We answer some common questions

What are Prescribed Minimum Benefits (PMBs)?

The Medical Schemes Act sets out a list of medical conditions that all medical schemes have to cover. We call this list Prescribed Minimum Benefits. As a member of TFG Medical Aid Scheme, you have cover for the diagnosis and treatment of conditions on the list of Prescribed Minimum Benefits.

Prescribed Minimum Benefits include:

• Any life-threatening emergency medical condition
• A defined set of 270 conditions
• 27 chronic conditions.

What is a network provider and why should I use one?

We negotiate rates with healthcare providers on your behalf and make sure that the providers follow certain rules. We call healthcare providers we have a payment agreement with designated service providers (DSPs) or network providers.

When you visit a network provider, we pay their claims in full from your available day-to-day benefits. We cover the costs of diagnosing and treating Prescribed Minimum Benefit conditions in full if you visit a network provider. If you use a non-network provider, you have to pay the difference between what we pay and what they charge yourself.

To find a network provider, log in to www.tfgmedicalaidscheme.co.za and click on Find a healthcare provider.

What do you mean when you say you pay at the Scheme Rate?

We use “Scheme Rate” as an umbrella term for all the rates we’ve negotiated with network providers. For example, if we say we pay for a visit to the GP at the Scheme Rate, we pay the GP at the rate we’ve negotiated for GP consultations.

What is the Scheme Rate?

This is the amount we pay for medicine and the fee for dispensing it. Try to use a pharmacy in our network so you don’t have to pay part of the cost of medicine yourself.

How can I get hold of you?

Ambulance and other emergency services: 0860 999 911
General enquiries, oncology, HIV care programme: 0860 123 077
Preauthorisations: 0860 123 077