
THERE FOR YOU

One goal and one goal only: improving the health of our members
As a restricted membership scheme we are not for profit, but simply want to ensure that you and your dependants have great medical cover and the support you need to live a healthy life.

Savings are passed on directly to you
Unlike open schemes, we don’t have to spend a lot of money on marketing to attract new members. This is just one of the ways in which we save… and thus pass the savings on to you. In fact, independent benchmarking shows that our benefits are comparable with those offered by the top open-membership schemes, but that our contributions are much lower!

We look for reasons to pay claims
Open schemes usually apply strict conditions around the payment of benefits, as paying more than what is legally required may have a negative impact on their surplus levels and related profitability. Generally they do not pay ex gratia claims. Our objective is breaking even and maintaining our solvency ratio. We therefore pay claims within our rules and also offer ex-gratia assistance to our members through a managed governance process.

Bells and whistles… we’ve got them, too!
Open schemes are in competition with each other for the same member pool, and often add extra benefits to make their offering more attractive… gym memberships and the like. With our partner Sanlam Reality, we can now also offer you a lifestyle rewards programme where you can pay a minimal monthly fee and enjoy extras such as heavily discounted gym fees, movies, flights and more!
ALL OUR PLANS OFFER:






THE PLANS DIFFER MAINLY IN HOW THE FOLLOWING ARE COVERED:
![]() Everyday services benefits |
![]() Non-PMB chronic conditions |
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PLATINUM
Flexibility for a healthy family with a higher income who wants excellent cover for everyday services benefits such as GP consultations. |
Offers the highest benefits, paying up to 3 x Medical Scheme Rate (MSR). | Covers PMB and approved non-PMB conditions from a set benefit limit, then from Routine Medical Benefit, then covers PMB unlimited. |
COMPREHENSIVE
Cover for higher healthcare needs, especially chronic conditions, with a savings allocation allowing more flexibility for everyday services benefits. |
Covers certain benefits from a personal medical savings account, allowing more flexibility. | Covers approved non-PMB conditions from a set benefit limit; PMB conditions unlimited. |
TRADITIONAL
Cover for medium healthcare needs, especially chronic conditions, with sublimits on everyday services benefits. |
Covers listed benefits up to pre-set sub-limits. | Covers approved non-PMB conditions from a set benefit limit; PMB conditions unlimited. |
SAVINGS
Maximum flexibility for a generally healthy family who is happy to have everyday services covered from an annual savings allocation. |
Covers all benefits from funds available in the personal medical savings account. | Covers both PMB and approved non-PMB from a set benefit limit, then covers PMB unlimited. |
HOSPITAL NETWORK
If you have no immediate healthcare needs, but want the peace of mind of having cover mainly for unforeseen hospital procedures and serious diseases. |
Restricted cover for everyday services (1 network GP consultation). | Cover only for PMB conditions and Major Depression. |
WHAT PLAN TO CHOOSE?
Weigh up your needs with what you can afford…
YOUR NEEDS
- How healthy are you and your loved ones? What were your medical expenses during the previous benefit year, and do you anticipate any medical procedures or any need for high-cost drugs during the next benefit year?
- Do you prefer to pay less for a Plan that does not cover much in the way of day-to-day medical needs, or would you rather pay more and have a Plan that offers more comprehensive cover for day-to-day medical needs?
- Do you or any of your loved ones suffer from a chronic disease that would require chronic medicine or treatment? If so, is it a condition that is covered by all the Plans, or only by the higher-cost Plans (or not at all)?
WHAT YOU CAN AFFORD
- Use our handy calculator tool to calculate your family’s monthly contribution rate for each Plan to make sure that you can afford the Plan you select. Before moving to a lower-cost Plan, make sure that you will still have good enough cover for your medical needs.
TIP: If you are retiring during the next benefit year, choose a Plan which will take into account your financial circumstances at retirement.
FOR 2020
This is an overview only – please see the 2020 Member Guide for specific amounts and rates,
as well as conditions that may apply.
BENEFITS: HOSPITAL AND TRAUMA
All Plans offer unlimited cover for major medical expenses (but with sub-limits on certain procedures and benefits).
Claims are paid at Medical Scheme Rate or cost or medicine price, whichever is the lesser. Remember that conditions such as pre-authorisation, co-payments and case management may apply – see the 2020 Member Guide.
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IN AN EMERGENCY |
You and your loved ones have access to emergency medical transportation (if authorised by ER24) 24 hours a day, 7 days per week, in South Africa, Lesotho, Swaziland, Zimbabwe, Botswana, Namibia, Mozambique and Angola. (Call +27 102 053 038 if outside the borders of South Africa.)
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FOR MEDICAL ADVICE |
ER24 also has an “Ask the Nurse” medical advice and information line. Although it is not possible to make an accurate diagnosis over the phone, this can help you decide whether you need an ambulance, see your doctor, or simply go to the pharmacy.
BENEFITS: HEALTH SCREENING
To help you and your loved ones prevent disease, all Plans offer screening tests and vaccinations.
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Blood sugar |
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Blood pressure |
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Cholesterol |
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Measurement of height, weight and waist circumference |
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Body Mass Index calculation |
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HIV Screening |
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Vaccinations |
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Pap smear |
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Prostate Specific Antigen |
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Mammogram |
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Colorectal screening |
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Glaucoma screening |
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Bone density screening |
BENEFITS: MANAGED CARE PROGRAMMES
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Diabetes Management Programme |
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Mental Health Programme |
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GoSmokeFree Programme |
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Back and Neck Rehabilitation Programme |
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Oncology Benefit Management Programme |
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HIV and AIDS Management Programme |
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Renal Dialysis and Organ Transplant Programme |
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Active Disease Risk Management Programme |
BENEFITS: CHRONIC MEDICINE




