2021 BENEFIT AND CONTRIBUTION - SCHEDULE - Bankmed
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BENEFIT AND
CONTRIBUTION
SCHEDULE
2021
MORE THAN A MEMBER. MORE WITH BANKMED.
Contents
01 02 03
CONTACT US GET TO KNOW PLAN OPTIONS
BANKMED
PG 2 PG 4 PG 6
04 05 06
BENEFIT INFORMATION OUR DIGITAL TOOLS BANKMED PRIVACY
STATEMENT
PG 15 PG 64 PG 66
CONTACT US
MEDICAL EMERGENCIES: CLAIMS Your pharmacist can call 0800 BANKMED COMPLAINTS
(0800 226 5633)
0860 999 911 Include your membership number and AND DISPUTES
make sure the claim is easy to read Healthcare Professionals can
Should you have a complaint about your
GENERAL QUESTIONS E-mail: claims@bankmed.co.za
call 0800 132 345
membership, please let us know in writing:
Essential and Basic Plans
Website: www.bankmed.co.za Fax: 021 527 1940 E-mail for employees:
E-mail: chronicbasicessential@bankmed.co.za enquiries@bankmed.co.za
Call: 0
800 BANKMED (0800 226 5633) Post: B
ankmed Claims, Private Bag X2,
Rivonia 2128 Fax: 011 539 7000 E-mail for pensioners:
• toll-free on a Telkom landline
Your pharmacist can call 0800 BANKMED pensioners@bankmed.co.za
E-mail for employees:
CLAIM USING THE BANKMED (0800 226 5633)
enquiries@bankmed.co.za APP OR THE WEBSITE
PG 64 Post: Complaints Bankmed, Private Bag X2,
Register to gain access to these benefits Rivonia 2128
E-mail for pensioners:
By law, we have to respond to written complaints
pensioners@bankmed.co.za PRE-AUTHORISATION FOR HIV PROGRAMME FOR HIV within 30 days, but we always
Fax: 021 527 1926 HOSPITAL ADMISSION, DAY AND AIDS (CONFIDENTIALITY PG 23
do try to respond much sooner.
GUARANTEED)
Post: B
ankmed Customer Services, SURGERY, MRI, CT SCAN OR
Lodge a formal complaint
Private Bag X2, Rivonia 2128 RADIONUCLIDE SCAN BABY-AND-ME PROGRAMME
FOR PREGNANCY AND PG 22 If you have given us a reasonable chance to address
DIGITAL TOOLS Call: 0
800 BANKMED (0800 226 5633) CHILDBIRTH your concerns, and you are still not satisfied with
• toll-free on a Telkom landline
View information about your membership the outcome of the process, you can lodge a formal
ONCOLOGY PROGRAMME
and update your contact details: Fax: 021 527 1928 PG 23 complaint with the Council for Medical Schemes:
FOR CANCER TREATMENT
Website: Log in to the member portal E-mail: treatment@bankmed.co.za Customer Care Line: 0861 123 267
at www.bankmed.co.za CHRONIC ILLNESS BENEFIT PG 18 • ShareCall from a Telkom landline
HOSPITAL CARE
PG 19
Mobile site: Log in to m.bankmed.co.za AND PROCEDURES Reception: 012 431 0500
Bankmed App: Download and log in Authorisation for chronic medication COVID-19 BENEFITS PG 62 Fax: 086 673 2466
Your username and password are the same Call: 0
800 BANKMED (0800 226 5633) E-mail: complaints@medicalschemes.co.za
for the website, mobile site and App. REPORT FRAUD Post: C
ouncil for Medical Schemes, Block A,
• toll-free on a Telkom landline
Call: 0800 004 500 / 0800 007 788 Eco Glades 2 Office Park,
FIND A HEALTHCARE Core Saver, Traditional, Comprehensive 420 Witch Hazel Avenue, Eco Park, Centurion
SMS: 43477
PROFESSIONAL IN OUR PG 65 and Plus Plans 0157 or Council for Medical Schemes,
NETWORK E-mail: bankmed@tip-offs.com
E-mail: chronic@bankmed.co.za Private Bag X34, Hatfield, 0028
Post: Freepost DN298, Umhlanga Rocks 4320
Fax: 011 770 6247
2
Glossary
Annual Threshold Membership or Member
This is a rand amount for the Plus Plan. We use the number of adult The Principal Member is the person who pays the monthly
and child dependants on the membership to calculate the Annual contribution and is the main member on the membership, and the
Threshold for the year. membership contract holder. In the case of Bankmed, the Principal
Member is an employee of a participating employer or bank that has
Claims are paid out at 100% of Scheme Rate from your Medical
an agreement with Bankmed. Alternatively, membership may extend
Savings Account for Designated Service Providers, once this is
to continuation members such as retirees or surviving dependants.
exhausted you are able to access the Above Threshold Benefit.
Networks and Designated Service Providers
Above Threshold Benefit
We negotiate tariffs for you with hospitals, pharmacies, GPs and
The Above Threshold Benefit gives Plus Plan members cover for
specialists. When these Healthcare Professionals agree to charge
healthcare they receive without being hospitalised when they reach
the Bankmed Rate, we contract with these Healthcare Professionals
their Annual Threshold. It is an Insured Benefit.
and call them Network Providers or Designated Service Providers.
These providers must meet our quality standards and charge you
Day-to-day Benefits the agreed rates.
Day-to-day expenses include items such as medication, visits to your GP,
x-rays and blood tests. Prescribed Minimum Benefits (PMBs)
On the Plus, Comprehensive, and Core Saver Plans, we pay these According to the Medical Schemes Act, all medical schemes have to
expenses from your Medical Savings Account. pay for a minimum level of care for a list of medical conditions.
On the Traditional, Basic, and Essential Plans, we cover these
Scheme Rate
expenses from the Insured Benefits subject to limits.
Healthcare Professionals in our network charge the Scheme Rate. If
Deductible you visit a Healthcare Professional who is not in our network, they
The deductible is an upfront payment that you have to pay to a can charge you more than the Scheme Rate and you will be liable for
hospital, day clinic or other healthcare facility before you can receive the difference.
treatment. The facility will not admit you until you pay the deductible.
Dependants
A dependant is either a spouse, partner, child, or special dependant.
Applications will need to be submitted to Bankmed for membership.
Insured Benefit
This is a benefit Bankmed pays from pooled contributions, instead of
using your personal Medical Savings Account (if you have one).
3
GET TO KNOW
BANKMED
We care about your health and wellbeing Bankmed gives you better benefits
Bankmed has over 100 years of experience in the Banking
and Healthcare industry
38%
BETTER VALUE
38.7% VS 34.5%
We are experts in providing insights into your HOW BANKMED WORKS
health and wellness needs and have the ability to
offer you a medical scheme tailored to your unique Bankmed is registered in accordance with the Medical
requirements. Schemes Act 131 of 1998. The Council for Medical
Schemes has approved all our rules and benefits. Bankmed’s Solvency Ratio as at
We offer tools to measure and improve your health 31 December 2018 vs Industry Average
through the Wellness and Preventive Care Benefits. A Board of Trustees manages the Scheme for you.
