What are limits?

Last updated: 27 June 2005

These are limits, either overall or in categories, which are the maximum that a member and his dependants can spend in a particular year for out-of-hospital expenses. Schemes work according to a financial year, 01 January to the end of December. These categories usually include things such as visits to the doctor, prescribed medication, glasses or contact lenses, specialists, physiotherapists and so forth.

On low-cost medical schemes these day-to-day limits are often not very high, but the hospital cover is quite sufficient. This is how that particular option within a medical scheme can afford to keep the monthly contributions low. On some options within a medical scheme, the day-to-day limits could be high, but this will then be reflected in the higher monthly contribution. If a medical scheme covers 80% of the NRPL rate of a visit to the GP, the remainder of 20% will have to be paid by the member. If the GP charges more than NRPL rate, the difference will be for the member's own account.