MEDICAL AID BENEFITS : Version 1. NB: GAP COVER: Please confirm with each patient if Gap Cover is available on their medical aid plan
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1 AECI AECI BASIC CARE CROSS SCHEME RATE x 100% 6.00% SERVICE PROVIDER MEDSCHEME AECI COMPREHENSIVE PLAN SCHEME RATE x 100% AFROX ALLIANCE MIDMED ALTRON Check MIDMED ANGLOMEDICAL SCHEME (AACMED) 7.00% MEMBER DISCOVERY MANAGED CARE PLAN SCHEME RATE x 100% STANDARD CARE PLAN SCHEME RATE x 100% VALUE CARE 100% x Prime Cure tariffs. ANGLOVAAL GROUP 6.00% MEMBER DISCOVERY DH Premier / SCHEME RATE x 100% BANKMED 6.50% SERVICE PROVIDER METROPOLITAN BASIC PLAN SCHEME RATE x 100% COMPREHENSIVE PLAN SCHEME RATE x 125% CORE SAVER PLAN SCHEME RATE x 100% PLUS PLAN SCHEME RATE x 300% TRADITIONAL PLAN SCHEME RATE x 100% PMB PLAN SCHEME RATE x 100% BARLOWORLD SCHEME RATE x 100% 6.20% SERVICE PROVIDER MEDSCHEME BESTMED ALL PLANS SCHEME RATE x 100% 6.60% SERVICE PROVIDER BESTMED BMW DH Premier / SCHEME RATE x 100% 6.00% SERVICE PROVIDER DISCOVERY BONITAS 6.20% SERVICE PROVIDER MEDSCHEME BONCAP SCHEME RATE x 100% BONCLASSIC SCHEME RATE x 100% BONCOMPREHENSIVE SCHEME RATE x 300% BONSAVE SCHEME RATE x 150% BONESSENTIAL SCHEME RATE x 100% PRIMARY SCHEME RATE x 100% STANDARD SCHEME RATE x 100% BPSA 6.00% SERVICE PROVIDER METROPOLITAN SCHEME RATE x 100% SCHEME RATE x 200% - If patient has been seen at Life Health Hospital or Mediclinics BCIMA (BUILDING INDUSTRIES) SCHEME RATE x 100% 6.00% SERVICE PROVIDER UNIVERSAL HEALTH CAMAF 6.00% SERVICE PROVIDER SANLAM HEALTH ALLIANCE SCHEME RATE x 300% DOUBLE PLUS SCHEME RATE x 300% ESSENTIAL PLUS SCHEME RATE x 200% FIRST CHOICE SCHEME RATE x 100% NETWORK CHOICE SCHEME RATE x 100% VITAL SCHEME RATE x 300% CAPE MEDICAL PLAN 8.00% MEMBER CAPE MEDICAL SILVER SCHEME RATE x 100% PREMIUM SCHEME RATE x 200% SELECT SCHEME RATE x 200% COMMED 6.00% SERVICE PROVIDER ALLCARE FUNDAMENTAL SCHEME RATE x 100% STANDARD SCHEME RATE x 100% (DSP)/ NON-DSP x 75% SR DE LUXE SCHEME RATE x 100% COMPCARE 6.00% MEMBER UNIVERSAL HEALTH AXIS SCHEME RATE x 100% DYNAMIX SCHEME RATE x 100% MUMED SCHEME RATE x 100% NETWORX SCHEME RATE x 100% (Preferred Provider) PINNACLE SCHEME RATE x 200% SYMMETRY SCHEME RATE x 100% DE BEERS SCHEME RATE x 100% 6.00% MEMBER DE BEERS
