Use contracted networks and save in 2019!
Knowing your healthcare cover well and being network-savvy can save you unexpected costs and admin time. So, take a little time to know your cover. You may be surprised to see how convenient it is to use networks and the extra value you get.
It makes sense to take advantage of networks whenever you can
Using a network will be more convenient and by tapping into network arrangements, you can cut down on unexpected co-payments. So, not only would this keep your healthcare costs down, but SABMAS will also pay healthcare professionals within the network directly
Three ways you can save by being network-savvy
1. At GPs
Some doctors charge more than the tariff specified by your medical scheme. This is something they have a right to do, but it means that if your health plan only covers you for the specified tariff, you may have to make a co-payment.
Our GP Network consists of Preferred Providers who have contracted with the Scheme in order to provide you with quality care at an affordable rate. If you visit a medical practitioner who forms part of our GP Network, the provider will not charge more than the contracted rate. That means the only co-payment you may incur is the 20% co-payment, as per the Scheme Rules. Please be aware that if you do not use a provider who is part of the GP Network, you will still only be reimbursed at 80% of the Scheme Rate and therefore may have co-payments greater than 20% if the provider charges more than the Scheme Rate. As of 1 January 2019, all members on the Essential Option will be required to choose a GP to visit.
If you see your chosen GP, we will pay 80% of the agreed or Scheme Rate, and the 20% will be the member portion. If you see someone other than your chosen GP, we will pay 60% of the agreed or Scheme Rate. The member portion will be 40%. 20% being a co-payment for not seeing your nominated GP and the 20% surcharge that applies to all consultations.
2. At specialists
The Specialist Network is the group of specialists we’ve negotiated with to give you quality healthcare services at specified rates. If you decide to use a specialist who’s not on our list, and who charges more than our Scheme Rate, you will have to
pay for the additional cost. As of 1 January 2019, all members on the Essential Option will be required to consult a GP before you see a Specialist, in order to get the fullest cover. If you go straight to the Specialist, SABMAS will only pay 60%
of the Scheme Rate.
3. At pharmacies
When you use pharmacies that the Scheme has an arrangement with, you get your medicine at the most affordable price and it offers you additional value.
Clicks Direct Medicines is the only network pharmacy for chronic medication on the Essential Option. If you are on the Comprehensive Option, you are free to choose from the wide range of pharmacies in our Network.
Another savings tip, is to ask your pharmacist about generic alternatives to branded medicines. Generic medicines cost less but are similar to the branded alternatives in their composition and how they work.
Finding a network doctor
Before you even make the appointment to see a Healthcare Provider, you can log in to our website at www.sabmas.co.za and use our self-help search tool MaPS, to identify a Network Provider in your area.