What are Ex Gratia cases?

The Scheme may consider the approval of Ex Gratia assistance in cases where treatment and care are 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

The Board shall not authorise payment for services other than those provided for in the Scheme rules but may, in its absolute discretion and upon written request by a member, authorise an Ex Gratia payment in respect of a benefit. This requires proof that undue hardship would otherwise be imposed upon a member.

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

The Ex Gratia process

Applications for Ex Gratia are submitted to the Clinical Committee to decide. This may take up to a month. If the application is approved, an Ex Gratia authorisation letter will be sent to the member.