Does medical aid cover weight management in South Africa?
Usually only in part. Obesity isn't a prescribed minimum benefit in South Africa, so medical schemes don't have to cover weight management. Many still pay for some of the pieces, and some weight-related conditions are covered.
The short version
- Schemes aren't obliged to cover weight management programmes or medication for weight loss.
- Doctor consults, dietitian visits and blood tests may be paid from day-to-day benefits or savings.
- Conditions such as type 2 diabetes, high blood pressure and high cholesterol are on the Chronic Disease List, so their treatment is covered.
- Ask your scheme before you start. The questions are below.
Why weight management often isn't covered
Prescribed minimum benefits (PMBs) are the conditions every medical scheme must cover, whatever your plan. Obesity is not one of them, so schemes are not required to pay for its treatment. That leaves each scheme to decide what, if anything, it covers.
What may be covered
- Doctor consults, usually from day-to-day benefits or your medical savings account
- Dietitian visits, often from day-to-day benefits, sometimes with a referral
- Blood tests, especially when they're part of managing a chronic condition
- Physiotherapy and biokinetics, which can matter if weight is affecting your joints
- Wellness screenings that some schemes fund once a year
Conditions that are covered
The PMB Chronic Disease List includes type 1 and type 2 diabetes, hypertension (high blood pressure) and hyperlipidaemia (high cholesterol). If you have one of these, your scheme must cover its diagnosis and treatment, according to its rules and formulary. Your doctor will treat these conditions as part of your care, and the invoice will show the codes your scheme needs.
What usually isn't covered
- Weight management programmes and memberships
- Many medicines prescribed for weight management, depending on your scheme
- Supplements
Questions to ask your scheme
- Do you cover any weight management treatment on my plan? On what conditions?
- Are GP consults by video paid from day-to-day benefits or savings? Is there a limit?
- How many dietitian visits are covered, and do I need a referral?
- Which blood tests are covered, and do they need pre-authorisation?
- If I'm prescribed a medicine, is it on your formulary? What's the co-payment?
Write down the name of the person you spoke to, the date and any reference number. It helps if a claim is queried later.
How it works with BettaHabit
Consults are billed by the practice, with an invoice you can submit to your scheme. Rehab sessions and blood tests are billed by whoever provides them. Our memberships and supplements aren't usually claimable. Every cost is listed on our pricing page.