General

- How much time do I have to claim a benefit?

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 considered for payment 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 on www.dbbs.co.za (under Fraud).

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 assist in the 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.

- How can I ensure that my GP and other health-care service providers are paid timeously?

In the interests of efficiency and reducing the risk of fraud, the Society’s policy is to pay all service providers only via electronic funds transfer (EFT) and claims are processed and paid within a maximum period of 14 days of receipt. In view of this, members are encouraged to advise their service providers accordingly and to ensure that the Society is provided with their banking details to ensure that they receive their payments timeously.

- How can I avoid co-payments for after-hours/unscheduled doctor’s consultations?

Please note that any after-hours and any unscheduled doctor’s consultations (which are not emergencies) will only qualify for a benefit at the normal doctor’s consultation (tariff 0190) SRPL rates . Any additional charges will not be settled by the Society and the member will need to pay the provider directly. For example, if you voluntarily choose to visit the doctor after hours, you will pay the difference between the normal SRPL consultation rate and the after-hour consultation fee. Remember to check with the receptionist when an “after-hours or unscheduled visit” fee will be charged.

Most doctors (including facilities such as Medi-Cross) charge an after-hours consultation fee for consultations conducted after normal working hours and during week-ends. Also note that, if you phone your doctor during normal working hours and he/she fits you in on that specific day without an official pre-booked appointment, you will be charged for an unscheduled consultation. You will be liable for the standard 10% co-payment of the normal consultation fee plus the additional amount charged by the doctor.

Doctor’s house calls or and consultations at, for example, frail care centres will be paid at normal consultation rates unless clinically assessed to be medical emergencies.