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All chronic medicine benefits (both PMB and non-PMB) are first covered from a set chronic medicine benefit limit (R11 340 per family per year for 2020). |
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All chronic medicine benefits (both PMB and non-PMB) are first covered from a set chronic medicine benefit limit (R11 340 per family per year for 2020). |
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A set chronic medicine benefit amount is used to cover non-PMB conditions (R11 340 per family per year for 2020). |
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PMB conditions are covered separately, and unlimited. |
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A set chronic medicine benefit amount is used to cover Major Depression only (R4 430 per family per year for 2020). |
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PMB conditions are covered separately, and unlimited. Pharmacy Direct is the DSP. |

THE OFFICIAL PMB CONDITIONS
Addison’s disease, Asthma, Bipolar mood disorder, Bronchiectasis, Cardiac failure, Cardiomyopathy, Chronic renal disease, Chronic obstructive pulmonary disease (emphysema), Coronary artery disease (angina pectoris and ischaemic heart disease), Crohn’s disease, Diabetes insipidus, Diabetes mellitus type 1 & 2, Dysrhythmias, Epilepsy, Glaucoma, Haemophilia, HIV/AIDS, Hormone replacement therapy, Hyperlipidaemia (high cholesterol), Hypertension (high blood pressure), Hypothyroidism, Multiple sclerosis, Parkinson’s disease, Rheumatoid arthritis, Schizophrenia, Systemic lupus erythematosus and Ulcerative colitis.

