POLMED Medical Aid Scheme

Overall, POLMED offers 2 medical aid plans (Marine and Aquarium) starting from R117 per month. Additionally, POLMED offers 24/7 emergency support but lacks comprehensive gap coverage on any policy.

POLMED Review – Analysis of Medical Aids’ Main Features

1. ☑️ POLMED at a Glance
2. ☑️ POLMED Regulation
3. ☑️ POLMED Plan Overview
4. ☑️ POLMED – Advantages over Competitors
5. ☑️ How to apply for Medical Aid with POLMED
6. ☑️ How to Submit a Claim with POLMED
7. ☑️ How to Submit a Compliment or Complaint with POLMED
8. ☑️ How to Switch my Medical Aid to POLMED
9. ☑️ POLMED Customer Support
10. ☑️ POLMED vs Fedhealth vs GEMS – A Comparison
11. ☑️ POLMED Member Reviews
12. ☑️ POLMED – Our Verdict
13. ☑️ POLMED Pros and Cons
14. ☑️ POLMED Frequently Asked Questions

POLMED at a Glance

You might consider adding GAP Cover

POLMED Regulation

The Council for Medical Schemes regulates POLMED Medical Scheme. The Council governs South Africa’s medical plan business for Medical Schemes (CMS), a regulating body set up under the Medical Schemes Act, No. 131 of 1998 (the Act). The CMS is responsible for a range of tasks related to the oversight of medical insurance plans, such as:

• Responsible for registering medical insurance plans and ensuring they comply with the law and other laws.
• Making sure healthcare plans have the money to pay claims.
• Examining and authorizing proposed price hikes for medical plans.
• Accepting and examining member complaints and initiating disciplinary action against medical plans that violate the Act or other applicable rules.
• Helping medical insurance plans follow the law and other laws.

Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.

POLMED Plan Overview

POLMED Aquarium Plan

Benefit Rules

• This option restricts coverage to hospitals designated by the network service provider.
• It also provides a reasonable amount of outpatient (daily) care.
• This option is intended to meet the needs of families with minimal healthcare requirements or well-controlled chronic conditions.
• This option is not intended for members who require regular medical care or who desire extensive access to health benefits.
• Where the benefit is contingent upon pre-authorization, referral by a network service provider (DSP) or nominated network general practitioner (GP), adherence to established protocols, or enrollment in a managed care program, members must be aware that there may be no benefit or a significantly reduced benefit if pre-authorization, referral by a network service provider or nominated network GP, adherence to established protocols, or enrollment in a managed care program are not met (a co-payment may be required).
• Pre-authorization, referral by a network service provider or nominated network GP, adherence to established protocols, or enrollment in a managed care program are required to provide the best care for the member and their family and to safeguard the Scheme’s funds.
• All benefit amounts and limits are annual unless otherwise specified.
• No annual limit applies to PMBs or life-threatening emergencies.
• For involuntary access to PMBs, the tariff is typically 100% of the POLMED rate, agreed tariff, or the actual cost.

In-Hospital Benefits

Overall in-hospital limits:

• Subject to the Scheme’s applicable managed healthcare programs and including the application of treatment protocols, case management, and pre-authorization.
• An R5,000 fine may be imposed if prior authorization is not obtained.
• R15,000 co-payment for non-network hospital admission.
• There is no co-payment if the procedure is performed in a network hospital or day clinic.
• Non-PMB admissions will be subject to a per-family cap of R200,000.
• Subject to PMBs, i.e., no limit for life-threatening emergencies or PMB conditions.
• Subject to the applicable tariff, i.e., 100% of the POLMED rate, the Agreed tariff, or the POLMED rate.
• Cost for compelled access to PMBs.
• Anesthetists – 150% is covered according to the POLMED rate.

Standalone Benefits

Medical and Surgical Appliances – the following conditions apply:

• Hearing aids must be prescribed by an audiologist for members to be reimbursed.
• The formula for hearing aids applies. Products not included in the POLMED Formulary are subject to a 20% co-payment.
• Pre-approval is required for the delivery of oxygen.
• All costs for maintenance are excluded from the Scheme.
• Funding will be determined per applicable clinical and funding protocols
• Quotes will be necessary.

POLMED Marine Plan

Benefit Rules

Benefit Design:

• This option provides unlimited hospitalization at the prescribed rate and out-of-hospital (daily) benefits.
• This option is intended to meet the needs of families with substantial healthcare requirements.

