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The first tariff structure is that of the Board of Healthcare Providers (BHF). Most medical aids base their payments to healthcare providers (doctors, dentists, hospitals etc.) on this structure.

If your medical aid pays only 80% of the BHF tariff for you to see your GP, and the BHF tariff is, say, R100, and that's what your GP charges, you will have to pay R20 of the bill yourself. If your GP charges R120, you will have to pay in R40. This means that your GP does not charge BHF rates and you have to pay the difference between BHF rates and the final bill.

The second tariff structure is that of the South African Medical Association (SAMA), which represents doctors in private practice. This association publishes an annual rates guide of what it thinks its members should be paid for their services. These rates are generally much higher than the BHF rates.

If your medical aid pays only 80% of BHF rates for visits to a specialist and the BHF rate is, say, R200, you will be paid out R160 by your medical aid. If the specialist charges R400, you will still be paid out R160. The remaining R240 will be for you to cough up. Obviously this depends on your individual medical aid itself, or the option you have chosen within it. There have always been two tariff structures in South Africa, according to which tariffs for medical treatments were determined. Then the Competitions Board stepped in, and in January 2004 the Department of Health issued a single guideline – the NRPL., which stands for the National Reference Price List for Health Services.
 

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