Your cover for designated service providers (DSPs) and providers who are not DSPs

How we cover you when you use designated service providers

At Remedi Medical Aid Scheme, we aim to bring you comprehensive healthcare cover. One of the ways we do this is through our designated service providers (DSPs).

What a designated services provider is

A DSP is a healthcare provider or facility that is contracted with Remedi. These providers are carefully selected and they must meet our standards to remain DSPs on our Scheme. So, you can always be assured that these providers will provide you with the best treatment.

Why you should use a DSP

We encourage you to use our DSP network as much as possible. Not only does this assure you that you're getting quality healthcare services, you also won't have any co-payments or deductibles (amounts you must pay yourself).

Using DSPs is particularly important for covering your Prescribed Minimum Benefit (PMB) conditions and treatment in full.

What are Prescribed Minimum Benefits?

By law, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:

• An emergency medical condition (see the section below for what is considered an emergency medical condition).
• A list of 271 diagnoses.
• A list of 27 chronic conditions.

These are called Prescribed Minimum Benefits and these will be covered if:

• Your medical condition qualifies for cover and is part of the defined lists of PMB conditions.
• The treatment for your condition matches the treatment outlined in the defined benefits.

You must use DSPs in our PMB hospital (Mediclinic) as well as GP, Specialist and Mental Health Networks. This doesn't apply in the case of a medical emergency, but we might request that you are transferred to a Mediclinic hospital or other service provider in our network once you have been stabilised.

Please note: If you do not use a DSP, we may (depending on your chosen benefit option) pay up to 100% of the Scheme Rate or a reduced Scheme Rate for any PMB claim. This means that you will be responsible for the difference between what we pay and what the provider charged for the treatment.

Defining emergency medical conditions

An emergency medical condition is the sudden and, at the time, unexpected onset of a health condition that requires immediate medical and surgical treatment, where if you don't receive the treatment would result in serious impairment to bodily functions, or serious dysfunction of a bodily organ, or part, or would place your life in serious jeopardy.

An emergency does not necessarily require a hospital admission. We may ask you for additional information to confirm the emergency.

Very important

In case of emergency, you can go to any hospital and we cover you at cost for the first 24 hours or until you're stabilised. If you need further hospital treatment, you may be moved to a network hospital. If you choose to not be transferred, if required to be moved to a network hospital, you will be responsible for paying the remainder of the hospital account.

Get more information

• Find a DSP in your area on our website or call us at 0860 116 116.
• Please visit www.yourremedi.co.za. Once logged in, follow this path: Find a document > Benefit Guides to get more information of how we fund your DSP and non-DSP claims.