The Alpha option is the most popular and is, in essence, a “pay-upfront” option. We therefore, recommend that members:
- Negotiate cash discounts with providers.
- To relieve the pain of having to pay upfront with cash:
- Why not put aside as little as R50 per month into your own medical savings fund? (MEDIMED Alpha option is significantly cheaper than anything else on the market and you could keep some of this savings to support the times when you need medical treatment).
- If you have a credit card use it. MEDIMED refunds weekly. (if you submit your claim immediately you should get your refund before having to pay your credit card).
- Ask your doctor and/or pharmacy for the lowest cost generic. This is because MEDIMED uses the “Maximum Medical Aid Price” (MMAP) as a reference price – this is basically the average of all generics in a particular class of medicine. By asking for the lowest cost generic the price will be within the benefit paid by MEDIMED, otherwise you will have to pay in extra.
- Obtain your medicines from a “recommended pharmacy”. These are pharmacies who have undertaken to charge a dispensing fee at the same level as the MEDIMED dispensing fee benefit. A list of these pharmacies is available from the MEDIMED customer care team. Alternatively, Clicks pharmacies are also recommended pharmacies.
Medisave Max and Standard are both options that have savings accounts attached to the day-to-day benefits. Members should therefore manage their day-to-day expenses carefully to ensure that there are enough benefits to last for the full year. Members should also study their benefit guides carefully as there are certain measures that were put in place to ensure that members’ savings accounts last longer i.e. the “preventative care benefit” as well as a list of procedures that will be paid from the Scheme risk instead, if pre-authorised. Please contact the customer care team for more information.
The Medisave Essential option is a capitated option, where your selected practitioner is the key to your healthcare requirements. There are no limits on consultations, medication, radiology, pathology, etc. Medication is prescribed in accordance with a medication formulary. It is therefore not necessary for a member to manage his/her costs as the provider controls and manages the costs. This option is unfortunately only available to members that reside in the Nelson Mandela Metropole.