(CMS Annual Report 2018/19)
They put your interests first, and make sure we can
Our communication hub provides you with keep paying claims now and into the future. You choose
information, news and tips on how to create half of the trustees by voting at our Annual General
and maintain a healthy lifestyle. Your health Meeting (AGM), and your employers appoint the other
and wellbeing is our number one priority! half of the trustees that make up the Board Of Trustees.
WE GIVE YOU COVER SO
AA+ GLOBAL CREDIT RATING
YOU CAN ACCESS QUALITY
Bankmed has been awarded the AA+ Global Credit
HEALTHCARE
Bankmed takes part in a yearly survey commissioned
Rating for eleven years in a row. We are one of the
few closed medical schemes in South Africa to have
achieved this rating.
6
PLANS
AA+
GLOBAL CREDIT
by the Health Quality Assessment. This survey
RATING IN 2020
measures the quality of the medical care members Bankmed is built on a solid financial base. We aim to
of medical schemes receive. Based on the 2019 give you more benefits and lower contributions when
Health Quality Assessment findings, Bankmed compared with the rest of the market.
members receive better quality healthcare in the We offer a range of Plans to suit our Global Credit Rating – 2020
industry across most clinical quality indicators. members’ healthcare needs and pockets
4
What sets Bankmed apart?
‘We believe that we must embark on a journey aimed at dramatically improving the way our
members engage with wellness. By assessing the way that the COVID-19 pandemic has so rapidly
changed the way we manage our health and our behaviour, I believe that with the correct
leadership and focus, we can do the same when it comes to managing our day-to-day health
4.9%
VS 8.2%
management going forward.’
Bankmed CEO, Teddy Mosomothane.
Non-healthcare Expenses Ratio PREVENTIVE SCREENING TESTS WE COME TO YOU
(Administration, Managed Care and
General Administration Expenses) AND WELLNESS INITIATIVES Bankmed has a caring and helpful contingency of professionals who come to your
workplace to assist you with any questions about your Plan benefits or services.
Bankmed as at 31 December 2018 Our wellness initiatives help you to identify any conditions before they become
vs Industry Average a problem. We pay for your screening tests and ensure that you get the best
(CMS Annual Report 2018) possible treatment should your tests identify you as being at-risk. Aside from PLANS DESIGNED SPECIFICALLY FOR YOU
helping to improve your longevity and overall mental and physical wellbeing,
All our Plans, benefits and contributions are designed to reflect our intimate
wellness initiatives also aid in lowering the cost of healthcare, reducing
knowledge of your challenges, workplace environment, lifestyle choices and
absenteeism, increasing productivity, reducing injuries, compensation
health risks.
and disability-related costs, and they help boost morale and loyalty within
an organisation.
WE’VE GONE DIGITAL
COVID-19 COVID-19 We have risen to the COVID-19 challenge and ensured that while face-to-face
events are on hold, our virtual AGM and Year-end events are world class digital
Since the outbreak of the COVID-19 pandemic Bankmed has brought assurance
experiences.
to members with an agile response to the virus, keeping in line with the
World Health Organisation (WHO) recommendations ensuring we bring you Bankmed has created a digital world to meet the evolving needs of our members.
comprehensive cover with your health and wellbeing our main priority. Our Bankmed App and website are designed for a superior member experience.
Our platforms have been crafted by User Design experts to provide seamless
and effortless access to relevant forms, information and claim submissions
CMS Annual Report 2018
at a click of a button!
5
PLAN OPTIONS
Getting value from your Plan
TIPS ON HOW TO GET UNLOCK THE POWER
THE MOST VALUE OUT OF OUR DIGITAL TOOLS
OF YOUR PLAN Our website and App give you information
at your fingertips without having to call us
• Use a Healthcare Professional in our network
or wait for business hours:
• Avoid using your day-to-day benefits by
• Submit claims
registering on the Chronic Illness Benefit
for chronic medication or the Baby-and-Me • Download important documents to prove
Programme if you are pregnant membership or submit for taxes
• Have your procedures done in a day surgery or • Search for a Healthcare Professional
day clinic, you will need to pay a deductible if
• Share your medical history with your
admitted to hospital
Healthcare Professionals through your
Electronic Health Record (EHR)
BABY-AND-ME PROGRAMME PG 22
CHRONIC ILLNESS BENEFIT PG 18
GENERAL EXCLUSIONS
HIV PROGRAMME
PG 23
(CONFIDENTIALITY GUARANTEED) What bankmed does not cover
See the complete list of
ONCOLOGY PROGRAMME PG 23
Bankmed exclusions by
reviewing the scheme rules on
PRESCRIBED MINIMUM BENEFITS PG 16
the website
www.bankmed.co.za
FIND OUT MORE ABOUT
PG 20
UPFRONT PAYMENTS
6
Choosing the Plan Make sure your healthcare cover suits your needs and budget.
for you This infographic gives a broad overview of things you need to keep in mind when choosing your Plan:
01
YES
On the Basic, Essential and Traditional
Plans you must use Bankmed networks
02
ARE YOU YOUNG, HEALTHY and follow defined processes to see
AND ON A STRICT BUDGET? a specialist. You must also use our
medicine lists (formularies) for certain
ARE YOU treatments and medication. Consider
COMFORTABLE where you work and live before choosing
Core Saver Essential a Plan that relies on you being restricted
BEING RESTRICTED
Comprehensive TO A SPECIFIC Basic to networks.
Plus HOSPITAL NETWORK Traditional You still benefit from using our networks
NO YES
OR SERVICE on the Core Saver, Comprehensive or
The Essential and Basic PROVIDER?
Plans provide cover Plus Plans, but using networks are not
Core Saver for basic healthcare a requirement for cover on these Plans.
Traditional Essential expenses, known as You still have to pay an amount upfront if
Prescribed Minimum you are admitted to a hospital that is not
Comprehensive Basic Benefits (PMBs). part of our network.
Plus This means you receive NO
cover for PMBs even if you
have a restricted budget.
You are required to use
01 our Bankmed networks
to ensure full cover.
YES
DO YOU WANT A MEDICAL
SAVINGS ACCOUNT?
04 Traditional
NO Comprehensive
Is your Plus
DO YOU HAVE chronic
Any plan
NO YES A CHRONIC condition a
CONDITION? PMB?
Essential Core Saver YES Any plan
Basic Comprehensive
Traditional Plus Compare the different Plans, what benefits they
offer and what the limits and restrictions apply.
