Genesis Medical Scheme
1.8|172 reviews
LB
Lily B
1 reviews | Active since Member
30 Jan 2026, 08:53
Limited cover for mental health PMB
I would like to express my utmost disappointment with Genesis medical scheme regarding cover of my stay in Kenilworth Akeso mental health facility. Genesis has said that if I want the standard 21 day PMB cover for mental health, I need to go to a DSP. However, as far as I can see all of the DSPs anywhere near me in Cape Town are public health care facilities. As a result, Genesis is only paying R54000 which covers 6 days in Kenilworth Akeso. I am outraged. If I wanted to go to a public health care facility, I could pay for it myself, as they are catered to one’s income level. Furthermore, my psychiatrists have never heard of another medical aid scheme pulling a stunt like this - they are used to all medical aid schemes covering the standard 21 days in a mental health clinic. Furthermore, if I had a physical injury, there would be no doubt that I could be admitted to a private hospital and be covered by Genesis. Mental health is just as important to my mortality. I have been a loyal customer of theirs and expect better, non-discriminatory treatment. I would like to fully benefit from the Kenilworth Akeso program which is three weeks, in order to have a chance at recovery. I will be spreading the news of their disappointing decision far and wide and ensure that everyone I have recommended Genesis to is aware that they should not choose Genesis.
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Replies (56)Genesis Medical Scheme's replyOfficial
30 Jan 2026, 13:04 Dear Ms Bovim Our correspondence with you, as well as your review on this platform, has reference. Our mental illness benefit, if not obtained from one of our DSPs, is limited to R54,000 per beneficiary per annum in a private facility. This benefit is in no way discriminatory as it is a stated benefit that is not only in line with the Medical Schemes Act, but has also been approved and registered by the Registrar of Medical Schemes. It is common practice in South Africa that medical schemes' mental illness benefit, in terms of PMB treatment, is limited to a maximum of 21 days WHEN treatment is obtained from a scheme's DSP. If, however, treatment is not obtained from a DSP, the provisions of the Act no longer have relevance, and benefits are then limited as provided for in the registered rules of the scheme. We do realise that this is not what you want to hear, but it is equally important to state that we are not depriving you of the treatment that you require. Decisions regarding treatment are always between a doctor and his/her patient; a medical scheme merely provides funding for medically appropriate treatment in terms of the provisions of the Medical Schemes Act and the Rules of that scheme. Genesis is most certainly not “pulling a stunt” or discriminating against you, or any of our members, in any way. PMB treatment in private hospitals is reimbursed in terms of the Rules where limits may apply. PMB treatment in a DSPs will be reimbursed subject to PMB level of care as prescribed in the Medical Schemes Act. We do take note of your threats but caution you against defamatory remarks. All our rights are reserved in law. Yours sincerely GENESIS MEDICAL SCHEME
Best regards,
Genesis Medical Scheme's reply30 Jan 2026, 13:04
Official
Dear Ms Bovim Our correspondence with you, as well as your review on this platform, has reference. Our mental illness benefit, if not obtained from one of our DSPs, is limited to R54,000 per beneficiary per annum in a private facility. This benefit is in no way discriminatory as it is a stated benefit that is not only in line with the Medical Schemes Act, but has also been approved and registered by the Registrar of Medical Schemes. It is common practice in South Africa that medical schemes' mental illness benefit, in terms of PMB treatment, is limited to a maximum of 21 days WHEN treatment is obtained from a scheme's DSP. If, however, treatment is not obtained from a DSP, the provisions of the Act no longer have relevance, and benefits are then limited as provided for in the registered rules of the scheme. We do realise that this is not what you want to hear, but it is equally important to state that we are not depriving you of the treatment that you require. Decisions regarding treatment are always between a doctor and his/her patient; a medical scheme merely provides funding for medically appropriate treatment in terms of the provisions of the Medical Schemes Act and the Rules of that scheme. Genesis is most certainly not “pulling a stunt” or discriminating against you, or any of our members, in any way. PMB treatment in private hospitals is reimbursed in terms of the Rules where limits may apply. PMB treatment in a DSPs will be reimbursed subject to PMB level of care as prescribed in the Medical Schemes Act. We do take note of your threats but caution you against defamatory remarks. All our rights are reserved in law. Yours sincerely GENESIS MEDICAL SCHEME
Best regards,