Pre-authorization, referrals, protocols, and the management of programs:

• Members should be aware that in cases where receiving the benefit is contingent on obtaining prior authorization, being referred by a network service provider or nominated network general practitioner (GP), following established protocols, or enrolling in a managed care program, they may receive no benefit at all, or a significantly reduced benefit (a co-payment may be applied)
• To provide the best care for the member and their family and to safeguard the Scheme’s funds, pre-authorization, referral by a network service provider or nominated network GP, adherence to established protocols, or enrollment in a managed care program are all requirements.

Yearly Limits:

• All benefit amounts and caps are annual unless otherwise specified.

PMBs:

• There is no yearly cap on PMBs or life-threatening emergencies.

Tariffs:

• Unauthorized access to PMB will be charged at a rate equal to 100% of the POLMED rate, the agreed tariff, or the actual cost.

In-Hospital Benefits

Overall in-hospital limits:

• Every POLMED recipient is required to be referred to network specialists by a network General Practitioner (GP). The doctor must obtain authorization for the referral through the Interactive Voice Response system (IVR).
• The network primary care physician must provide a member with a referral number and letter to present to a network specialist. The Scheme may impose a co-payment of up to R1,000 if a member consults a specialist without a referral.
• The co-payment will be paid by the member directly to the specialist; the Scheme will not reimburse the co-payment.
• Unlimitable network service providers.
• Subject to PMBs, i.e., no limit for life-threatening emergencies or PMB conditions
• Costs will be 100% of the POLMED rate unless otherwise specified, the agreed price, or at a cost where there is involuntary access to PMBs

Standalone Benefits

Allied health services and alternative healthcare providers include Biokineticists, chiropractors, chiropodists, dieticians, homeopaths, naturopaths, orthoptists, osteopaths, podiatrists, reflexologists, and therapeutic massage therapists.

POLMED – Advantages over Competitors

• POLMED offers some of the most affordable options to South African Police Service (SAPS) members.
• POLMED is well-governed and transparent.
• The Claims process is quick and transparent.
• POLMED offers comprehensive coverage for several procedures, services, and illnesses.
• POLMED covers up to 100% of the POLMED rate on in-hospital procedures.

How to apply for Medical Aid with POLMED

To apply for Medical Aid through POLMED, you must be an employee of the South African Police Service (SAPS) appointed under the South African Police Service Act (68 of 1995). You can follow these steps to become a POLMED member if you qualify.

• Navigate to the POLMED website and click on “Members” from the lefthand toolbar.
• Next, click on “My Medical Scheme” and “Member Registration” from the available menus.
• Click on the “Download Application Form,” and the form will load.
• Read through the requirements and complete the required documents.
• Once the membership application has been received, an SMS confirmation will be sent to the mobile number provided on the application. When the member’s membership is activated, and processing is complete, a membership card will be mailed to them.
• Only the primary member and dependents listed on their membership card are permitted to use them.

How to Submit a Claim with POLMED

Members must note the following when they wish to claim from POLMED:

• Claims must be filed within one hundred twenty days of the service date. Claims received after the specified timeframe will be rejected as obsolete.
• Account statements in duplicate will be accepted for processing and payment.
• When the service provider charges above POLMED rates, you pay the difference directly to the service provider.

Obtain from the service provider a detailed account/statement. Members should be aware that many service providers electronically submit their claims. There are several ways to submit claims to POLMED for processing:

• Email your claim to [email protected].
• Fax your claim to 011 758 7660
• Post your claim to POLMED, Private Bag X16, Arcadia, 0007.
• Alternatively, you can visit any regional walk-in POLMED office to drop off your claim.

How to Submit a Compliment or Complaint with POLMED

Compliments and Complaints can be submitted directly to POLMED via:

• ✅ Email
• ✅ Telephone
• ✅ Post
• ✅ In-person at walk-in centers
• ✅ Fax

How to Switch my Medical Aid to POLMED

To switch your medical aid to POLMED, you can follow these steps:

• Research: Gather information about POLMED and compare it with your current medical aid scheme to see if it suits your needs.
• Contact POLMED: You can reach out to POLMED through their customer service line at 0860 765 633 or visit their website at www.medscheme.co.za for more information.
• Complete the application form: You can request an application form from POLMED or download one from their website. Complete the form with all the required information and attach any necessary supporting documents.
• Apply: Submit the completed form and the required documents to POLMED by email, post, or in person at a client service center.
• Please wait for approval: POLMED will review your application and notify you of their decision within a few working days. If approved, you’ll receive a welcome pack and instructions on how to activate your new membership.
• Cancel your current medical aid: Once you have received confirmation of your new membership, you can cancel your current medical aid.