NO www.bankmed.co.za
7
Plan Benefits
Plan Wellness and Preventive Care Benefits Use this network for full cover Treatment while admitted Chronic medication Prescribed Minimum
to hospital and other major Benefits (PMBs)
(Determine your risk, detect conditions early, (Prescribed Minimum Benefits
medical expenses
and improve your health) and other benefits)
Plus Personal Health Assessment Bankmed GP Network Comprehensive cover for hospitalisation R27 820 for each member We pay the full cost of
and most hospital care in any private a year Prescribed Minimum
Bankmed Stress Assessment Bankmed Prestige A and B Specialist
hospital Benefits from network
Network We pay less for the
Vaccinations and screenings Healthcare Professionals
Specific categories subject to rand limits medication you collect
Bankmed Pharmacy Network
Pap smear consultation from pharmacies that are Reduced benefits if you use
We pay for procedures performed
Bankmed Pharmacy Network for not in our network. You Healthcare Professionals who
Female contraception in-hospital at 300% of the Scheme
HIV medication might have to pay part of are not in our network. You
Workplace-based TB screening Rate
Bankmed Emergency Services the cost yourself may have to pay part of the
Human Papilloma Virus (HPV) vaccine for female for ambulance services treatment cost yourself
and male members aged nine to 16
Herpes Zoster vaccine for members 60+
Post-engagement Wellness Management Programme
Comprehensive Personal Health Assessment Bankmed GP Network Comprehensive cover for hospitalisation R23 330 for each member We pay the full cost of
and most hospital care in any private a year Prescribed Minimum
Bankmed Stress Assessment Bankmed Prestige A and B Specialist
hospital Benefits from network
Network We pay less for the
Vaccinations and screenings Healthcare Professionals
Specific categories subject to rand limits medication you collect
Bankmed Pharmacy Network
Pap smear consultation from pharmacies that are Reduced benefits if you use
In-hospital GP procedures covered
Bankmed Pharmacy Network for not in our network. You Healthcare Professionals who
Female contraception at 100% of Scheme Rate.
HIV medication might have to pay part of are not in our network. You
Workplace-based TB screening In-hospital specialist procedures
Bankmed Emergency Services the cost yourself may have to pay part of the
Human Papilloma Virus (HPV) vaccine for female covered at 100% of Scheme Rate cost of treatment yourself
for ambulance services
and male members aged nine to 16
Herpes Zoster vaccine for members 60+
Post-engagement Wellness Management Programme
Traditional Personal Health Assessment Bankmed Hospital Network Comprehensive cover for hospitalisation R21 545 for each member We pay the full cost of
and most hospital care in a restricted a year Prescribed Minimum
Bankmed Stress Assessment Bankmed GP Network
hospital network Benefits from network
We pay less for the
Vaccinations and screenings Bankmed Prestige A and B Specialist Healthcare Professionals
Specific categories subject to rand limits medication you collect
Network
Pap smear consultation from pharmacies that are Reduced benefits if you use
More extensive hospital network than
Bankmed Pharmacy Network not in our network. You Healthcare Professionals who
Female contraception for Essential and Basic Plans
Bankmed Pharmacy Network for might have to pay part of are not in our network. You
Workplace-based TB screening GP procedures performed in hospital
HIV medication the cost yourself may have to pay part of the
Human Papilloma Virus (HPV) vaccine for female covered at 100% of Scheme Rate cost of treatment yourself
Bankmed Emergency Services
and male members aged nine to 16 Procedures specialists do in the
for ambulance services
Herpes Zoster vaccine for members 60+ hospital is covered at 100% of
Scheme Rate
Post-engagement Wellness Management Programme
8Plan Wellness and Preventive Care Benefits Use this network for full cover Treatment while admitted Chronic medication Prescribed Minimum
to hospital and other major Benefits (PMBs)
(Determine your risk, detect conditions early, (Prescribed Minimum Benefits
medical expenses
and improve your health) and other benefits)
Core Saver Personal Health Assessment Bankmed GP Network Comprehensive cover for hospitalisation No overall limit, but We pay the full cost of
and most hospital care in an unrestricted benefits subject to Core Prescribed Minimum
Bankmed Stress Assessment Bankmed Prestige A and B Specialist
network of hospitals Saver medicine list Benefits from network
Network
Vaccinations and screenings (formulary) for Prescribed Healthcare Professionals
Specific categories subject to rand limits
Bankmed Pharmacy Network Minimum Benefit
Pap smear consultation Reduced benefits if you use
Organ transplants and oncology conditions only
Bankmed Pharmacy Network for Healthcare Professionals who
Female contraception treatment is limited to Prescribed
HIV medication We pay less for the are not in our network. You
Workplace-based TB screening Minimum Benefits
Bankmed Emergency Services medication you collect may have to pay part of the
Human Papilloma Virus (HPV) vaccine for female We pay for procedures performed from pharmacies that are cost of treatment yourself
for ambulance services
and male members aged nine to 16 in-hospital at 100% of Scheme Rate not in our network. You
Herpes Zoster vaccine for members 60+ might have to pay part of
the cost yourself
Post-engagement Wellness Management Programme
Basic Personal Health Assessment Bankmed Hospital Network Comprehensive cover for hospitalisation No overall limit, but We pay the full cost of
and most hospital care in a restricted benefits from Bankmed Prescribed Minimum
Bankmed Stress Assessment Bankmed GP Entry Plan Network
hospital network network Healthcare Benefits from network
Vaccinations and screenings Bankmed Entry Plan Specialist Professionals and subject Healthcare Professionals
Specific categories subject to rand limits
Network to Scheme approved
Pap smear consultation Reduced benefits if you use
Hospital network more limited than medicine list (formulary)
Bankmed Pharmacy Network Healthcare Professionals who
Female contraception for the Traditional Plan
Bankmed Pharmacy Network for are not in our network. You
Workplace-based TB screening Organ transplants, oncology treatment
HIV medication may have to pay part of the
Human Papilloma Virus (HPV) vaccine for female and renal dialysis, are limited cost of treatment yourself
Bankmed Emergency Services to Prescribed Minimum Benefits
and male members aged nine to 16
for ambulance services
Herpes Zoster vaccine for members 60+ We pay for procedures performed
in-hospital at 100% of Scheme Rate
Post-engagement Wellness Management Programme
Essential Personal Health Assessment Bankmed Hospital Network Limited to Prescribed Minimum Limited to Prescribed We pay the full cost of
Benefits from a restricted hospital Minimum Benefits, Prescribed Minimum
Bankmed Stress Assessment Bankmed GP Entry Plan Network
network (Designated Service Providers) covered at 100% of cost Benefits from network
Vaccinations and screenings Bankmed Entry Plan Specialist from Bankmed GP Entry Healthcare Professionals
Hospital network more restricted than
Network Plan Network and subject
Pap smear consultation for the Traditional Plan Reduced benefits if you use
Bankmed Pharmacy Network to Scheme approved
Workplace-based TB screening Healthcare Professionals who
Procedures performed in hospital medicine list (formulary)
Bankmed Pharmacy Network for are not in our network. You
Human Papilloma Virus (HPV) vaccine for female are limited to Prescribed Minimum
HIV medication may have to pay part of the
and male members aged nine to 16 Benefits
cost of treatment yourself
Bankmed Emergency Services
Herpes Zoster vaccine for members 60+
for ambulance services
Post-engagement Wellness Management Programme
9DAY-TO-DAY Medical Savings Account
BENEFITS ON (MSA)
DIFFERENT PLANS More than a member. More with Bankmed.
