Useful guidelines when planning a visit to your
Optometrist
Ask your healthcare provider if they are part of the Network optometrists
Network optometrists agree to provide services at the Bonitas rate and within the scheme rules . Any additional lens enhancements will be discussed to allow you to make an informed decision on additional payments . You can visit any optometrist , but if your optometrist is not part of the network , then they may invoice at industry rates which may result in co-payments on the basic benefit design .
Scheme Rate
The Scheme rate is in line with the benefit entitlement . Network optometrists agree to charge at scheme rate ( no co-payments on basic benefits ) however out of network optometrists may elect to charge at scheme rate or above scheme rate resulting in co-payments . Ask your optometrist which rate they charge .
Benefit entitlement
Network optometrists agree to have options available to members within their benefit entitlement . Discuss with your optometrists upfront if you do not want co-payments .
Scheme Rules
The benefit rules are communicated each year to all optometrists and should be explained during a consultation to members . The rules are registered with the Council for Medical schemes ( CMS ) and any additional services outside of the rules should be discussed as a co-payment or should be motivated if clinically required to avoid unnecessary co-payments .
Collecting spectacles
Once the services and materials are agreed upon with the provider , the claim will be submitted for payment to the medical aid . The spectacles will be ordered immediately . Your healthcare provider cannot submit claims if the services were not delivered , or the materials were not dispensed .
Co-payments should be made directly to the provider . The scheme will pay by law , within 30 days from receipt of the invoice . Payment will be made up to the benefit availability . The benefits are paid following the scheme rules registered with CMS . You may already have your spectacles by the time the account is paid to the Scheme .
To find a PPN provider call 041 065 0650 , visit www . ppn . co . za or email bonitas @ ppn . co . za .