2 DISCOVERY HEALTH: 6.00% MEMBER/CONTRACT DISCOVERY CLASSIC COMPREHENSIVE DH Classic /Classic_Premier_Arrangement CLASSIC CORE PLAN DH Classic /Classic_Premier_Arrangement CLASSIC PRIORITY DH Classic /Classic_Premier_Arrangement CLASSIC SAVER DH Classic /Classic_Premier_Arrangement COASTAL CORE DH rate x 100% or Premier COASTAL SAVER DH rate x 100% or Premier ESSENTIAL COMPREHENSIVE DH rate x 100% or Premier ESSENTIAL CORE DH rate x 100% or Premier ESSENTIAL PRIORITY DH rate x 100% or Premier ESSENTIAL SAVER DH rate x 100% or Premier EXECUTIVE PLAN DH rate x 300% KEYCARE ACCESS DH rate/ 110% - If part of Keycare Arrangement KEYCARE CORE DH rate/ 110% - If part of Keycare Arrangement KEYCARE PLUS DH rate/ 110% - If part of Keycare Arrangement ENGEN SCHEME RATE x 100% 6.00% SERVICE PROVIDER METROPOLITAN FEDHEALTH 6.20% SERVICE PROVIDER MEDSCHEME BLUEDOOR PLUS ANAES. ARRANGMENT x 130% / PARTICIPATING SPECIALISTS ARRANGEMENT x 100% MAXIMA BASIS ANAES. ARRANGMENT x 235% / MAXIMA CORE ANAES. ARRANGMENT x 235% / MAXIMA ENTRYSAVER ANAES. ARRANGMENT x 130% / PARTICIPATING SPECIALISTS ARRANGEMENT x 100% MAXIMA ENTRYZONE ANAES. ARRANGMENT x 130% / PARTICIPATING SPECIALISTS ARRANGEMENT x 100% STD SCHEME RATE x 200% / MAXIMA EXEC ANAES. ARRANGMENT x 235% / PARTICIPATING SPECIALISTS ARRANGEMENT x 210% STD SCHEME RATE x 200% / MAXIMA PLUS ANAES. ARRANGMENT x 235% / PARTICIPATING SPECIALISTS ARRANGEMENT x 210% MAXIMA SAVER ANAES. ARRANGMENT x 235% / MAXIMA STANDARD ANAES. ARRANGMENT x 235% / MAXIMA STANDARD NET ANAES. ARRANGMENT x 235% / ULTIMA 200 ANAES. ARRANGMENT x 235% / STD SCHEME RATE x 300% / ULTIMAX ANAES. ARRANGMENT x 235% / PARTICIPATING SPECIALISTS ARRANGEMENT x 300% FISHING INDUSTRY MEDICAL SCHEME (FISHMED) 6.50% SERVICE PROVIDER METROPOLITAN PRIMARY OPTION TREATMENT AT PROVINCIAL HOSPITAL STANDARD OPTION SCHEME RATE x 100% GEMS ALL PLANS SCHEME RATE x 100% 3.80% SERVICE PROVIDER METROPOLITAN GENESIS SERVICE PROVIDER GENESIS PRIVATE CHOICE SCHEME RATE x 100% PRIVATE PLAN SCHEME RATE x 200% PRIVATE PLUS SCHEME RATE x 200% PRIVATE COMPREHENSIVE SCHEME RATE x 200% GLENCORE (Was Xstrata Alloys) SCHEME RATE x 100% 6.00% SERVICE PROVIDER MEDSCHEME
3 GOLDEN ARROW SCHEME RATE x 100% 6.50% SERVICE PROVIDER METROPOLITAN GOLDFIELDS MEDICAL SCHEME Name Changed to Sisonke Health GRINTEK ELECTRONICS (GEMAS) SCHEME RATE x 250% 6.00% SERVICE PROVIDER UNIVERSAL HEALTH HARMONY SCHEME RATE x 100% 6.00% SERVICE PROVIDER PROVIDENCE HORIZON ALL PLANS SCHEME RATE x 100% 6.50% SERVICE PROVIDER MEDSCHEME HOSMED 6.00% SERVICE PROVIDER THEBEMED VALUE SCHEME RATE x 100% PLUS SCHEME RATE x 100% ESSENTIAL SCHEME RATE x 100% ACCESS SCHEME RATE x 100% IBM SA MEMBER IMPALA PLATINUM SCHEME RATE x 100% 6.00% SERVICE PROVIDER PROVIDENCE IMPERIAL GROUP ALL PLANS SCHEME RATE x 100% 6.60% SERVICE PROVIDER METROPOLITAN KEYHEALTH (Munimed) 6.50% SERVICE PROVIDER PROFMED EQUILIBRIUM