1 . Designated Service Providers ( DSPs ) and networks
Healthcare costs in South Africa are generally unregulated , which means providers are free to charge any tariff .
‘ Using DSPs and hospital networks means that favourable tariffs for members have been negotiated ,’ explains Callakoppen . ‘ Using networks also means you can reduce or eliminate co-payments .’
2 . Tariffs and rates of payments
The Scheme rate is the amount a scheme will pay for specific treatments and procedures . However , 100 % of the Scheme rate doesn ’ t necessarily mean that 100 % of the account will be paid . Ask for a quote from your practitioner and / or hospital ahead of any procedure . If there is a major discrepancy , try and negotiate an adjusted fee .
3 . The value-add benefits
Make use of the free wellness screening and testing offered on the ‘ Be Better Benefit ’ – this includes an annual wellness screening , per beneficiary , to check blood pressure , blood glucose , BMI and cholesterol .
There has been an intensified drive to detect , prevent or manage various chronic conditions as well as vaccinate against potential diseases and conditions as well as other benefits from Bonitas . These include : Flu vaccines , HIV tests , lipograms , mammograms , prostate screening , pap smears , pneumococcal vaccines , whooping cough boosters , HPV vaccines , stool tests for colon cancer , dental fissure sealants , online hearing screenings and contraceptives .
After completing an online wellness questionnaire or a wellness screening , you are able to access the ‘ Benefit Booster ’ providing access of up to R5 000 in additional funds to use for out-of-hospital expenses .
4 . Ask your pharmacist
Ask your pharmacist for over-the-counter medications for less serious illnesses . Pharmacists are able to provide sound medical advice about problems like rashes , colds or illnesses that are not severe . Also use generic medications where possible . A generic ’ s active ingredient or drug content is identical to the original but is between 30 % and 80 % cheaper .
5 . Managed care
The prevalence of Non-Communicable Diseases ( NCDs ) has been increasing year-on-year , so have mental health issues , which are a risk factor for NCDs and vice versa . For this reason , it is important to make full use of the Care programmes Bonitas offers . These include : Audiology , HIV / AIDS , cancer , diabetes , mental health , back and neck , hip and knee replacements as well as hospital-at-home .
6 . Remember to pre-authorise
Pre-authorisation is required for all hospital admissions , out-of-hospital screenings and procedures . Always ask if there are any co-payments or sub-limits that will apply and how to avoid these . For planned procedures , make sure you use a DSP or check whether the procedure can be in the doctor ’ s rooms or a day clinic .
7 . Be aware of consulting after hours
Be careful about using after-hours consultations or emergency rooms unless it ’ s absolutely necessary . In a bona fide medical emergency , you have no choice and this usually results in admission to hospital .
8 . Manage your chronic medicine correctly
The golden rule for chronic illness benefits is to try and use the medication on the scheme ’ s formulary and to obtain this from a specified pharmacy , either on the network or a DSP .
9 . PMBs
Make sure you understand what is covered under Prescribed Minimum Benefits ( PMBs ) and use a DSP to ensure that claims are paid from risk , not from your medical savings account .
10 . Gap cover
Gap cover is designed to cover the difference or part of the difference between what the medical scheme pays and the service provider charges for in-hospital procedures / treatment and specified outpatient procedures .
Ensuring you ‘ work smarter ’ with your benefits and medical expenses during the year , is a win-win situation for your health and pocket .
Bonitas Member Magazine Issue 3 / 2024
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