“DSP’s, PMB’s, dude what are you going on about?”. I’m actually talking about your medical aid plan and not some new psychedelic drugs kids are popping in nightclubs.You see your medical scheme is legally obliged to pick up the cost of certain procedures called Prescribed Minimum Benefits (PMB’s) in full regardless of which medical aid plan type you are on. That’s the good news. But…There always is a but right?
“DSP” stands for Designated Service Provider. Why you should be familiar with the term is because if you want the diagnosis, treatment or care of your PMB condition paid for in full you’ve got to use your medical schemes preferred service provider. A DSP could include a hospital, pharmacy or even a GP.
“So Why Is That Exactly?”
Simple really. When legislation in South Africa forced medical schemes to start paying for certain procedures in full, they needed to give them certain allowances. So the conversation went something like this.
“As a scheme you will pay for these particular procedures in full but we understand you need to control costs so we will allow you to make it compulsory for your members to use designated service providers or else you can charge them a co-payment on the PMB’s”
So that’s exactly what the situation is. If you fail to you the DSP selected by your medical scheme they can charge you a co-payment. And the co-payment going to either be a % of the bill or the difference between what the DSP tariff is and what your provider charged you.
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Until next time.
The InsuranceFundi Team