4 Questions to ask yourself when choosing your plan

The Essential and Basic Plans provide cover for basic healthcare expenses, known as Prescribed Minimum Benefits (PMBs).

This means you receive cover for PMBs even if you have a restricted budget. You are required to use our Bankmed networks to ensure full cover.

On the Basic, Essential and Traditional Plans you must use Bankmed networks and follow defined processes to see a specialist. You must also use our medicine lists (formularies) for certain treatments and medication. Consider where you work and live before choosing a Plan that relies on you being restricted to networks.

You still benefit from using our networks on the Core Saver, Comprehensive or Plus Plans, but using networks are not a requirement for cover on these Plans. You still have to pay an amount upfront if you are admitted to a hospital that is not part of our network.

Day-to-day benefits are offered in two ways:

1. Medical Savings:

Allows you to decide how to use the funds set aside for day-to-day medical expenses.

The advantage is that you do not pay for benefits you do not use and you can carry over unused funds to the next year. You are in charge of your day-to-day medical spend.

2. Set day-to-day benefits:

Covers specific day-to-day medical expenses (for example, one visit to a network dentist a year covered from Insured Benefits).

The advantage is that you still have cover for different categories of medical expenses even if you have used up one category’s benefits. For example, if you have used up the benefits for GP consultations, you still have cover for blood tests.

All Bankmed Plans offer cover for chronic conditions that qualify as PMBs are on the Chronic Disease List. You have to register for the Chronic Illness Benefit to get cover for the medication, tests and treatment you need for your condition.

Chronic Disease List: All Plans

Addison’s disease, asthma, bipolar mood disorder, bronchiectasis, cardiac failure, cardiomyopathy, chronic obstructive pulmonary disease, chronic renal disease, coronary artery disease, Crohn’s disease, diabetes insipidus, diabetes mellitus types 1 and 2, dysrhythmias, epilepsy, glaucoma, haemophilia, hyperlipidaemia, hypertension, hypothyroidism, HIV and AIDS, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, schizophrenia, systemic lupus erythematosus and ulcerative colitis.

While higher Plans can offer additional cover for these chronic conditions, we pay for specific care (PMBs) for these conditions no matter which Plan you are on.

Chronic Disease List: Traditional, Comprehensive and Plus Plans

Acne, allergic rhinitis, ankylosing spondylitis, chronic anxiety disorder, atopic dermatitis (eczema), attention deficit disorder, cystic fibrosis, depression, gastro-oesophageal reflux disease, gout, motor neurone disease, osteoarthritis, osteoporosis, Paget’s disease, psoriasis and Meniere’s disease.

The Basic Plan covers treatment for Major Depression. The Comprehensive and Plus Plan, covers treatment for Alzheimer’s disease.