SCHEME RATE x 100% ESSENCE SCHEME RATE x 100% GOLD SCHEME RATE x 100% PLATINUM SCHEME RATE x 100% SILVER SCHEME RATE x 100% LA-HEALTH LA ACTIVE DH Premier / SCHEME RATE x 100% 6.00% MEMBER DISCOVERY LA COMPREHENSIVE DH Premier / SCHEME RATE x 100% LA CORE DH Premier / SCHEME RATE x 100% LA FOCUS DH Premier / SCHEME RATE x 100% LA KEYPLUS SCHEME RATE x 100% LIBCARE SCHEME RATE x 150% 6.50% SERVICE PROVIDER LIBCARE LIBERTY 6.00% SERVICE PROVIDER LIBERTY COMPLETE PLUS SCHEME RATE x 200% COMPLETE SELECT SCHEME RATE x 100% COMPLETE STANDARD SCHEME RATE x 100% HOSPITAL PLUS SCHEME RATE x 200% HOSPITAL SELECT SCHEME RATE x 100% HOSPITAL STANDARD SCHEME RATE x 100% SAVER PLUS SCHEME RATE x 200% SAVER SELECT SCHEME RATE x 100% SAVER STANDARD SCHEME RATE x 100% TRADITIONAL BASIC SCHEME RATE x 100% TRADITIONAL STANDARD SCHEME RATE x 100% TRADITIONAL ULTIMATE SCHEME RATE x 300% LONMIN SCHEME RATE x 100% 6.00% MEMBER DISCOVERY MAKOTI MEDICAL SCHEME PRIMARY PLAN SCHEME RATE x 100% (Provincial Hospitals) 6.00% MEMBER ENABLEMED COMPREHENSIVE PLAN SCHEME RATE x 100% MALCOR DH RATE x 100% 6.00% MEMBER DISCOVERY MASSMART SCHEME RATE x 100% 6.00% SERVICE PROVIDER UNIVERSAL MBMED SCHEME RATE x 100% 6.20% SERVICE PROVIDER MEDSCHEME MEDIHELP ALL PLANS SCHEME RATE x 100% 6.60% SERVICE PROVIDER STRATA HEALTCARE MEDIMED 6.00% SERVICE PROVIDER PROVIDENCE ALPHA SCHEME RATE x 75% NON-PMB / 100% x for PMB'S MEDISAVE ESSENTIAL SCHEMe RATE x 100% MEDISAVE MAX SCHEME RATE x 150% MEDISAVE STANDARD SCHEME RATE x 100% MEDIPOS ALL PLANS SCHEME RATE x 100% 6.50% SERVICE PROVIDER METROPOLITAN MEDSHIELD 6.00% SERVICE PROVIDER MEDSHIELD MEDIBONUS SCHEME RATE x 100% (Non Surgical Procedures - include Dental) MEDIBONUS SCHEME RATE x 200% (All Surgical Procedures) MEDIPLUS SCHEME RATE x 100%
4 MEDIVALUE SCHEME RATE x 100% MEDSHIELD...Continue COREPLUS SCHEME RATE x 200% PREMIUM PLUS SCHEME RATE x 200% STANDARD COVER SCHEME RATE x 100% 80% PLAN 31/12/ Defaulting to other options METROPOLITAN PREMIER SCHEME RATE x 100% 6.60% SERVICE PROVIDER METROPOLITAN CLASSIC SCHEME RATE x 100% MIDMED SCHEME RATE x 150% 6.00% SERVICE PROVIDER PRIVATE HEALTH MINEMED MOMENTUM HEALTH 5.50% MEMBER MOMENTUM INGWE SCHEME RATE x 100% ACCESS SCHEME RATE x 100% CUSTOM SCHEME RATE x 100% EXTENDER SCHEME RATE x 200% INCENTIVE SCHEME RATE x 200% SUMMIT SCHEME RATE x 300% MOTO HEALTH 6.00% MEMBER METROPOLITAN CLASSIC SCHEME RATE x 150% CUSTOM SCHEME RATE x 100% ESSENTIAL SCHEME RATE x 100% HOSPICARE SCHEME RATE x 100% OPTIMUM SCHEME RATE x 200% NASPERS 6.00% MEMBER DISCOVERY BASIC OPTION DH Custom Direct / SCHEME RATE x 100% PLUS OPTION DH Premier / SCHEME RATE x 100% NEDGROUP MEDICAL AID SCHEME SCHEME RATE x 100% 6.60% MEDSCHEME NETCARE SCHEME RATE x 100% (Anaesthetists & Specialists) 6.00% MEMBER PRIMEMED CP PROVIDER ARRANGEMENT x 150% (All Specialists) OLD MUTUAL STAFF 6.00% SERVICE PROVIDER MEDSCHEME ALL OTHER PLANS SCHEME RATE x 100% TRADITIONAL PLUS PLAN SCHEME RATE x 100% OPMED SCHEME RATE x 100% SERVICE PROVIDER OPMED PARMED SCHEME RATE x 300% 6.20% MEMBER MEDSCHEME PG BISON PG GROUP SCHEME RATE x 100% 6.50% MEMBER METROPOLITAN PICK AND PAY SCHEME RATE x 150% 6.00% SERVICE PROVIDER METROPOLITAN PLATINUM HEALTH 6.00% SERVICE PROVIDER PLATINUM HEALTH PLAT COMPREHENSIVE SCHEME RATE x 100% / NON-DSP x 80% PLAT CAP SCHEME RATE x 100% PLAT SAVE SCHEME RATE x 100% POLMED 6.00% SERVICE PROVIDER METROPOLITAN LOWER & HIGHER PLANS SCHEME RATE x 100% (SPECIALISTS) LOWER & HIGHER PLANS SCHEME RATE x 150% (ANAESTHETISTS) PROFMED 6.50% SERVICE PROVIDER PROFMED PROACTIVE SCHEME RATE x 120% PROACTIVE PLUS SCHEME RATE x 200% PROPINNACLE SCHEME RATE x 300% PROSECURE SCHEME RATE x 120% PROSECURE PLUS SCHEME RATE x 200% QUANTUM 6.00% MEMBER DISCOVERY ESSENTIAL COMPREHENSIVE DH Premier / SCHEME RATE x 100% ESSENTIAL SAVER DH Premier / SCHEME RATE x 100% KEYPLUS DH Keycare x 110% / SCHEME RATE x 100% RAND WATER BOARD ALL PLANS SCHEME RATE x 100% 6.20% SERVICE PROVIDER SANLAM REMEDI 6.00% MEMBER DISCOVERY CLASSIC DH Premier / DH Classic COMPREHENSIVE DH Premier / DH Classic STANDARD DH Keycare s x 110%
5 RENAISSANCE (BOTSWANA MEDICAL AID) SCHEME RATE x 100% SERIVICE PROVIDER RENAISSANCE RESOLUTION HEALTH 6.00% SERVICE PROVIDER AGILITY GLOBAL CLASSIC SCHEME RATE x 100% FOUNDATION SCHEME RATE x 100% HOSPITAL SCHEME RATE x 100% MILENNIUM SCHEME RATE x 100% PROGRESSIVE FLEX SCHEME RATE x 100% SUPREME SCHEME RATE x 100% RETAIL MEDICAL AID 6.00% MEMBER DISCOVERY DH Premier / SCHEME RATE x 100% RU-MED SCHEME RATE x 100% 6.00% SERVICE PROVIDER PROVIDENCE SA BREWERIES SCHEME RATE x 100% 6.50% MEMBER METROPOLITAN SABC SCHEME RATE x 100% 6.20% MEMBER MEDSCHEME SAMWUMED SCHEME RATE x 100% 6.00% SERVICE PROVIDER SAMWUMED SASOLMED SCHEME RATE x 150% 6.20% SERVICE PROVIDER MEDSCHEME SEDMED SCHEME RATE x 100% 6.00% SERVICE PROVIDER SEDMED SELFMED 6.50% MEMBER SELFMED MEDXXI SCHEME RATE x 100% SELFSURE SCHEME RATE x 100% 80% PLAN SCHEME RATE x 80% MED ELITE SCHEME RATE x 200% SISONKE HEALTH ALL PLANS SCHEME RATE x 100% 6.00% SERVICE PROVIDER PROVIDENCE (Was: GOLDFIELDS & SIBANYE) SIZWE ALL PLANS SCHEME RATE x 100% 7.00% SERVICE PROVIDER SIZWE SPECTRAMED 6.00% SERVICE