ADDITIONAL SCHEME-APPROVED CHRONIC CONDITIONS
Acne (cystic nodular), Allergic rhinitis (no criteria for Platinum, Comprehensive and Traditional Plans, while for Savings Plan will only be approved for children under the age of 12 years, or for patients on concurrent asthma therapy), Anxiety (if linked to another approved psychiatric chronic condition), Attention deficit syndrome (if prescribed by a specialist and under the age of 18 years), Behcet’s Disease, Deep vein thrombosis, Depression/Mood disorders, Eczema, GORD, Gout, Hyperthyroidism, Hypofunction of the pituitary gland, Insomnia (sleep disorders) (if linked to another approved psychiatric chronic condition), Migraine prophylactics (prevention), Obsessive Compulsive Disorder, Paget’s Disease, Psoriasis and Sjogren’s Disease.
In addition, for Platinum, Comprehensive and Traditional Plans: Alzheimer’s disease, Urinary tract infections, Cystitis, Chronic Sinusitis, Osteoarthritis and Osteoporosis.
BENEFITS: EVERYDAY SERVICES

Benefits are paid at up to 3 x MSR. | |
Sub-limits are available for certain benefits. | Other specific benefits are covered from the Routine Medical Benefit (RMB) limit. |
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Once these sub-limits are depleted, the available RMB limit can also be used to cover the above benefits. | |
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Once your sub-limits and RMB are depleted, you will be liable for payment. |
ROUTINE MEDICAL
BENEFIT LIMIT
Member: R20 450 Member +1: R34 380 Member +2: R36 450 Member +3: R44 300 |
This benefit can also be used to pay for certain other services, once you have used up those limits. |

15% of your monthly contribution is allocated to your PMSA. Benefits with sub-limits are paid at MSR, while benefits payable from PMSA are covered at cost. | |
Sub-limits are available for certain benefits. | Other specific benefits are covered from your Personal Medical Savings Account (PMSA). |
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Once your sub-limits and/or PMSA (whichever is applicable to the specific benefit) are depleted, you will be liable for payment. |
ANNUAL PMSA AMOUNT
(AVAILABLE UPFRONT)
Add up the amounts per beneficiary to calculate the total available for your family.
If you earn R4 500 pm or less |
Member: R7 842 Adult: R6 117 Child (max 2): R1 740 |
If you earn between R4 500 and R6 000 pm |
Member: R7 995 Adult: R6 237 Child (max 2): R1 782 |
If you earn between R6 001 and R10 000 pm |
Member: R8 034 Adult: R6 267 Child (max 2): R1 794 |
If you earn more than R10 000 pm from April 2020 |
Member: R8 160 Adult: R6 366 Child (max 2): R1 839 |

Benefits are paid at MSR. | |
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Sub-limits are available for certain benefits. |
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Once your sub-limits are depleted, you will be liable for payment. |