CORE SAVER, COMPREHENSIVE
AND PLUS PLANS
A Medical Savings Account (MSA) is used to pay for healthcare you
receive while you are not admitted to hospital. We use these funds to
pay for medical costs like GP visits, X-rays (radiology), medication, and
blood tests (pathology).
At the beginning of the year, we give you full access to a yearly amount.
You pay the amount back without interest as part of your monthly
contributions.
If you join Bankmed after 1 January, we work out your MSA amount for
the rest of the year by multiplying the monthly amount you contribute
towards your MSA by the number of months left in the year.
MAKING YOUR MEDICAL SAVINGS
ACCOUNT (MSA) LAST
Only you and your treating Healthcare Professional can decide what
treatment you need. Discuss with your Healthcare Professional to
ensure you get the best value for money and treatment.
Pace yourself
Work out a budget just as you would with a savings account at the bank.
Know how much you have available for the year and plan for important
check-ups over the year. Use pharmacies or clinic services that offer free
blood pressure tests or give flu shots. (We pay for the flu vaccine from
your Insured Benefit, so you do not use the funds in your MSA).
10Plan Medical Savings Account Day-to-day benefits
Plus Yes We pay day-to-day claims from your Medical Savings Account until you reach the Annual Threshold
Once you reach the Annual Threshold, you gain access to the Above Threshold Benefit, which gives more cover if you have high out-of-hospital expenses
Comprehensive Yes We use the funds in your MSA to pay for GP and specialist consultations, acute medication (medication you have to take for a short time), blood tests (pathology) and
X-rays (radiology)
Unlimited cover from the Insured Benefit for procedures performed by GPs or specialists in their rooms, and basic dentistry (such as dentist consultations, teeth cleaning
and fillings)
We only pay the full cost if you use Healthcare Professionals in our network; otherwise you may incur a co-payment
Cover from the Insured Benefit up to a set limit for advanced dentistry, orthodontics and other specified categories. When you reach the limit, we start paying from the
available funds in your MSA
Traditional No We pay from the Insured Benefit for GP and specialist consultations, acute medication (short-term medication), X-rays (radiology), blood tests (pathology),
basic dentistry, advanced dentistry and orthodontics up to the Plan limit
Unlimited cover from the Insured Benefit for procedures performed by GPs and specialists in their rooms
We only pay the full cost if you use Healthcare Professionals in our network; otherwise you may have to pay part of the cost yourself
Limited cover for eye test and glasses or contact lenses every two years
Core Saver Yes Unlimited cover for Prescribed Minimum Benefits (PMBs) if you use GPs or specialists in our networks and get the recommended care for the condition. You have to
register on the Chronic Illness Benefit for chronic conditions
Prescribed Minimum Benefits
We pay for two consultations for non-PMB conditions from the Insured Benefit. Once this is used up, we pay for day-to-day benefits from the available funds in your MSA
We use the available funds to pay for non-PMBs such as dentistry, orthodontics, eye care, and acute medication (short-term medication you have to take for a short time)
that a Healthcare Professional prescribes
Members on this Plan have limited cover from the Insured Benefit for acute medication a pharmacist prescribes and gives you
Basic No Unlimited cover for primary healthcare services such as GP consultations, acute medication (short-term medication you have to take for a short time) on our medicine list
(formulary) and basic dentistry from Healthcare Professionals in our network
Limited benefits for eye care from the Bankmed Optometry Network every two years
We offer other benefits up to a limit if you get them from a Bankmed Entry Plan Network GP or this GP refers you to someone else (writes a letter saying you should see
another Healthcare Professional in our network)
No benefit for advanced dentistry or orthodontic treatment
Essential No Cover limited to Prescribed Minimum Benefits
11Annual Threshold vs Above
Threshold Benefit
Plus Plan only
The Above Threshold Benefit (ATB) gives you additional cover if you use up
the yearly amount we pay into your Medical Savings Account (MSA) at the
beginning of the year.
An Insured Benefit can only be accessed once you reach the Annual
Threshold. There are limits to how much we pay from the ATB.
THE ANNUAL THRESHOLD LIMITS TO AMOUNTS ADDING UP
We use the number of adult and child dependants on a membership AND BENEFIT CATEGORIES
to calculate the Annual Threshold for the year.
There is a limit to how much of your Medical Savings Account is used
We use the Scheme Rate instead of the cost of medication or to pay for specific categories of treatments, which adds up to the
treatment to calculate when you reach the Annual Threshold. When Annual Threshold. Some of the categories are:
claims pay out at 100% of the Scheme Rate from your Medical Savings
• Prescribed acute medication (medication you have to take for a
Account and add up to the Annual Threshold, you can access the
limited time)
Above Threshold Benefit.
• Claims for tooth and gum care (including preventive and basic
SELF-PAYMENT GAP dentistry, advanced dentistry and all other dental services)
If you do not use network Healthcare Professionals, and your Healthcare • Optometry consultations, prescription lenses and readymade
Professional charges more than the Scheme Rate, you could run out of readers, contact lenses, fitting of contact lenses and other eye-
funds in your Medical Savings Account before you reach the Annual care such as refractive surgery. Ask your Healthcare Professional
Threshold. This means that you will have a Self-payment Gap. about the available DSP lens options which are covered in full
If you have a Self-payment Gap, you will have to pay all claims. If you Your general limits for the categories can be more than the limits for the
do not have benefits available, please continue to send your claims Above Threshold Benefit. However, we do not pay out more than your
to us, so we can count your eligible claims towards closing your Self- family’s limits for the Above Threshold Benefit.
payment Gap and ensure you access your Above Threshold Benefit
when the Above Threshold has been reached.
