Do I have a Casualty Benefit on the TFG Health Benefit Plan?

You can visit a casualty unit at a Scheme network hospital to access your casualty benefits, even if your chosen GPs are not available and you have used your out-of-area network visits. You must get pre-authorisation and pay the first R355 of the casualty account upfront to the casualty unit, for each person for each event. We will pay the balance of the casualty unit account from your Hospital Benefit up to a maximum of 100% of the Scheme Rate.

What does the Casualty Benefit covers?

The following is covered from your casualty benefit where authorised:

• The GP consultation at the Scheme Rate
• Certain blood tests and basic X-rays
• Material used for your casualty treatment

If you must see a specialist in casualty, the GP-to-specialist referral process must be followed before we will pay claims from the Specialist Benefit (subject to the yearly specialist benefit limit).

In an emergency where you or your dependant must be admitted to hospital, the casualty unit must pay the R355 back to you if you have already paid it.

Visit your allocated GP for your follow-up visit, instead of paying another R355 for a follow-up visit at the casualty.

How do I find a network hospital?

You can use the Find a healthcare professional tool on www.tfgmedicalaidscheme.co.za or on the Discovery app to find a hospital in your area that offers full cover. Alternatively you can call us on 0860 123 077.

What does my Chronic Illness Benefit (CIB) cover on TFG Health?

You get cover for the 26 chronic conditions on the Prescribe Minimum Benefit (PMB) list of chronic conditions. We will pay your approved medicine in full if it is on our medicine list. We will not pay for your medication if you choose to use medicine not on the medicine list. Your GP can ask us to review approval of the medicine that is not on the list if they have clinical proof why they cannot prescribe medicine on the list.

You must get your approved chronic medicine from one of our network pharmacies or from your chosen KeyCare GP (if they are a dispensing GP). If you get your medicine from any other pharmacy, you will have a 20% deduction.

You can find the list of chronic medicines on our website www.tfgmedicalaidscheme.co.za. Once you have logged in, click on TFGMAS and then on Medicine.