What is a PMSA?
The Personal Medical Savings Account is a savings account held by a member’s medical scheme to which a certain percentage of a member’s contribution is paid on a monthly basis. These funds can only be used to defray health care expenditure.
From the beginning of each benefit year, the personal medical savings account is credited with a percentage of a member’s contribution as determined in the medical scheme rules.
This savings fund is made available upfront to a member; in other words, the full year’s savings funds are made available at the beginning of each benefit year.
Please remember that the Platinum, Traditional and Hospital Plans have no PMSA contributions and therefore no PMSA balance. Also remember that if you move to any of the Plans without a PMSA, your PMSA balance will be paid out to you after 6 months, together with the balance of Unit Trusts.
What can the money in my PMSA be used for?
YOU CAN USE THE MONEY IN YOUR PMSA TO PAY FOR:
- Everyday Services, on the Savings and Comprehensive Plans
- Any services that are deemed medically necessary, but are not covered under the Wellness Benefits and Everyday Services Benefits.
- The difference between the actual cost of a service and MSR, other than PMB.
What are accumulated savings?
If a member does not use all the money in the PMSA in any given year, the accumulated savings are recorded separately.
What can the money in my accumulated savings be used for?
YOU CAN USE THE ACCUMULATED SAVINGS FOR:
- Services that are generally or specifically excluded according to the Rules of the Scheme. These services should be obtained from a registered practitioner, and you must advise the Scheme in writing to ensure that these services are paid from your accumulated savings.
- Claims during a waiting period.
- Any claims that come in after the PMSA and Everyday Services Benefits sub-limits (where applicable) have been depleted on the Comprehensive and Savings Plans.
YOU CANNOT USE THE MONEY IN YOUR PMSA OR ACCUMULATED SAVINGS TO PAY FOR:
- PMB conditions
- Costs that are higher than the medicine price (for example, the administration fee).
Will the money in my PMSA and accumulated savings earn interest?
Any money in your PMSA and accumulated savings will earn interest at a rate of 50% of the actual average interest rate earned by the Scheme.
Can I withdraw money from my PMSA?
No, the Scheme Administrator will manage your PMSA. When claims have to be settled they will automatically deduct the money from your PMSA.
What happens if I do not have enough money left in my PMSA to settle my claims?
The Scheme will pay these claims up to the available PMSA balance and then from available accumulated savings, whereafter you will be liable to settle the difference directly with your supplier.
Is there a credit facility?
The PMSA offers a credit facility, which means that you can use the credit balance in your PMSA to settle claims, even if you have not made all the monthly contributions to your PMSA.
How will I know what the balance in my PMSA or accumulated savings account is?
For the most up-to-date information on your balances, you can use the telephonic self-help facility (0860 100 080), NedChat or you can view detailed statements of all your transactions, available benefits, and the balance in your PMSA/accumulated savings on the Member Zone and on your monthly member statements.
What will happen to the balance in my PMSA should I decide to change to a Plan that does not have a PMSA allocation?
Your PMSA balance will be paid out to you after six (6) months, to allow the Scheme to settle any claims that may be submitted in the period after you terminate your membership. PMSA is subject to tax implications.
What happens to the money in my PMSA if I am no longer a member of the Scheme?
If your membership of the Scheme ends, for example, if you resign, are retrenched, pass away or transfer to your spouse’s employer-preferred medical scheme, the following will happen:
- Any amounts that have been paid by the Scheme, but which exceed the benefits to which you are entitled, will be recovered from you or your estate.
- The money in your PMSA will be used by the Scheme to pay any non-PMB outstanding claims.
- If there is no money in your PMSA, only the benefit amount will be paid to the service provider. You (or your estate) will be responsible for settling the balance with the service provider.
- The onus is on you, as the member, to notify the Scheme of your new medical scheme, banking and/ or your contact details.
If you have used your upfront PMSA and resigned before the end of the benefit year, the overspent amount must be paid back to the Scheme within 30 days of the termination date.
Six months after your membership of the Scheme has ended , the balance in your PMSA will be calculated and paid out into the banking account recorded by the Scheme, if the following applies:
- If you do not join another medical scheme
- If you join another medical scheme on a Plan that does not have a savings account
- If you join another medical scheme as a dependant
- If you move to a Plan that does not have a PMSA
If you pass away, the balance in your PMSA will be kept by the Scheme to be used by your dependants who become continuation members of the Scheme, if applicable, or be paid to your estate after six months.
If I leave the Scheme for another scheme with a PMSA, can I transfer my PMSA/accumulated savings balance to my new scheme?
If you are joining another medical scheme with a PMSA, we request that you provide us with your new medical scheme details by emailing these to nedgroupregistery at medscheme.co.za. Upon receipt of this information, the Scheme will arrange to transfer the balance of your PMSA to your new medical scheme after the 6th month following your termination date. This option will allow you to not incur any tax on the balance.