12Contributions 2021
Essential Plan (No Medical Savings Account) Basic Plan (No Medical Savings Account)
Schedule of monthly contributions with effect from 1 January 2021 Schedule of monthly contributions with effect from 1 January 2021
2021 Total Contribution 2021 Total Contribution
M A C M A C
< R5 000 R745 R668 R187 < R5 000 R1 144 R855 R287
R5 001 - R6 000 R815 R734 R213 R5 001 - R6 000 R1 256 R942 R325
R6 001 - R7 000 R900 R810 R232 R6 001 - R7 000 R1 384 R1 034 R357
R7 001 - R8 000 R988 R889 R253 R7 001 - R8 000 R1 519 R1 154 R391
R8 001 - R9 000 R1 129 R1 018 R280 R8 001 - R9 000 R1 736 R1 316 R435
R9 001 - R10 000 R1 256 R1 129 R316 R9 001 - R10 000 R1 931 R1 461 R485
R10 000+ R1 430 R1 288 R360 R10 000+ R2 199 R1 649 R551
Core Saver Plan (With Medical Savings Account)
Schedule of monthly contributions with effect from 1 January 2021
2021 Total Contribution Risk Contribution Savings Contribution
M A C M A C M A C
< R5 000 R1 724 R1 298 R433 R1 469 R1 107 R369 R255 R191 R64
R5 001 - R6 000 R1 847 R1 387 R462 R1 575 R1 182 R395 R272 R205 R67
R6 001 - R7 000 R1 977 R1 484 R494 R1 686 R1 265 R419 R291 R219 R75
R7 001 - R8 000 R2 076 R1 558 R521 R1 770 R1 327 R442 R306 R231 R79
R8 001 - R9 000 R2 238 R1 682 R565 R1 907 R1 434 R482 R331 R248 R83
R9 001 - R10 000 R2 353 R1 768 R590 R2 006 R1 509 R504 R347 R259 R86
R10 000+ R2 594 R1 941 R652 R2 213 R1 654 R556 R381 R287 R96
13Traditional Plan (No Medical Savings Account)
Schedule of monthly contributions with effect from 1 January 2021
2021 Total Contribution
IMPORTANT
Contributions for child dependants are limited to a maximum
M A C
of three children.
< R5 000 R2 874 R2 152 R717
Visit the Bankmed website www.bankmed.co.za
R5 001 – R10 000 R3 350 R2 510 R841
R10 000+ R3 486 R2 618 R873 LATE-JOINER PENALTY
The Medical Scheme Act instructs medical schemes to charge
a late joiner penalty if someone joins a medical scheme for the
first time when they’re 35 years or older, or if someone isn’t a
Comprehensive Plan (With Medical Savings Account) member and has a break in coverage for more than three months
Schedule of monthly contributions with effect from 1 January 2021 then joins a medical scheme again.
2021 Total Contribution Risk Contribution Savings Contribution The Act calls this person a late joiner. This does not apply to
members or their dependants who were members of a medical
M A C M A C M A C
scheme before 1 April 2001 and who have not had a break in
R0 – R10 000 R3 829 R2 868 R962 R3 154 R2 363 R792 R675 R505 R170 coverage for more than three months after each other.
R10 000+ R3 987 R2 989 R997 R3 284 R2 461 R821 R703 R528 R176 The Board of Trustees can decide to charge a late joiner an extra
percentage of their contribution depending on how long they
have not been a member of a medical scheme. The penalty is
permanent and will apply for the duration of the membership.
Plus Plan (With Medical Savings Account) Penalty bands Maximum penalty
Schedule of monthly contributions with effect from 1 January 2021
1 to 4 uncovered years 5%
2021 Total Contribution Risk Contribution Savings Contribution
5 to 14 uncovered years 25%
M A C M A C M A C
15 to 24 uncovered years 50%
All Incomes R6 749 R5 053 R1 689 R5 170 R3 871 R1 294 R1 579 R1 182 R395
25+ uncovered years 75%
Annual Threshold If you can prove that you’ve been a member of a South African
medical scheme before, we subtract the years of membership
M A C
from your current age when we work out your late joiner penalty.
Threshold Level R20 200 R15 100 R5 000
Threshold Amount R18 800 R14 100 R4 600
14BENEFIT
INFORMATION Cover for medical emergencies
In an emergency, contact Bankmed Emergency Services
on 0860 999 911. This number is on your membership card,
we suggest you also save it on your mobile device.
If you are admitted to hospital in an emergency, • The medical condition starts suddenly
please contact us for authorisation within 48 hours. and is unexpected
• The condition has to be treated at once
EMERGENCY SERVICES (treatment could involve an operation)
Bankmed Emergency Services offers real-time
• If treatment does not start at once, the
emergency care for all members. This number is
condition could cause weakened bodily
available 24 hours a day, seven days a week for
functions, serious and lasting damage
any emergency calls. Highly qualified emergency
to organs, limbs or other body parts,
personnel manage this line. They assess each
or even death
case and provide immediate feedback and help.
If you have a sudden health problem, it is not always
If you need medically equipped transport in
clear if the condition is a medical emergency or not.
South Africa, our Emergency Services will send
To pay for treatment as a Prescribed Minimum
an ambulance or helicopter to take you to hospital.
Benefit, we may ask you to send us proof that
We pay for the cost from your Hospital Benefit;
the situation was a medical emergency.
it does not matter if you are admitted to hospital
or not.
You can go to any hospital in a medical emergency.
CALLING FROM OUTSIDE
We will pay for your emergency hospital admission OF SOUTH AFRICA
at any hospital, even if it is not in our network.
If you are outside the borders of South Africa,
The Medical Schemes Act sets out what an call +27 11 529 6616 in an emergency or if you
emergency medical condition is. Even if a have any questions.
Healthcare Professional tells you it’s a medical
This line is only for international callers. If you
emergency, we only pay in full for a medical
are travelling outside of South Africa, we suggest
condition if:
that you save this number on your mobile device,
so you have it on hand in an emergency.
15Prescribed Minimum Benefits (PMBs)
According to the Medical Schemes Act, all medical schemes have to pay for a specific
minimum level of care for a list of medical conditions. These are called Prescribed
Minimum Benefits (PMBs)
You have cover for PMB conditions, no matter which Plan you choose. However, there are conditions and limits to this cover.
Medical schemes have to pay the costs related to the diagnosis, treatment and care of:
• Any emergency medical condition
• A limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs)
• 27 chronic conditions (defined in the Chronic Disease List)
CONDITIONS FOR COVER HOW WE PAY
You must meet three requirements to have your treatment paid in full: We pay for the cost of the diagnosis, treatment and care of Prescribed
1. Your condition must be on the Prescribed Minimum Benefits list Minimum Benefits (PMBs) in South Africa, in full as an Insured Benefit
2. Y
ou must use the recommended treatment and medication for if you meet the three requirements (Conditions for cover) for full
your condition coverage. We always pay for emergency medical treatment, even if you
You must use medication from our medicine list (formulary), use a non-network Healthcare Professional.
or you may incur a co-payment If it is not a medical emergency, a network Healthcare Professional
3. You must use our Designated Service Providers (DSPs) is available, and you use a non-network Healthcare Professional, we
A Designated Service Provider is the same as a network Healthcare cover the diagnosis, treatment and care of PMBs at the Scheme Rate.
Professional. In other words, they are a Healthcare Professional we
You have to get pre-authorisation, your treatment has to follow the
have an agreement with. You are allowed to use a non-Designated
clinical protocols, and you have to register on our Managed Care
Service Provider, but this may mean you have to pay part of the
Programmes for PMB cover. This means you must apply for these
claim yourself (co-payment)
benefits or we pay for treatment from your day-to-day benefits.
