How do I choose a medical scheme?
Choosing the right medical scheme is very important. |
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How do I select the option that's best for me?
Before making this choice, you should take a careful look at your personal medical needs. |
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Can anyone become a member of a medical scheme?
Medical schemes used to have the right to reject applications from old or sick applicants, but they may no longer do so legally. |
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What is a co-payment?
Medical schemes seldom cover 100% of any medical bills. A co-payment is the portion of the bill for which you are responsible. |
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What are day-to-day limits?
These are limits, either overall or in categories, which are the maximum that a member and his dependants can spend in a particular year for out-of-hospital expenses. |
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What is a medical savings account?
This is a fixed amount of money that a medical scheme member can choose to put in a savings account on a monthly basis. |
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Can one person belong to more than one medical scheme?
No person may belong to more than one medical scheme. |
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What does BHF stand for?
It refers to the tariff structure of the Board of Healthcare Funders. |
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What are SAMA rates?
SAMA rates give the tariff structure of the South African Medical Association, which is a guideline for doctors in private practice. |
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Who qualifies as a dependant on a medical scheme?
In terms of the Medical Schemes Act, no medical scheme may refuse to admit persons who are dependent on the member. |
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Can I put my ex-spouse on my medical scheme?
If a court awards medical benefits to your spouse in a divorce case, you can keep your ex-spouse on your medical scheme. |
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Does my employer have to subsidise my contributions to the medical scheme?
No, employers do not have to subsidise contributions of their employees to medical schemes. |
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If I resign from the scheme, until when can I claim?
You can submit claims for medical treatment up until the day your medical scheme membership expires. |
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Can a medical scheme terminate my membership?
Yes, if you belong to a closed scheme and you are retrenched or made redundant. An open scheme can only terminate someone's membership if they do not pay their contributions. |
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How are medical scheme contributions determined?
There are three different things which determine medical scheme contributions. |
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What does it mean if a doctor is contracted in?
It means that that particular doctor will charge BHF rates to members of that particular scheme and you will not be left with large co-payments. |
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What is a DSP (designated service provider)?
A healthcare provider or group of providers selected by the scheme as the preferred provider or providers. |
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What are prescribed minimum benefits (PMBs)?
These are benefits in respect of relevant health services prescribed by the regulations under the Act. |
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May a medical scheme refuse to admit my dependant?
No, in terms of the Medical Schemes Act, no medical scheme may refuse to admit persons who are dependent on the member. |
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If a member dies, will his registered dependants still be covered?
Yes, without any break in membership and provided contributions are paid. It is important to inform the scheme if one chooses not to continue.
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Can you still claim if you have given notice to leave the scheme?
You are still covered for medical treatment until the last day of your notice period. |
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What are day-to-day services?
Day-to-day services are all medical services where the member is not hospitalised. This will include your spectacles, medication, doctors' visits, specialist visits and so forth. |
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What does NHRPL stand for?
This is the guideline price published by the Department of Health for all medical services. |
