Primary Care Consultation Benefit

Modified on Tue, 16 Nov 2021 at 08:22 AM

The cover provide Gap Cover portion; the difference between the medical scheme rate and the provider rate of the consultation fee charged up to the maximum payable percentage or OAL, whichever is lesser. This benefit is dependant on the benefit design of your medical scheme option: hospital plan, savings plan, and/or traditional medical scheme option.



Options

Ultimate Gap | Corporate Comprehensive

 Plus Gap | Gap Assist | Gap Lite | Gap Only | Exact Cover | Exact with Gap and Copay | Corporate Base


Benefit description:

This benefit provides cover for the difference between what a primary provider charges for a consultation and what your Scheme pays. This includes GP consultations, dental consultations and  alternative therapist consultations.


Alternative therapist consultations include chiropractors, physiotherapists, biokineticists, occupational therapists, homeopathy, and Audiologists - recognised and paid for by your medical aid.


Important points to consider:

  • This benefit only covers costs related to the consultation and not any scans or tests done during the consultation.
  • Tariff codes covered are 0190, 0191 and 0192.


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