Many medical schemes contract with select groups of doctors and hospitals to ensure that their members are charged within the scheme rates and are provided with health services that are efficient and of a high standard. These doctors and hospitals are generally referred to as Designated Service Providers (DSP). Options which make use of DSPs are generally less costly than those that allow freedom of choice of healthcare provider. If you select a DSP option, it is important that you know and accept your obligation to use a doctor or hospital from the list of DSPs. It is also important that you check the list of DSPs so that you know which GP, specialist or hospital you would access when and if you need to. This obviously excludes cases where emergency treatment is necessary.
It is very important to check the level at which your chosen benefit option pays, e.g. 100%, 200%, 300% of tariff. This means that if your scheme pays at 100% of the tariff specified in its rules, and the doctor charges 200%, you may have to co-pay the remaining 100%. Generally speaking, the more comprehensive the option, the higher the rate at which the scheme will pay.Note, however, that this does not apply to the list of PMBs which must be paid in full by the scheme. But remember that while medical schemes must cover the PMB in full, members are expected to use the DSP network of providers and facilities to receive these benefits with no co-payments, except where it’s impossible to do so.
Postal Address: P.O. Box 1701, Gallo Manor, 2052
Physical Address: Country Club Estate Office Park,
21 Woodlands Drive, Building 2, 1st Floor, Woodmead 2191.
Tel: +27.11.258 8982
Fax: +27.11.258 8511
Website Designed and Maintained By
Health Funders Association, © 2018