Updated 08 February 2016

What you absolutely must know about your medical savings account

Many medical scheme members have difficulty understanding just how the medical savings account (MSA) works. Here's some help.

On many full medical schemes members have what is called a medical savings account (MSA). This is usually a percentage of their contributions that gets put into a separate account, from which certain benefits are paid, such as doctors’ visits and acute medication, to name but two.

Read more: FAQ on medical schemes

Once you have exhausted this, you will move into what is known as a ‘self-payment gap’. Certain benefits (depending on your individual scheme), such as X-rays and chronic medication and hospitalisation are not paid from the MSA. So these remain covered regardless of whether you have exhausted your MSA, or not.

Here are some facts on MSAs which every medical scheme member should know.

  • The MSA may not be more than 25% of your total contribution.

  • A member and his/her dependants do not each get a separate MSA. They have one MSA between them, but it is obviously proportionally a lot bigger than that given to a single member.

  • Members need to submit an account not later than the last day of the fourth month following the month in which the service was rendered. Accounts submitted later than this will not be paid, unless the scheme deems the circumstances to be exceptional.

  • Members cannot withdraw their MSA in cash if they have a credit balance. You can only get the balance in cash if you terminate your membership and do not join another scheme option with an MSA, or if you choose no longer to be a medical scheme member.

  • You cannot pay monthly membership contributions out of your medical savings account.

  • According to the Medical Schemes Act, co-payment cannot be settled out of your MSA.

  • Your scheme must provide you with regular statements which show which accounts have been paid, exactly what they were for, and what your MSA balance is now.

  • Your scheme should settle your claims within 30 days of receipt of the claim.

  • Every scheme has predetermined amounts that it will pay for certain procedures. These will be indicated on your statement. Private doctors are entitled to charge more than the amount determined by the scheme. Some schemes have networks of doctors contracted in to particular schemes, who undertake not to charge more than the set amounts for certain procedures.
(Sources: The Council for Medical Schemes, Health24)

(Compiled by Susan Erasmus)

Read more:
Hospital plan vs. medical scheme
How to choose a medical scheme

Susan Erasmus is a freelance writer for Health24.


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