Frequently Asked Questions |
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Why can my adult dependant who is working not remain on Minemed Medical Scheme?
Minemed is a restricted membership scheme for Harmony employees and their dependants who are immediate family, only. If your child or adult dependant (other than your wife) is working and earns more than the monthly social pension, they may not belong to Minemed Medical Scheme. It is very important to note that should your child require healthcare and it is discovered that he/she is employed and earning more than the social pension, Minemed will NOT cover the costs of their medical expenses. |
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What about my ex-spouse?
Your ex-spouse is no longer your immediate family, and therefore may not belong to Minemed Medical Scheme, even if your divorce contract stipulates that you are responsible for his/her medical aid, you will need to pay for him/her to belong to a commercial medical scheme. |
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Why do I have to pay a contribution penalty for my wife?
If your spouse is over the age of 35 years, and has not been on a medical scheme without a break in cover since April 2001, a Late Joiner Penalty will be imposed. All medical schemes apply Late Joiner Penalties. The percentage penalty is calculated by taking his/her age, less 35, less number of years on medical scheme/s, and then the following table is applied:
1 - 4 years without cover = 5% penalty
5 - 14 years without cover = 25% penalty
15 - 24 years without cover = 50% penalty
25 + years without cover = 75% penalty
REMEMBER : THIS PENALTY IS UNFORTUNATELY FOR LIFE!
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Do I need to obtain authorization in the case of an emergency?
Although authorization is not required immediately in the case of an emergency, MINEMED must be notified on the first business day after admission to hospital to avoid you becoming responsible for the penalty or the claim being rejected, should MINEMED consider the admission to have been medically unnecessary. |
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Who do I phone to get authorization?
* For Hospitalisation, Prosthesis or Specialised Radiology : phone
either (041) 395 4481 or the share-call number : 0860434003.
* For Specialist Authorisation : Contact your closest medical centre
or phone the share-call number : 0860434003.
* For Chronic Medication Authorsiation : Phone (041) 395 4482 or
the share-call number : 0860434003.
* For Ambulance/Emergency Services: ER24 on 084 124
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Why must my pathology tests be sent to Lancet/Pathcare/Voigt and Partners only?
Minemed has negotiated a very good arrangement with Lancet/Pathcare/Voigt and Partners which means that they are paid a small capitation fee each month per member, and they then take the risk for all pathology claims. This means that our members on the Essential Option can get an unlimited pathology benefit.
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Does Minemed provide medical insurance if I travel overseas?
If you are travelling outside the borders of S.A., emergency medical cover is available at no extra cost through ER24. Please phone 084124 approximately 7 days before you travel to arrange for a certificate to be emailed, mailed or faxed to you confirming your cover.
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Why does Minemed not pay my specialist account in full?
Minemed covers medical expenses at National Reference Price List (NHRPL). This is a recommended price list published by the Department of Health. Providers can however charge up to 400% more than NHRPL (which means that you will be liable for the difference). By obtaining pre-authorisation before visiting a specialist, you will be directed to a specialist who charges NHRPL, so that you do not end up having to pay the balance from your own pocket.
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The benefit schedule says that no co-payments apply, yet when I get my medication from the pharmacy, he always charges me a co-payment?
Certain pharmacies charge additional administration and professional fees, or dispense medication that is not on the formulary. The member will then be liable for the difference. Visit your closest medical centre, or phone the share-call number to find a pharmacy near by who does not charge extra administration fees, or negotiate with your pharmacist.
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