As member of a medical scheme it is important to remember that it is your responsibility to ensure the following:
- You are aware of your benefits, co-payments, limits, exclusions and waiting periods
- You understand which items and procedures will not be covered by your medical scheme
- You are familiar with the amount available in your savings benefit
- You know of any preferred or designated service provider agreements and how it will affect the cover provided by your medical scheme if you choose to use the services of non-designated service providers
- You are a valid member and all your premiums are up to date
We strongly recommend that you familiarise yourself with the rules of your medical scheme when obtaining pre-authorisation for your admission to hospital. Please confirm with your medical scheme whether any levies, co-payments or exclusions may apply, and whether there are any aspects of your treatment for which you personally will be liable for payment.
The hospitalisation costs for patients who belong to medical schemes are charged in accordance with Netcare tariffs. These tariffs are negotiated on an annual basis with the respective registered schemes. The hospital account is normally sent directly to the medical aid scheme for payment. You as member, however, remain responsible for this account, especially in cases where medical schemes fail to pay the account or only partially settle the account. Our pre-admission patient administrator will also advise you on the financial considerations with regard to your procedure and/or treatment.
Please ask our pre-admission staff for any assistance you may require, or access our online pre-admission portal for further information. Your cooperation in terms of obtaining authorisation and clarifying co-payment terms will ensure a quicker and more efficient admission process.