21.3% of your monthly contribution is allocated to your PMSA. Benefits with sub-limits are paid at MSR, while benefits payable from PMSA are covered at cost. | |
Most of the listed benefits are covered from your Personal Medical Savings Account (PMSA). | Sub-limits are available for certain maternity benefits only. |
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Once your sub-limits and/or PMSA (whichever is applicable to the specific benefit) are depleted, you will be liable for payment. |
ANNUAL PMSA AMOUNT
(AVAILABLE UPFRONT)
Add up the amounts per beneficiary to calculate the total available for your family.
If you earn R6 000 pm or less |
Member: R5 598 Adult: R4 812 Child (max 2): R1 710 |
If you earn between R6 001 and R10 000 pm |
Member: R5 718 Adult: R5 088 Child (max 2): R1 785 |
If you earn more than R10 000 pm |
Member: R6 105 Adult: R5 988 Child (max 2): R2 028 |
Remember that certain benefit limits and conditions such as treatment protocols apply – see the 2020 Member Guide.
PLATINUM | COMPREHENSIVE | TRADITIONAL | SAVINGS | |
![]() Consultations: General Practitioners, Homeopaths and Specialist consultations |
![]() Payable from Routine Medical Benefit. |
![]() Covered from available PMSA. |
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![]() Covered from available PMSA. |
![]() Optical benefits: Eye tests, lenses, contact lenses and fittings |
![]() Additional sub-limits available. Once exhausted, payable from Routine Medical Benefit limit. |
![]() Sub-limits available, with frames covered from available PMSA. |
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![]() Covered from available PMSA. |
![]() Maternity benefits: Antenatal visits Ultrasound scans Antenatal classes |
![]() Additional sub-limits available. |
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![]() Additional sub-limits available. |
![]() Dentistry: Basic dental services and advanced dentistry |
![]() Additional sub-limits available. Once exhausted, payable from Routine Medical Benefit limit. |
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![]() Covered from available PMSA |
![]() Medicines: Prescribed medicine (acute) Pharmacy advised therapy (PAT) |
![]() Payable from Routine Medical Benefit. |
![]() Covered from available PMSA. |
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![]() Covered from available PMSA. |
![]() Pathology |
![]() Payable from Routine Medical Benefit. |
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![]() Covered from available PMSA. |
![]() Radiology (X-rays) |
![]() Payable from Routine Medical Benefit. |
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![]() Covered from available PMSA. |
![]() Supplementary health services (for example, chiropody, chiropractic services, speech therapists, biokinetics) |
![]() Payable from Routine Medical Benefit. |
![]() Covered from available PMSA. |
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![]() Covered from available PMSA. |
![]() Physiotherapy |
![]() Payable from Routine Medical Benefit. |
![]() Covered from available PMSA. |
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![]() Covered from available PMSA. |
![]() Psychology |
![]() Payable from Routine Medical Benefit. |
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![]() Covered from available PMSA. |
![]() Medical appliances (including CPAP) |
![]() Payable from Routine Medical Benefit. |
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![]() Covered from available PMSA. |
![]() Wheelchair and associated appliances |
![]() Additional sub-limits available. |
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![]() Covered from available PMSA. |
![]() Hearing aids |
![]() Payable from Routine Medical Benefit. |
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![]() Covered from available PMSA. |
![]() Oral contraceptives |
![]() Additional sub-limits available, including for Mirena device. |
![]() Covered from available PMSA. |
![]() Payable from Prescribed medicine (acute) sub-limit. |
![]() Covered from available PMSA. |
FOR 2020

1 January 2020 – 31 March 2020 (same amounts as from April 2019) |
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Member | Adult | Child (max 2) | |
PLATINUM | |||
All income levels | R5 211 | R4 065 | R1 248 |
COMPREHENSIVE (includes 15% allocation to PMSA) | |||
R0 – R4 500.99 pm | R3 867 | R3 016 | R851 |
R4 501 – R6 000.99 pm | R4 210 | R3 283 | R941 |
R6 001 + pm | R4 295 | R3 350 | R970 |
TRADITIONAL | |||
0 – R6 000.99 pm | R3 720 | R2 900 | R816 |
R6 001 + pm | R3 793 | R2 959 | R880 |
SAVINGS (includes 21.3% allocation to PMSA) | |||
0 – R6 000.99 pm | R2 075 | R1 786 | R634 |
R6 001 + pm | R2 262 | R2 220 | R753 |
HOSPITAL NETWORK | |||
0 – R6 000.99 pm | R1 278 | R1 112 | R403 |
R6 001 + pm | R1 587 | R1 563 | R545 |
1 April 2020 – 31 December 2020 |
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Member | Adult | Child (max 2) | |
PLATINUM | |||
All income levels | R5 680 | R4 431 | R1 360 |
COMPREHENSIVE (includes 15% allocation to PMSA) | |||
Up to R10 000.99 pm | R4 526 | R3 529 | R1 012 |
R10 001 + pm | R4 617 | R3 601 | R1 043 |
TRADITIONAL | |||
Up to R10 000.99 pm | R3 999 | R3 118 | R877 |
R10 001 + pm | R4 077 | R3 181 | R946 |
SAVINGS (includes 21.3% allocation to PMSA) | |||
Up to R10 000.99 pm | R2 231 | R1 920 | R682 |
R10 001 + pm | R2 432 | R2 387 | R809 |
HOSPITAL NETWORK | |||
Up to R10 000.99 pm | R1 318 | R1 146 | R415 |
R10 001 – R20 000.99 | R1 665 | R1 640 | R572 |
R20 001 + pm | R1 698 | R1 672 | R583 |
Contributions for active employees are based on Total Guaranteed Package (TGP).
OF YOUR BENEFITS
This is how you can save money:













A SPECIALIST
To ensure co-ordinated care, and to minimise unnecessary costs, members should be referred to any specialists by their GP. To create a specialist referral, the GP needs to access the Medscheme interactive voice system to obtain a specialist referral number.
The referral number will apply to either a type of specialist (for example, a dermatologist) or a specific specialist for a period of time that the GP decides on, which can be up to 6 months. The patient still has the choice of which specialist to visit.
There are some exceptions to this rule and members will not need a specialist referral number in the following instances:
- 1 visit per year to a gynaecologist for a gynaecological check-up and pap smear for female patients
- 1 visit per year to a urologist for a check-up for male patients
- Visits to a paediatrician for children under 1 year of age
- Visits to optical and dental specialists
- Maternity consultations by a gynaecologist
- Medical management under the Prescribed Minimum Benefit treatment plan
In case of an emergency, where a patient had to consult a specialist without prior authorisation, a referral number can be obtained after the visit. The patient would need to contact his/her GP to obtain the referral number within 72 hours of the emergency.
Members should remember that obtaining a referral number from a GP is not a guarantee of full payment – specialist consultations will be paid up to the Medical Scheme Rate, or such rate as agreed with the specialist, and subject to available benefits. Authorisations will only be valid for six months.
OR OUT-OF-POCKET EXPENSES YOU CAN EXPECT
In an effort to manage escalating healthcare costs and over-utilisation of benefits, the Scheme has implemented certain co-payments that would apply under certain circumstances. For ease of reference, this section gives an overview of all the co-payments that you may incur. Depending on your decisions, you may incur one or a combination of these.
HOSPITALISATION
If you are admitted to hospital … | … you will have to pay | What you can do to avoid additional costs: |
for a non-emergency and your admitting practitioner is not part of the Nedgroup GP or Specialist Networks, your claims will be covered at Medical Scheme Rate, and… |
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Make sure that your admitting practitioner is on the Nedgroup Network, as your hospital claims will then be covered up to 2 x Medical Scheme Rate and you will not have a R2 500 co-payment on hospital bills. |
for a non-emergency and you do not contact the Scheme before you are admitted to hospital to pre-authorise your admission (unless it is a valid emergency), … |
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Always pre-authorise a hospital admission, as well as in-hospital tests such as MRI, radio-isotope or CAT scans, at least three days beforehand. In an emergency, the Scheme must be notified on the first working day after the admission. |
for back and neck pain and you did not have an assessment via the Back and Neck Rehabilitation Programme … |
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If you have back and neck pain, register on the Scheme’s Back and Neck Rehabilitation Programme for an assessment. |
In addition, for members/beneficiaries on the HOSPITAL NETWORK PLAN
If you are admitted to a NON-NETWORK hospital… | … you will have to pay | What you can do to avoid additional costs: |
for a non-emergency | a co-payment of R7 000, at the point of admission to the hospital. | Use only hospitals that are on the specified list of hospitals for the Hospital Network Plan. |
LAPAROSCOPIC SURGERY AND OTHER PROCEDURES WITH CO-PAYMENTS
Laparoscopic procedures are more expensive, and the procedure may in general be performed as an open procedure. The Scheme, like many other medical schemes, funds these procedures with a co-payment, rather than only cover open procedures.
If you have any of the following procedures*… | … you will have a co-payment of | What you can do to avoid additional costs: |
Upper GI endoscopy (gastroscopy) | R500 | If performed in a doctor’s rooms, no co-payment will apply. |
Laparoscopic hernia repair | R2 500 | The alternative, if you do not want to incur the co-payment, would be to undergo open surgery. |