If you need to go to the hospital and it is not a medical emergency, we After you reach the rand limit for chronic medication, we only
only cover claims if you contacted us and got pre-authorisation before provide funding for medication as a PMB.
you were hospitalised.
Find Healthcare Professionals in our network.
Overview of networks on different Plans
www.bankmed.co.za
16Please note: WHAT IF I CANNOT USE A NETWORK IS MY CONDITION COVERED?
• Prescribed Minimum Benefits (PMBs) only apply to claims in
South Africa. If you claim for a healthcare service that is a PMB in
HEALTHCARE PROFESSIONAL? A Healthcare Professional must diagnose you with a condition on the
list of 270 Prescribed Minimum Benefit diagnoses. For us to cover
South Africa, but you received the care or treatment outside the In a medical emergency, go straight to the nearest hospital. If it is not
your healthcare costs, your Healthcare Professional must use the
borders of South Africa, we treat them as ordinary claims and pay an emergency, you should use a Healthcare Professional, pharmacy
correct ICD 10 code for the condition.
them according to your Plan’s benefits or hospital in our network for Prescribed Minimum Benefit (PMB)
care to make sure we pay for the cost of care in full. We cover chronic medical conditions through our Chronic Illness
• You have to get pre-authorisation, use medication on our
Benefit. If you are diagnosed with a chronic Prescribed Minimum
medicine list (formulary) and get the recommended treatment There are other situations in which we pay for PMBs in full even
Benefit (PMB) condition, you must register before you have access
for the claim to qualify for PMB cover if you do not use a Healthcare Professional in our network, as long
to cover. If you do not register, we pay for your treatment from your
as you contact us for permission (pre-authorisation) beforehand.
• We only pay for the cost of diagnosis as a PMB if the test confirms day-to-day benefits.
Examples of these situations are:
that the medical condition is a PMB condition
The Chronic Disease List (CDL) specifies medication and treatment for
• The healthcare service is not available from someone in the Bankmed
• When this schedule sets out insured limits, we pay claims the 27 chronic conditions that are covered in this section of the PMBs:
Network, or you would have to wait for an unreasonably long time
(including PMBs) up to the limit. When you reach the limit,
to receive the treatment or service • Addison’s disease • Dysrhythmias
we only pay for treatment as a PMB if you meet the conditions
• Asthma • Epilepsy
• You need immediate medical or surgical treatment for a PMB
• The Council for Medical Schemes tells medical schemes not to pay • Bipolar mood disorder • Glaucoma
condition, and the circumstances or location mean you cannot
for PMBs from your Medical Savings Account (MSA). Once you register
reasonably use a network provider • Bronchiectasis • Haemophilia
for a chronic PMB condition, we do not pay for treatment from
• Cardiac failure • Hyperlipidaemia
your MSA • No network provider is within a reasonable proximity to your
• Cardiomyopathy • Hypertension
home or work address
• Even if we usually pay for care or treatment from your MSA • Chronic obstructive • Hypothyroidism
or do not offer a benefit, we pay for PMBs as long as members Visit www.bankmed.co.za pulmonary disease • Multiple sclerosis
meet the conditions for cover
• Chronic renal disease • Parkinson’s disease
• Coronary artery disease • Rheumatoid arthritis
• Crohn’s disease • Schizophrenia
• Diabetes insipidus • Systemic lupus
• Diabetes mellitus erythematosus
types 1 and 2 • Ulcerative colitis
• HIV
Visit the Council for Medical Schemes’ website page
www.medicalschemes.com
17Chronic Illness Benefit
You are covered for 27 chronic conditions (including HIV and AIDS).
You must register on the Chronic Illness Benefit, once approved we will start paying for your chronic medication.
If you do not register, we pay for your chronic medication from your day-to-day benefits.
MEDICINE ADVISORY SERVICES TIPS FOR EXTENDING CHOOSE MEDICATION WISELY
Core Saver, Traditional, Comprehensive YOUR BENEFITS According to the International Generic Pharmaceutical Alliance,
generics can be between 20 and 90 percent cheaper than the
and Plus Plans When you apply to join the Chronic Illness Benefit, and Bankmed
original medication. When you collect your medication from the
Our aim is to provide structure and make sure your chronic reviews your application, we suggest that your treating Healthcare
pharmacy, ask the pharmacist if a generic is available and the cost
medication works for you. Professional prescribes the generic version of the medication.
implication. You can save by using a single medication to treat
We do this to make sure you have the best cover for your
We provide an efficient pre-authorisation process for you when a number of symptoms. For example, if you have a runny nose,
condition.
taking chronic medication, and combine advanced technology congestion and a headache.
with pharmacological and medical expertise to assess applications By law, only you and your treating Healthcare Professional can
for medication in line with clinical guidelines. decide what treatment is best for you. We will not change your What is generic medication?
medication without your Healthcare Professional’s permission.
A generic contains the same active ingredients as the original
HOW TO REGISTER Essential and Basic Plans medication, but comes in different packaging. They have the
same dosage, strength, quality, performance characteristics and
We ask your treating Healthcare Professional about your medical You have to use medication on our medicine list (formulary) for it
intended use as the original. They are usually less expensive than
condition, and may require test results or additional proof to to be covered. Please speak to your Healthcare Professional and
the original medication. Original medication is more expensive
confirm that your medical condition qualifies for cover. consult the Bankmed website or App to check if medication is on
since only the company that developed it can sell it just after they
our list.
produce it. Generics are made when the patent runs out, and
Core Saver, Traditional, Comprehensive
Core Saver, Traditional, Comprehensive different companies can manufacture the medication.
or Plus Plan
and Plus Plans
To get authorisation for chronic medication at once, your
Healthcare Professional or pharmacist can contact Bankmed on If the medication you use is not on our medicine list (formulary),
0800 13 23 45. you may have to pay part of the cost yourself. This is true even
if the medication is a generic. Please speak to your Healthcare
Alternatively, ask your treating Healthcare Professional to fill
Professional and consult the Bankmed website to check if the
in a registration form, visit www.bankmed.co.za. E-mail the
medication is on our list.
completed form to chronic@bankmed.co.za, or fax it to
011 770 6247.
Essential or Basic Plan
Ask your treating Healthcare Professional to fill in a registration
form, visit www.bankmed.co.za. E-mail the completed form to
chronicbasicessential@bankmed.co.za or fax it to 011 539 7000.
