In this episode we look at the definition of medical aid and highlight that it is medical insurance. This means all submitted claims are according to the scheme rules. The hospitals, doctors and pharmacists aren’t simply claiming items against a budget like with a credit card. All items claimed on medical aid must comply with the scheme rules.
Medical Aids are regulated by the Medical Schemes Council (MSC) and they stipulate all the rights of members and all the responsibilities of medical schemes. We celebrate the recent win by the ICPA (Independent Community Pharmacists Association) to allow members to choose which service provider they want to use to collect their chronic treatment from.
Did you know that medical schemes have to pay for all conditions listed as Prescribed Minimum Benefits (PMBs)? These include chronic conditions like hypertension, asthma & epilepsy but also includes medical emergencies that the medical aid simply can’t refuse to pay regardless of how low your option is. We explain concepts like medical saving accounts (MSA), threshold benefits, above threshold, acute funds, chronic fund & OTC fund.
Listen to find out more,