Benefits can become complicated. For your own good, here’s what you should know.
day-to-day benefits: out-of-hospital services and visits to specialists, GPs, dentists and allied and support professionals as well as the prevention, examination, diagnosis and treatment of diseases;
medicine: chronic and acute medicines; and
major medical expenses: for hospitalisation, appliances, ambulance services, maternity benefits, and the management of physical and mental deficiencies.
Schemes have the right to control their risk by being effective and efficient as well as using interventions like formularies, pre-authorisation treatment protocols and designated service providers.