18Hospital care and procedures
HOSPITAL BUILDING If your Healthcare Professional contacts us and gets authorisation on
your behalf, you have to make sure you receive all the information
VS BEING IN HOSPITAL about the authorisation from the Healthcare Professional. You cannot
hold Bankmed responsible if your Healthcare Professional does not
We pay for the treatment and care you receive while admitted to
share this information with you. This includes information about:
hospital from the Hospital Benefit. We do not pay for all healthcare
you receive in a hospital building from the Hospital Benefit. There • What we cover and what we do not cover
is a difference between being hospitalised and visiting a Healthcare
• Upfront payments (deductibles) to the hospital before you
Professional who has an office inside the hospital building.
receive treatment
When we say you are in-hospital, admitted to hospital, or • How much you have to pay yourself (co-payments and
hospitalised, we mean that you had to sign in to hospital at shortfalls)
reception and that you have a hospital bed. We pay for procedures,
We require the following information from your treating
and your hospital stay in this case from the Hospital Benefit without
Healthcare Professional when you contact us for pre-authorisation:
using your day-to-day benefits.
• Your treating Healthcare Professional’s practice number
We pay for healthcare you receive in the hospital building (like visits
to the casualty unit, visits to specialists, scans and blood tests) from • Name of the hospital to which you or your dependant
your day-to-day benefits if you do not have a hospital bed. will be admitted
• The date of admission
HOSPITAL PRE-AUTHORISATION • The diagnosis code (ICD 10 code)
• Any tariff and procedure codes
If you are admitted to hospital in an emergency, please contact
us for authorisation within 48 hours. We send you and the hospital an authorisation letter as soon as the
admission is approved. If we have your cellphone number, we also
You must get pre-authorisation before you are admitted to hospital
send you an SMS with pre-authorisation details.
for a planned procedure. Contact us for pre-authorisation as soon
as you and your Healthcare Professional have agreed on a date for Pre-authorisation does not mean we pay all the
admission by using one of the below channels: costs for your hospital stay
• Call: 0800 BANKMED (0800 226 5633) When we give you pre-authorisation, we confirm that your hospital
• E-mail: treatment@bankmed.co.za admission meets our clinical guidelines for funding. It does not
• Fax: 021 527 1928 guarantee we will cover all the costs related to the hospitalisation
as this depends on your Plan’s limits.
Always check your Plan’s limits in this Benefit and Contribution
Schedule and call us on 0800 BANKMED (0800 226 5633) for benefit
confirmation if you are unsure.
19UPFRONT PAYMENT (DEDUCTIBLE) UPFRONT PAYMENT (DEDUCTIBLE)
You may have to pay an amount to a hospital or a day clinic before FOR NOT USING A NETWORK FACILITY No upfront payment for following
specific procedures or if you do not use a network hospital if you are
Unless it is a medical emergency, you have an upfront payment before procedures in a network day clinic:
on a Plan that makes use of hospital networks. We call this amount an
you can receive treatment or care in a day clinic or hospital that is not
upfront payment or deductible. The facility will not admit you until you • Adenoidectomy
in our network.
pay the amount. You do not have any upfront payments for emergency • Arthrocentesis
admissions, readmissions within six weeks of discharge or childbirth. Basic, Core Saver, Comprehensive and Plus Plans • Cataract surgery
Day clinic: R260 for each admission
Only one upfront payment (deductible) • Cautery of vulva warts
Hospital: R660 for each admission
for each admission • Circumcision
For example: Traditional Plan
• Colonoscopy
• A Traditional Plan member going to a non-network hospital Day clinic: R260 for each admission
Hospital: R5 475 for each admission • Cystourethroscopy
(R5 475 upfront) for dental treatment (R1 950 upfront) pays
• Diagnostic dilation and curettage
R5 475 upfront for not using a network hospital as this is more
Essential Plan
than the dental upfront payment • Gastroscopy
No cover outside our hospital and day clinic networks.
• Hysteroscopy
• A Comprehensive Plan member going to a non-network hospital
(R660 upfront) for dental treatment (R1 950) pays R1 950 upfront
AVOID UPFRONT PAYMENTS • Myringotomy
for the dental procedure as this is more than the non-network • Myringotomy with intubation (grommets)
upfront payment (DEDUCTIBLES) FOR SPECIFIC • Nasal cautery
You do not have to pay an amount upfront if: PROCEDURES • Nasal plugging for nose bleeds
• You are admitted to a non-network hospital in a medical You have to contact us to get pre-authorisation before you go to • Proctoscopy
emergency (as a Prescribed Minimum Benefit). If you do not use a day clinic or hospital for a procedure. Specific procedures can • Prostate biopsy
a network hospital or day clinic, and it is not a medical emergency, be performed in a day clinic instead of in-hospital so you can avoid
• Removal of pins and plates
you have to make an upfront payment having an upfront payment by using a day clinic in our network.
• Sigmoidoscopy
• You are admitted to hospital for childbirth Basic, Core Saver, Traditional, Comprehensive • Tonsillectomy
• You are admitted to hospital again within six weeks of being and Plus Plans • Treatment of Bartholin’s cyst or gland
sent home if you have complications from a procedure that you Network day clinic: No upfront payment
• Vasectomy
already paid an amount upfront for Non-network day clinic or network hospital: R1 725 for
each admission. • Vulva or cone biopsy
• You are admitted to a state hospital
• We inform you that you do not have an upfront payment if you
Essential Plan
Network day clinic: No upfront payment for Prescribed Minimum
are admitted to a day clinic for specific procedures
Benefit conditions
Please ensure you have the required authorisation for any
Non-network day clinic or network hospital: R1 725 for each
procedures performed In-hospital or a Day Surgery Facility.
admission for Prescribed Minimum Benefit conditions
Call: 0800 BANKMED (0800 226 5633)
You only have cover for procedures to treat Prescribed Minimum
Benefit conditions. If the condition is not a Prescribed Minimum
Benefit, you have to pay for all the procedure and related costs
yourself.
20UPFRONT PAYMENTS (DEDUCTIBLES) HOW WE PAY YOUR TREATING MAKE SURE YOUR CONTACT DETAILS
FOR DENTAL ADMISSIONS HEALTHCARE PROFESSIONAL ARE ALWAYS UP TO DATE
Only the Traditional, Comprehensive and Plus Plans offer cover for Your benefits (rate of cover and limits) are set out in this Benefit We send pre-authorisation letters to you (the member) and your
tooth and gum (dental) treatment in-hospital. If you are on another and Contribution Schedule. Healthcare Professional if we give you pre-authorisation. If your
Plan, you have to pay for all the procedure and related costs yourself. dependant is 18 years or older, we send them their own pre-
Always discuss costs with the treating Healthcare Professional and ask
authorisation. These letters contain important information
Traditional, Comprehensive and Plus Plans if they charge the Scheme Rate. If they charge more than the Scheme
about what Bankmed will and will not cover.
Day clinic: R260 for each admission Rate, you have to pay the difference (co-payment).
Hospital: R1 950 for each admission Please make sure that we always have your correct e-mail address.
Ask if the other Healthcare Professionals (such as an anaesthetist
If your dependant is 18 years or older, please make sure we have
Basic, Essential and Core Saver Plans or an assistant) will be involved in your treatment and if they charge
their e-mail address as well.
