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Ex Gratia

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× The Scheme may consider the approval of ex gratia assistance in cases where treatment and care is clinically essential, but the member’s benefits have been depleted. There is no guarantee that an application will be approved and the criteria used by the Committee and its decisions remain final and cannot be disputed.
About Ex Gratia
Ex gratia is not an additional benefit or an extension of a benefit. It is used in special cases for financial assistance towards medical expenses incurred by a member to maintain health and prevent substantial mental or physical suffering.

The rate of reimbursement will be between 80% and 100% of the POLMED rate.

The cut-off date for the submission of applications is the end of April of the following year.

The following does not qualify for ex gratia:

  • Stale claims (older than 120 days)
  • Co-payments of any sort
  • Scheme exclusions
Ex gratia process
Click below to view the Application for Ex Gratia benefits process:
Application for Ex Gratia benefits process

Submit the form to:
Fax: 0860 104 114
Post: POLMED Ex Gratia, Private Bag X16, Arcadia 0007
E-mail: polmedexgratia@medscheme.co.za

Result
Applications for ex gratia are submitted to the Clinical Committee to make a decision. This may take up to a month. If the application is approved, an ex gratia authorisation letter is sent to the member.

 

The ex gratia authorisation letter must be attached to a claim when submitted to POLMED for payment. Claims of this nature can be submitted via email to polmedcurrentclaims@medscheme.co.za