HOT TIPS for understanding your healthcare option

Medical Savings Accounts (MSA)

Our Millennium and Millennium Select options are the only new generation options that Resolution Health Medical Scheme offers where an allocated amount is set aside in a Medical Savings Account (MSA) for the member to use on the healthcare services of their choice. When these savings are all used up, the member then has to pay for services that would have been paid for out of the MSA out of their own pocket up until a certain limit, called a Self-Payment Gap. Once this gap has been reached, the member is once again covered from their Above Threshold Benefit (ATB) up to an annual limit.

 

Traditional vs. New Generation options

A new generation option is one which operates with a Medical Savings Account (MSA) which the member manages and allocates as desired for day to day and out-of-hospital healthcare services. Any funds left over in the MSA are carried over to the next year. A traditional option, on the other hand, has allocated amounts for each healthcare service which the member can utilise up to an annual limit. It is important to understand that a traditional option does not accumulate funds from year to year like a MSA does and if a member does not use a specific benefit for several years they will still only have the annual allocated amount available for that benefit should they need it.

 

Overall Annual Limit (OAL) and sub-limits

An OAL is the total annual amount that a member can use for a group of services. An example would be day-to-day cover where an OAL may be applied for all forms of care under that category of benefits. A sub-limit indicates that there is a limit to how much of the OAL can be used on a specific benefit. For example, an OAL of R4 000 may be set for day-to-day cover, where a sub-limit of R2 000 is set for GP visits.

 

Stale claims

As per the Scheme rules and general industry practice, you have 4 months in which to submit your claim to us before it is deemed stale and we will no longer be able to process it. It is therefore very important to not leave the submission of claims up to your service provider and we strongly recommend that you follow up with them and us to make sure that the claim has been submitted and received timeously for any medical treatment you undergo.

 

Pre-authorisation

In the case where you are having a planned procedure, it’s very important to obtain pre-authorisation at least 14 days in advance. This is because we may need additional information such as x-rays, scans or motivations in order to give your procedure the funding go-ahead. It is also important to remember that there may be certain procedures that are not covered on your option or which have restrictions, such as only covered if done in the consulting rooms. Be sure to find out about what your cover entails when you make your annual option selection each year.