Laparoscopic hysterectomy | R2 500 | |
Laparoscopic radical prostatectomy | R2 500 | |
Laparoscopic pyeloplasty | R2 500 | |
Knee arthroscopy | R2 500 | Certain hospital gap cover products may cover the procedure co-payment. |
Balloon sinuplasty | R2 500 | |
In-hospital dental work and you are on the Comprehensive, Traditional or Savings Plan (or Hospital Network Plan for removal of impacted wisdom teeth only) | R1 500 |
*These co-payments will not apply if the procedure qualifies under the Prescribed Minimum Benefits. Please see Prescribed Minimum Benefits for more information.
NON-EMERGENCY SPINAL FUSION AND HIP/KNEE REPLACEMENTS
If you … | … you will have to pay | What you can do to avoid additional costs: |
live reasonably close to a DBC Centre but declined going for an assessment via the Back and Neck Rehabilitation Programme before undergoing non-emergency spinal fusion or laminectomy surgery | a R25 000 co-payment (unless you do not live within 30km of a DSP) | Register on the Scheme’s Back and Neck Rehabilitation Programme for an assessment. |
went for an assessment at DBC and were deemed eligible for the Back and Neck Rehabilitation Programme, but declined to enrol on the programme before going for non-emergency spinal fusion or laminectomy surgery | a R25 000 co-payment (unless you do not live within 30km of a DSP) | Register on the Scheme’s Back and Neck Rehabilitation Programme. |
have a non-emergency hip or knee replacement that is not undertaken by the Scheme’s Designated Service Providers, ICPS or JointCare | a R10 000 co-payment (unless you do not live within 30km of a DSP) | Choose ICPS or JointCare, two groups of orthopaedic surgeons that specialise in performing hip and knee replacements, for your surgery. Call 0860 100 080 for details of a DSP orthopaedic surgeon closest to you. |
CONSULTATIONS WITH SPECIALISTS
If you … | … you will have to pay | What you can do to avoid additional costs: |
consult a specialist, without your GP getting a referral for the visit from the Scheme | a 30% co-payment on the cost of the consultation with the specialist | Make sure your GP gets a referral number from the Scheme. |
PHARMACY CLAIMS – PMB, NON-PMB AND ONCOLOGY
If you claim for … | … then | What you can do to minimise your costs and make your benefits go further: |
medicine dispensed by a non- Nedgroup Network Pharmacy |
For PMB chronic medication, only 75% of the medicine cost will be covered from the chronic medicine benefit. There will be a 25% co-payment at the point of sale, for which you will be liable.
For non-PMB chronic medication, in other words medication used to treat Scheme-approved additional chronic conditions (which are Plan-specific), you will be liable for 100% of the cost at the point of sale. |
Use a Nedgroup Network Pharmacy for all your PMB and non-PMB chronic medication – call the chronic medicine department for a Nedgroup Network Pharmacy provider in your area. |
oncology specialised drugs | You need to make use of the Scheme’s DSP, Pharmacy Direct. If you obtain your medication from a pharmacy other than Pharmacy Direct, there will be a 25% co-payment at the point of sale, for which you will be liable. | Use Pharmacy Direct to obtain oncology specialised drugs. |
CHRONIC MEDICINE BENEFITS
If you claim for a medicine… | … then | What you can do to avoid co-payments or additional costs: |
that is not approved on the chronic medicine programme (benefit) or is not an approved formulary generic |
The claim will be not be processed and paid from the chronic benefit.
It may be covered from a different benefit or you may be liable to pay for the medication. |
Please note clinical entry criteria and formularies are applied, which will determine the outcome of your chronic application |
that is not listed on the Chronic Medicines Formulary or is not the approved item(s) on your chronic authorisation decision letter | The claim for the medication will be rejected and you will be liable to pay for the medication. |
If you do not want to incur this cost, use medicine on the Chronic Medicines Formulary. This list of cost-effective medicines is based on local and international studies, and complies with the criteria developed by the Council for Medical Schemes.
