Be Network-savvy. Find a Specialist in Your Network

No-one likes unexpected costs and extra admin if they can help it. This is especially true when it comes to your healthcare. You expect a lot from your healthcare provider, the best cover, the best value and the easiest way to get the care you need.

Your choice of cover can mean you need to use networks

Having a Benefit Plan 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 Plan 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 will be more convenient, and by tapping into network arrangements, you can cut down on unexpected co-payments/deductibles. So, not only would 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.

There are so many more benefits offered by both the TFG Health and TFG Health Plus Benefit Plans. Although TFG Health and TFG Health Plus offer amazing benefits, there is a difference in the benefits offered by these Benefit Plans

Here are just a few added benefits the TFG Health Plus Benefit Plan offers:

TFG Health members are covered up to a maximum of 100% of the TFG Health Direct Payment Arrangement Rate at KeyCare Network providers. For members who see specialists who work within the Network Hospitals, up to a maximum of 100% of the Scheme Rate is covered. Members must be referred by a chosen pre-selected KeyCare GP in the KeyCare GP Network. Members on this Benefit Plan must make use of providers in a Network to receive cover in full.

With regard to members who are registered on the TFG Health Plus Benefit Plan, members can visit with any GP or specialist of their choice, as well as obtain services in any hospital, however, they will need to ascertain whether the specialist or services are contracted with the Scheme at 100% of Scheme Rate or not. Specialists are covered at 100% of the Scheme Rate where the member visit with a specialist who has entered into a designated service provider arrangement with the Scheme. Specialists who are not contracted with the Scheme may attract a 20% deductible. If the Service Provider charges above the Scheme Rate, you must pay the balance of the account.

For members registered on TFG Health Plus, radiology and pathology are covered up to 80% of the Scheme Rate for radiology and 100% of Scheme Rate for pathology. Psychiatry and clinical psychology, which are covered up to 80% of Scheme Rate at providers who are not contracted with the Scheme and 100% of the Scheme Rate where they have entered into a contract with the Scheme. Members are covered at 100% of the Scheme Medicine Rate for acute medicine at pharmacies the Scheme has contracted with. If members need medical appliances, 80% of the cost is covered. There are still many more benefits included in TFG Health Plus, and you can obtain more information and detail on our website, www.tfgmedicalaidscheme.co.za.