PROVIDER AGILITY SPECTRA COBALT SCHEME RATE x 100% SPECTRA AZURE SCHEME RATE x 100% SPECTRA CAPRI SCHEME RATE x 100% SPECTRA CYAN SCHEME RATE x 100% SPECTRA AQUE SCHEME RATE x 100% SUREMED SERVICE PROVIDER METROPOLITAN CHALLENGER SCHEME RATE x 150% NAVIGATOR SCHEME RATE x 125% SHUTTLE SCHEME RATE x 100% EXPLORER PREFERRED PROVIDERS ONLY SWAZIMED ALL PLANS SCHEME RATE x 100% 6.00% SERVICE PROVIDER MEDSCHEME TFG MEDICAL AID 6.00% MEMBER DISCOVERY (WAS FOSCHINI MEDICAL AID) PLAN A DH Premier / SCHEME RATE x 100% PLAN B DH Premier / SCHEME RATE x 100% THEBEMED ENERGY PLAN SCHEME RATE x 100% 6.00% SERVICE PROVIDER THEBE YA BOPHELA UNVERSAL PLAN SCHEME RATE x 100% TIGER BRANDS 6.00% SERVICE PROVIDER UNIVERSAL HEALTH OPTION A SCHEME RATE x 200% OPTION B SCHEME RATE x 150% OPTION C SCHEME RATE x 100% TOPMED 6.00% MEMBER PRIVATE HEALTH RAINBOW COMPREHENSIVE SCHEME RATE x 300% PROFFESSIONAL SCHEME RATE x 200% PALADIN COMPREHENSIVE SCHEME RATE x 150% SAVINGS SCHEME RATE x 100% ACTIVE SAVER SCHEME RATE x 100% HOSPITAL SCHEME RATE x 150% NETWORK SCHEME RATE x 100% / NON-NETWORK x 70% LIMITED SCHEME RATE x 80% (Member to pay provider directly and claim back from fund) TRANSMED ALL PLANS SCHEME RATE x 100% 6.00% SERVICE PROVIDER METROPOLITAN
6 TSOGO-SUN GROUP ALL PLANS DH Premier / SCHEME RATE x 100% 6.00% MEMBER DISCOVERY UMVUZO ALL PLANS SCHEME RATE x 100% 7.00% SERVICE PROVIDER UNIVERSAL UNIVERSITY OF KWA-ZULU NATAL DH Premier / SCHEME RATE x 100% 6.00% MEMBER DISCOVERY UNIVERSITY OF WITWATERSRAND (WITSMED) SCHEME RATE x 100% 6.00% SERVICE PROVIDER DISCOVERY WITBANK COALFIELDS (WCMHS) SCHEME RATE x 100% 6.00% SERVICE PROVIDER WCMHS WOOLTRU 6.50% SERVICE PROVIDER METROPOLITAN CORE SCHEME RATE x 100% PLUS SCHEME RATE x 100% EXTENDED SCHEME RATE X 300% XSTRATA ALLOYS (Name change to GLENCORE) DISCOVER THE FREEDOM AND POWER PROVIDED BY PRECISION MEDICAL SOLUTIONS THE RISING STAR AMONG SOUTH AFRICA'S MEDICAL BILLING FIRMS! FOR MORE INFORMATION CONTACT MARISA RICARDO x 102 DOES YOUR ADMINISTRATION STAFF OR BILLING COMPANY ADD THIS TYPE OF VALUE TO YOUR PRACTICE? LET PRECISION MAKE THE DIFFERENCE! IF YOU SHOULD HAVE A QUERY ABOUT ANY OF THE ABOVE INFORMATION PLEASE INFORM US: precisionmed@mweb.co.za Disclaimer: This information is compiled using generally available data including the websites of the individual medical aids. While care is taken to ensure its accuracy Precision Medical Solutions accepts no responsibility for any losses that may be incurred as a result of the use of this information.
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