Knowing your Benefit Option cover well and being network savvy can help you make the most of your health benefits. So, take a little time to get to know your cover. You may be surprised to see how convenient it is to use networks and the extra value you get.

Your choice of cover can mean you need to use networks

Having a Benefit Option that recommends the use of networks can affect your day-to-day benefits and the medical aid cover you have at certain healthcare providers. Your Benefit Option can require you to make use of specific hospitals, pharmacies, doctors or specialists in a network. It is all to your benefit. Using networks makes it possible for medical schemes to have arrangements in place that allow a lower contribution for those who use the network. This is great, since it means that your medical scheme can offer you full cover in these networks – without unexpected costs – as long as you have benefits available.

It makes sense to take advantage of networks whenever you can

Using a network is more convenient. By tapping into network arrangements, you can cut down on unexpected deductibles. So, not only does this keep your healthcare costs down, but usually, the medical scheme will also pay healthcare professionals within their network directly. These healthcare providers know the network arrangements well. This means you will not have any extra administration and your medical scheme can let you know when any extra costs are already included in their agreement with the healthcare provider.

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 Benefit Option only covers you for the specified tariff, you may be responsible for a co-payment.

It can be embarrassing to discuss money with your healthcare provider, but when you make an appointment, you are entitled to ask what rates your doctor charges and whether or not you will have any deductibles. Discussing the costs upfront means you can make informed decisions about how you spend the funds you have available for day-to-day care. If you're set on that specific provider and you are happy to pay more, at least you'll know upfront exactly how much you need to pay.

As part of the Benefit Option offering of Remedi Medical Aid Scheme you have access to an extensive GP network. The cost of consultations is paid in full and you do not have a co-payment as long as you have benefits available to cover the consultation and your allocated GP is Remedi’s appointed designated service provider.

2. At specialists

If you visit a specialist for the first time, they can ask you to pay for the first consultation upfront. When you have medical aid, you can send in this claim for reimbursement. Before you visit a specialist, take a look at the information your medical scheme has available about specialists they have a payment arrangement with. Also, find out what your specialist will charge and whether or not they have an arrangement with your medical scheme to give you full cover and the benefit of direct payment when you need to submit claims.
When you choose to see a specialist that is not part of a payment arrangement with your medical scheme, you may need to pay consultations upfront, pay a portion of the costs or submit these claims to your medical scheme yourself. Check with your medical scheme's call centre to find out what your options are. Don't be shy to discuss and agree on rates with your specialist. It can help you avoid extra costs and paperwork.

3. At pharmacies

Remedi Medical Aid Scheme has over 2 500 pharmacies in their direct service provider network (DSP) and as part of its contracted preferred suppliers. When you use pharmacies that your medical scheme has an arrangement with, you get your medicine at the most affordable price and it offers you additional value.

It's always worth finding out whether or not your medical scheme offers you this service or access to a network of pharmacies so you can save as much on your medicine spend as possible. Another savings tip is to ask your pharmacist about generic alternatives to branded medicine. Generic medicine cost less but are similar to the branded alternatives in their composition and how they work.