No cover for dentistry performed in a hospital or day clinic. the Scheme Rate.
You and your dependants cannot hold Bankmed responsible for
If you negotiate tariffs upfront, you can avoid unexpectedly having
any consequences if you or your dependants do not receive letters
UPFRONT PAYMENTS (DEDUCTIBLES) to pay a substantial amount yourself.
because we do not have your correct contact details.
FOR OESOPHAGOSCOPY AND SIMPLE We pay a lower fee if more than one procedure
ABDOMINAL HERNIA REPAIR is performed while under one anaesthetic DISCHARGE PLANNING
Industry guidelines require that Healthcare Professionals charge lower
While you are in hospital, your Healthcare Professional and the
You always have an upfront payment for: fees for second and subsequent procedures performed under one
hospital stay in contact with us to make sure we can update your
• Oesophagoscopy anaesthetic than they would charge if they perform each procedure
authorisation if your treatment plan changes. A case manager also
• Simple abdominal hernia repair separately.
helps you with leaving the hospital if you need rehabilitation in
Basic, Core Saver, Traditional, Comprehensive Your treating Healthcare Professional is aware of these guidelines and another setting such as a step-down facility, or if you need home
should follow them. Ask them to go through any planned charges with nursing. Cover for step-down facilities and home nursing depends
and Plus Plans
you before the procedure and discuss the cost. Make sure that you are on your Plan’s benefits.
Day clinic: R260 for each admission
not billed the full amount if you have more than one procedure under
Hospital: R660 for each admission
one anaesthetic.
21Cover for pregnancy and
childbirth
Core Saver, Traditional and
Comprehensive Plans
BABY-AND-ME PROGRAMME
Bankmed’s pregnancy programme Baby-and-Me, provides additional cover for
pregnancy and childbirth. Only members on the Core Saver, Traditional and
Comprehensive Plans can access this programme. Members on the Plus Plan
do not qualify for the additional coverage from the Insured Benefit.
Reasons to join
We provide additional coverage from the Insured Benefit during pregnancy for
services such as ultrasounds and further consultations. A client relationship
manager can help you register on the programme and give you advice
throughout your pregnancy and after the birth of your baby.
When you register, you receive:
• A Bankmed baby hamper*, which can be redeemed at any
Toys R Us / Babies R Us stores nationally
• Additional cover
• Regular communication at different milestones throughout
your pregnancy
• Help with hospital pre-authorisation
• A hospital checklist to prepare you for your hospital stay
*
The contents of the Bankmed baby hamper can be changed without notice depending on stock
availability.
How to join
Complete the Baby-and-Me application form to join the programme:
• E-mail: babyandme@bankmed.co.za
• Call: 0800 BANKMED (0800 226 5633)
• Website: www.bankmed.co.za
22Cover for cancer Cover for HIV and AIDS
If you are diagnosed with cancer and For members living with HIV and AIDS, Bankmed’s HIV Programme
your cancer treatment is approved, provides comprehensive disease management. You must register on
you have access to cover through the the HIV Programme to get access.
Oncology Programme. You must register We take the utmost care to protect your right to privacy and
confidentiality. Once registered you will have cover for all-inclusive care.
on the Oncology Programme to access
this benefit. All medication on our medicine list (formulary) is paid in full as long
as you collect your medication from a network pharmacy. We pay for
approved medication that is not on our list up to a set monthly amount.
To register or find out more, contact us on:
Essential, Basic and Core Saver Plans • E-mail: hiv@bankmed.co.za
You only have cover for approved Prescribed Minimum Benefit • Call: 0800 BANKMED (0800 226 5633)
cancer treatment. We do need your treatment Plan, in order
• Fax: 011 539 3151
to approve your cover.
Traditional, Comprehensive and Plus Plans
You have unlimited cover, this means that we do not stop paying for
approved treatments. You will need to send us your treatment Plan,
in order to approve your cover before your Healthcare Professional
commences treatment.
Treatment covered
We follow the South African Oncology Consortium’s guidelines to
make sure you have access to the most appropriate level of treatment
for your particular stage of cancer.
We pay for chemotherapy, radiotherapy and other healthcare services
based on proven effectiveness, evidence-based healthcare, and
cost-effectiveness.
We will not pay for healthcare services that do not meet all criteria.
To register or find out more, contact us on:
• E-mail: oncology@bankmed.co.za
• Call: 0800 BANKMED (0800 226 5633)
• Fax: 011 539 5417
23ESSENTIAL PLAN BASIC PLAN TRADITIONAL PLAN CORE SAVER PLAN COMPREHENSIVE PLAN PLUS PLAN
2021 2021 2021 2021 2021 2021
NON-MEDICAL SAVINGS ACCOUNT PLANS MEDICAL SAVINGS ACCOUNT PLANS
Does this Plan have a Medical No No No Yes Yes Yes
Savings Account (MSA)?
Percentage of Gross N/A N/A N/A 14.7%* 17.6%* 23.4%*
Contribution allocated to *
T he percentage of Gross Contribution allocated to the Medical Savings Account is not fixed per
Medical Savings Account
Plan. The percentage varies by dependant type, income band, rounding of values and manner
in which contribution increases have been calculated. The percentage published in this Benefit
and Contribution Schedule is, therefore, an aggregated value.
1 OVERALL ANNUAL LIMIT
Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited
2 CLAIMS FOR SERVICES RENDERED OUTSIDE THE BORDERS OF SOUTH AFRICA (FOREIGN CLAIMS)
It is recommended that you consider taking out comprehensive travel insurance prior to travelling abroad, as not all foreign claims will be covered (or covered in full)
2.1 Cover available for PMB Foreign claims covered at the Foreign claims covered at the relevant Scheme Rate and/or Rand limit subject to benefits available on your selected Plan
conditions and life-threatening relevant Scheme Rate and/or
emergencies only Rand limit subject No benefits for emergency/ ambulance transport outside the borders of South Africa
to benefits available on
your selected Plan Medical motivation and prior approval required for non-emergency surgery outside the borders of South Africa
No benefits for emergency/ No benefits for emergency/
ambulance transport outside ambulance transport outside
the borders of South Africa the borders of South Africa
No benefits for services No benefits for services not
not normally covered at normally covered at the
the Scheme’s preferred Scheme’s preferred provider
provider network (Bankmed network (Bankmed GP Entry
GP Entry Plan Network) for Plan Network) for out-of-
out-of- hospital consultations, hospital consultations,
medication and treatment medication and treatment
(except via Bankmed GP Entry (except via Bankmed GP Entry
Plan Network providers Plan Network providers
in Lesotho) in Lesotho)
Medical motivation and prior Medical motivation and prior
approval required for non- approval required for non-
emergency surgery outside emergency surgery outside
the borders of South Africa the borders of South Africa
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