Frequently Asked Questions

Chronic medication benefits
 

How do chronic medication benefits work?

If you or any of your dependants suffer from the chronic conditions listed below and require chronic medication, you must register on the Chronic Medication Program. Your doctor must obtain authorisation from the Society before precribing chronic medication.

Once you have registered on the programme and the proper authorisation has been granted, the Society will pay 100% of the cost, on condition that you obtain your chronic medication from the DSP, in this case Chronicare, and subject to the limits as described in the benefit summary. If you do not register on the Chronic Medication Programme, or do not obtain your medication from the DSP, the cost of your chronic medication will be deducted from your acute medication benefits and you will be liable for the 30% co-payment of the acute benefit provided for.

Please note that homeopathic medication does not quality for chronic medication benefits.

What process must be followed before I can get my chronic medication?

From 1 January 2009, you must follow these two easy steps to have your chronic medication delivered to you:

1. As in the past, your doctor is still required to register you on the Society's chronic medication programme by calling 086 000 4747.
2. Once your doctor has received authorisation from the Society, fax or e-mail your prescription to 086 688 0070 or info@chronicare.co.za. Please note that you are a DBBS member, and provide your member, cellphone and telephone number.

Where can I get my chronic medication?

The dispensaries in Kimberley, Lime Acres and Cullinan will remain open and continue to offer the same services as before. This means that if you live near one of these dispensaries, you may continue to collect your chronic and acute medicine from them as in the past.

If collection is not possible, your chronic medicine will be delivered to you free of charge either via courier or to your nearest post office if you prefer this method. You will be notified via SMS by Chronicare when medicine is dispatched.

What chronic illnesses are covered?

Prescribed Minimum Benefit Conditions

In addition to the above chronic conditions, the Society will also cover the following:

Hospitalisation
 

What must I do if I require hospitalisation?

All admissions to hospital require pre-authorisation, which can be obtained by contacting the Society toll-free at 0800 111 669.

The Society has a preferred provider arrangement with a number of hospitals throughout South Africa. These hospitals are known as 'network hospitals'. If you have a procedure for which you have obtained pre-authorisation from the Society at a network hospital, you will not have to pay any additional charges from the hospital. (See the list of network hospitals here).

Please note that if you have a procedure for which you have obtained pre-authorisation from the Society at a non-network hospital, you may not receive the same level of benefit as you would have if you had used a network hospital.

The Society will settle the account directly and in full if the procedure is for a day admission, i.e. admitted and discharged on the same day. Should you have to stay overnight or longer, the Society will only settle the account at RPL rates and you will be liable for any difference.

Please remember that when you are in hospital, there are also other costs to consider apart from the actual hospitalisation, e.g. for specialists. It is your responsibility to check what the specialists' charges will be and what portion will be covered by the Society. If the service providers charge in excess of the RPL tariffs, the Society will apply the scheme rate to these claims only if the hospitalisation has been pre-authorised at a network hospital.

How can I minimise costs not covered by the Society should I need to have an operation?

If you are going to have an operation, find out beforehand who all the service providers will be and what they will charge (relative to the RPL rate). If necessary, negotiate with them for reduced rates.

Find out from your referring doctor or specialist what service providers (other than the network hospital) will be involved in your case, for example:

• the surgeon(s)
• the anaesthetist
• any doctors or specialists assisting the surgeon
• follow-up treatments in hospital, such as physiotherapy, pathology tests, x-rays, etc.

Ask the doctor/service providers what they will charge in comparison with the RPL tariffs. (You can also phone the Society on 053 807 3400 for information on RPL tariffs.) Try to negotiate with all your service providers to charge the RPL tariff if they quote a higher rate. If you are not successful, consider using an alternative specialist.

Emergencies
 

What happens if I need to be admitted to hospital in case of an emergency?

The Society will cover the hospital and specialist charges for emergency* hospital admissions at cost, provided that the Society is informed within 48 hours (or the next working day) following such an admission.

* Definition of emergency: The sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the patient's life in serious danger.

What if I need an ambulance in an emergency?

You and your registered dependants are covered in South Africa, Botswana, Namibia, Lesotho and Swaziland and have unlimited access to emergency medical transportation 24 hours a day, provided that this is authorised by ER24.

Services offered by ER24:

• 24-hour access to the ER24 Emergency Call Centre
• Dispatch of emergency response
• Emergency telephonic advice
• Information and advice hotline
• Medical transportation by ambulance or aircraft
• Authorised inter-hospital transfers

In addition to emergency transportation, you will also receive emergency medical advice and assistance. ER24's operators will guide you through a medical crisis situation, provide emergency advice and organise for you to receive the support you need - available at all times.

If you need emergency assistance, contact ER24 at:
0860 084 124 (South Africa)
+27 390 1601 (Botswana)
+27 11 847 4424 (Lesotho/Swaziland)
+27 61 230 505 (Namibia)

General
 

How much time do I have to claim?

Please submit your claims as soon as possible, but no later than four months from the date on which the service was rendered. In terms of the Medical Schemes Act, claims not submitted within four months will not be paid by the Society.

What do I do if I suspect that someone is defrauding the Benefit Society?'

Phone the Society's toll-free Fraud Line on 0800 204 724 or use the anonymous email facility.

All calls and emails will be treated confidentially and you will not have to disclose any personal details. Please give as much detail about the suspected instance of fraud as possible to allow the fraud team to do a proper investigation.

Can I belong to more than one medical scheme?

No. It is illegal to belong to more than one medical scheme at the same time.

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