Members should take their chronic decision letter with them to their pharmacy provider, to ensure that the correct product is claimed. |
that is changed in terms of the strength or dosage or medicine type | The claim for the medication will be rejected and you will be liable to pay for the medication. | Send any prescription updates to the chronic medicine department for review and for authorisation updates before claiming any new medication deemed to be chronic. |
for a chronic condition that is not on the list of PMB chronic conditions, or on the list of additional Scheme approved conditions (which are Plan-specific) | The claim will be paid from your available Everyday Services Benefits (from the acute medicine sub-limits, where applicable), not from your Chronic Medicine Benefits. | You can apply for an ex gratia payment, which will then be considered by the Scheme’s ex gratia committee. Please note, however, that ex gratia applications are only granted in exceptional and deserving cases. |
PMB medication and you are on the Hospital Network Plan, but you do not use Pharmacy Direct | You will have to make a 25% co-payment. | Use only Pharmacy Direct, the DSP for the Hospital Network Plan, for PMB medication claims. |
for depression and you are on the Hospital Network Plan, but you do not use Pharmacy Direct | You will have to pay in full for the medicine, as it is not PMB medication. | Use only Pharmacy Direct, the DSP for the Hospital Network Plan, for depression medication claims. |
NEW! HIV medication | You need to make use of one of the Scheme’s DSPS, Pharmacy Direct or Clicks Pharmacy. If you obtain your medication from a pharmacy other than these DSPs, there will be a 25% co-payment at the point of sale, for which you will be liable. | Use Pharmacy Direct or Clicks Pharmacy to obtain NEW HIV medication. |
See Chronic Medicine Benefits for more information.
MANAGEMENT OF PRESCRIBED MINIMUM BENEFITS (PMB) CONDITIONS
If you … | … the following will apply | What you can do to minimise your costs and make your benefits go further: |
are diagnosed with a PMB condition and choose to consult with a GP or specialist that is not on the Nedgroup Network |
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Choose a GP or specialist on the Nedgroup Network, as your PMB-related accounts will then be paid from the PMB benefit at a Scheme-agreed rate, and you will not be liable for any co-payment on your specialist’s claim, should you be admitted to hospital. |
ONCOLOGY CONSULTATIONS
If you claim for … | … you will have to pay | What you can do to minimise your costs and make your benefits go further: |
a consultation with a non-ICON oncologist | The difference between what is charged and the cover of Medical Scheme Rate | Use the Scheme’s DSP for oncology treatment, Independent Clinical Oncology Network (ICON), as consultations are covered at a negotiated fee. ICON is a dedicated network of oncologists committed to the comprehensive management of members with cancer. |
AND OTHER CONTINUATION MEMBERS
What happens when a member retires?
If you belong to the Scheme before you retire, you can choose to continue to belong to the Scheme, in which case you will be called a continuation member. (Retirees who were not members of the Scheme before retirement do not qualify for membership after retirement.)
PLEASE REMEMBER THAT:
If you choose to leave the Scheme after retirement, you cannot join the Scheme again at a later stage.
What happens if the member passes away?
If the member passes away, dependants have the choice to become continuation members. In such a case, the Scheme needs to receive the following documents within three months of the member’s date of death to ensure continuation membership for the dependants:
- Copy of the death certificate of the member.
- Copy of the ID of the surviving spouse/ beneficiary.
- Copy of bank statement or cancelled cheque to upload bank details for debit order/refund purposes.
- Proof of income of the continuation member who will become the new main member – SARS assessment (ITA34) or Scheme affidavit.
PLEASE REMEMBER THAT:
Dependants of a deceased member who elect not to join the Nedgroup Medical Aid Scheme following the member’s death do not qualify to join the Scheme at a later stage.
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