 40 to 55, with biennial screening funded from age 56 onwards. Women under 40 may also qualify for a mammogram where there is a clinical reason, like a strong family history, subject to pre-authorisation.

Early detection gives you more treatment options and improves outcomes. Prevention starts with knowing what to look for and making time for the screenings that help protect your health.

Learn more about Profmed’s Preventative Care Benefit:

23/05/2026

This is why a medical aid is important!!

12/05/2026

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10/05/2026

12/04/2026

Many women think that irregular periods, acne, or trouble losing weight are just signs of stress or “bad hormones”. It could be PCOS, a common condition that often goes undiagnosed. Read our new to learn about the symptoms and of care: