Decision brief preview
Going to casualty
- Get care first if symptoms are severe.
- Ask if the facility is in-network for your plan.
- Keep ICD-10 codes, triage notes, and itemised accounts.
- Check emergency notification and co-payment rules afterwards.
Medical aid navigation
Know what to ask before you use your medical aid.
Before you go, pay, claim, or authorise, know what to ask.
Medical aid members are often not short of information. They are short of clarity at the moment they need to make a decision. This tool helps you slow the moment down and ask better questions before a benefit becomes a bill.
If this may be an emergency, get help first. Do not wait to check benefits. Call 10177 (ambulance) or 112 from a mobile, or go to the nearest appropriate emergency facility.
What’s happening?
01I need emergency careSomeone is seriously unwell or injured right now.Start 02Going to casualty / after-hoursYou are heading to casualty or an after-hours clinic.Start 03See a GP or pharmacy clinicA routine, non-urgent visit to a GP or clinic.Start 04I was referred to a specialistA GP or doctor referred you to a specialist.Start 05I was diagnosed with a chronic conditionRegistering for chronic medicine benefits.Start 06A scan, procedure, or hospital admissionPlanned care that may need authorisation.Start 07I need to understand PMBsWhat Prescribed Minimum Benefits mean for you.Start 08Check network or DSP rulesDesignated Service Providers and co-payments.Start 09My claim was rejectedUnderstand why and what to do next.Start 10I'm not sure what to doAnswer a couple of questions and we will point you the right way.Start
Urgent Care & planning Cover & claims
Example outputs
The kind of checklist you can expect
Decision brief preview
Planned scan/procedure
- Ask whether pre-authorisation is required before booking.
- Request ICD-10 and procedure/tariff codes from the provider.
- Confirm network, DSP, and co-payment risks in writing.
- Keep the quote, referral, and authorisation reference.
What this helps with
- The right questions to ask your scheme and provider
- Which codes and documents to request and keep
- Co-payment, network, and authorisation risks to check
- Plain-English explainers for the terms that trip people up
What it won’t do
- Diagnose you or recommend treatment
- Guarantee a claim outcome
- Tell you to switch schemes or plans
- Ask for your ID or membership number
What this MVP cannot do
Always confirm directly
This MVP cannot confirm your personal benefits, balances, authorisation status, provider network status, PMB status, or claim outcome. It does not connect to live scheme systems. Always confirm directly with your medical scheme, healthcare provider, or accredited broker.
New to the terms? Read the plain-English explainers for PMBs, DSPs, ICD-10 codes, authorisation, and claims disputes. You can also review the sources and limitations.