What Insurance Covers Partial Knee Replacement?
Yes — it is a Prescribed Minimum Benefit. Most schemes cover it in full on a hospital plan.
In South Africa, hip and knee replacement is classified as a Prescribed Minimum Benefit (PMB) under the Medical Schemes Act. This means every registered medical scheme must cover the diagnosis and treatment, including hospitalisation and implant, when the clinical criteria are met.
Co-payments and shortfalls vary by plan. Hospital plans typically cover the hospital and implant fully; surgeon, anaesthetist and physiotherapy fees may attract a shortfall depending on whether the practice charges at scheme rates or above.
Our rooms obtain pre-authorisation from your scheme before surgery and provide you with a written estimate of any expected shortfall so there are no surprises. Gap cover insurance, if you have it, usually covers the surgeon and anaesthetist shortfall.
Educational content only. Prefer to speak first? Try the Knee Check or contact the rooms directly.