Frequently asked Questions about Medshield medical aid hospital plans.

Are you thinking about getting a medical aid plan? If Medshield medical aid hospital plans are who you’re looking at, then here are some answers to your FAQ’s.

Medshield medical aid Hospital plans and How to reduce Medical costs

Medshield medical aid hospital plansEnsure you only use the service of providers affiliated with the Scheme. Also, discuss cheaper generic options with your doctor or chemist.

Always use the services of a GP as opposed to a specialist. When doctors prescribe treatment, verify the relevance and consider what benefits you have available and if there are cheaper options.

For afternoon or evening procedures, ensure you book in after 12 pm. This way the scheme is only liable for half day rates, not a full day.

How to access your Medshield medical aid Hospital plans benefits

Get value-added benefits through the Managed Healthcare Programmes and Partnerships. Read the Member Guide and be aware of the extras available for your option. You can also phone the Medshield Contact Centre on 086 000 2120/+27 10 597 4701 for more info.

Find out the hospitals linked to the Medshield network and ensure you get hospital pre-authorisation 72 hours before admission. In an emergency, confirm the authorisation by the first working day after the admission.

What is hospital Pre-authorisation?

It is an application to the Scheme before admission to ensure the treatment is approved. It will confirm the entry meets with protocols and guidelines and is the correct procedure.

Why is it Important?

It is a control measure to ensure your insurance covers the procedure. Any extra days or other procedures will again need approval beforehand to ensure payment.

How do I obtain approval for admission?

The member can either SMS or telephone.

Why do They decline some Admissions?

There is no approval if the process does not form part of a Medshield plan. Some procedure will not qualify for in-hospital benefits funds but will fall under out-of-hospital benefits. Also, some procedures may not be required at that time.

What is the Medshield medical aid Hospital plans Network?

The network is a group of hospitals throughout the country with which Medshield have a formal agreement to use their services for their members at an agreed tariff.

These agreements have enabled Medshield to negotiate cost effective tariffs.

What if there is no Medshield network Where I live?

The scheme will consider the following exceptions. In the case of an emergency admission, the member can use any hospital. When possible, the member must transfer to a network hospital.

If no network partner hospital is available within a 30km radius of a patient, a Medshield Case Manager will deal with the situation and assist the member in getting the necessary care.