Scheme Rules

We believe in clear and transparent communication.

You can access the Scheme Rules below to better understand your benefits, cover, and how your membership works.

Payment Run Updates

Stay informed about when claims are processed and payments are made. Regular payment updates help you plan and manage your healthcare expenses.

Ex-Gratia

In certain cases where treatment falls outside your benefits, financial assistance may be considered.

This is reviewed on a case-by-case basis through the Scheme’s Ex-Gratia Policy.

For more information, please contact Member Support.

Understanding Cover for Grandchildren

Alliance-Midmed requires every dependant to be directly linked to a principal member. This means that if your child is registered as a dependant on your membership and has a baby, the newborn cannot automatically be added to your membership as another dependant.

Simply put, the Scheme does not allow a dependant to have their own dependant.

Option 1: The Parent Becomes a Principal Member

If your child, who is the baby’s parent, becomes an active principal member of Alliance-Midmed, they can apply to register their baby as a dependant on their own membership.

Option 2: You Have Legal Responsibility for the Child

If you, as the grandparent, become legally responsible for the baby through legal adoption or court-ordered guardianship, you may apply to register the child as a dependant on your membership.

Supporting legal documentation will be required.

However, there are circumstances where your grandchild may qualify for membership.

Depending on your circumstances, you may be asked to provide documents such as:

  • An unabridged birth certificate
  • Adoption documents
  • Court-issued guardianship documents
  • Completed Scheme application forms
  • Any other supporting documents required to confirm eligibility

ewborns should be registered within 30 days of birth to help ensure uninterrupted cover and avoid waiting periods where applicable.

For a grandchild or third-generation membership application, registration can only be finalised once all required supporting documents have been submitted and verified.

Standard Scheme Rules and requirements, including applicable contributions and waiting periods, will apply.

Every family’s circumstances can be different. If you’re unsure whether your grandchild qualifies or what documents you need, our Client Services Team can guide you through the process.

Email: service@alliancemidmed.co.za

Have questions about registering dependants?
Our Client Services Team is here to help you understand the requirements and guide you through the application process.