Note: Before switching, make sure you understand the terms and conditions of your new medical aid and any waiting periods or exclusions that may apply.

POLMED Customer Support

You can contact POLMED customer support using the following channels:

• Telephone – 0860 765 633 (0860 POLMED)
• Fax – 0860 104 114
• Email – [email protected]
• Post – POLMED, Private Bag X16, Arcadia, 0007.
• Visit a walk-in center to speak to a customer support agent directly.

POLMED vs Fedhealth vs GEMS – A Comparison

POLMED Member Reviews

Great Support.

A few weeks ago, I received an invoice from my dentist to complete two crowns. Upon calling POLMED, I was informed that the dental authorization was declined due to an incorrect X-ray sent by my dentist. After several communication exchanges between POLMED and my dentist, I had the pleasure of speaking with Lindiwe. She was professional and courteous, providing me with a clear understanding of what needed to be done to receive authorization. I promptly forwarded the required information to Lindiwe, and the authorization was granted without issue. I can now proceed with completing the two crowns at my dentist’s office. – Lewis Wood

Excellent Customer Service.

I recently encountered a challenge related to a claim and enrollment in the maternity program. I contacted the client services department and was promptly assisted by a friendly operator who successfully addressed and resolved all of my inquiries. This was the best customer service experience I have had with POLMED. – Manie Ellis

Happy Member.

I would like to express my gratitude for POLMED’s approval of further treatments for my husband despite the depletion of our oncology benefits and the fact that his cancer was not listed as a Prescribed Minimum Benefit (PMB) condition. Your assistance in providing financial support has given my husband a fair chance to fight for his life. Thank you, POLMED. – Deacon Leblanc

POLMED – Our Verdict.

POLMED is a South African medical scheme that provides healthcare coverage for its members. It offers various options for members to choose from, such as hospital plans, chronic medicine management programs, and specialized dentistry coverage. The scheme also has a process for members to lodge complaints or disputes in case of unfavorable outcomes. POLMED provides medical care for Police Service employees in South Africa and offers a range of benefits to its members, with affordable monthly contributions.

POLMED Pros and Cons

POLMED Frequently Asked Questions

Who qualifies for POLMED medical aid?

Only employees of the South African Police Service (SAPS) appointed per the South African Police Service Act (Act 68 of 1995), and their dependents are eligible to join POLMED.

Which hospitals does POLMED cover?

All hospitals are run by Life Healthcare. Each Intercare Day Clinic and Subacute facility. All Mediclinic Hospitals. All National Hospital Network (NHN) hospitals and others.

Where can I view my POLMED statements?

You can view your statements on the Online Portal or at a Client Service Center. Furthermore, POLMED will email monthly statements to members.

What are the POLMED Medical Aid Options?

POLMED offers Marine and Aquarium options, each with its own benefits, conditions, and limits.

Where can I view the POLMED 2024 benefits?

You can view the POLMED 2024 benefits by visiting the POLMED website or contacting customer service for more information.

What is the POLMED email address?

POLMED’s email address for general queries is [email protected]. In addition, there is a comprehensive list of departments and their specific email addresses on the POLMED website.

How can I access my POLMED member login?

You can access your POLMED member login by visiting the POLMED website and navigating to the member login section.

You may be required to enter your username and password to log in to your account. If you have any issues accessing your account, you can contact POLMED customer service for assistance.

How can I get my POLMED Tax Certificate for 2023?

To get your 2023 POLMED Tax Certificate, you may have to log in to your account on the POLMED website or contact their customer service for assistance. Depending on your preference, they may provide you with a copy of your tax certificate through email or regular mail.

How do I Downgrade my Plan with POLMED?

Contact POLMED customer service via phone or email or visit a Walk-In center in South Africa and Request to downgrade your current plan.

How do I add a Beneficiary to POLMED?

If you want to add a child or adult dependent, you can log into your POLMED profile and choose “Forms & Downloads” from the main menu on the left-hand side of the page.