After a lengthy application process, we are pleased to announce that the Council for Medical Schemes (CMS) has approved and registered the Scheme Rules with effect from 1 January 2021. Some of the changes that were approved, were not shared with members during the year-end information sessions and/or communication. We have summarised only those changes as follows:
Previously members were required (according to the Rules) to return old membership cards to the Scheme. We have now changed the rules to state that members are allowed to discard old membership cards and no longer need to return them. (Rule 10.2)
Beat 3 and Beat 3 network
Co-payment on specialised diagnostic imaging received while hospitalised.
This co-payment has been removed. (Rule 1.2.13)
Palliative care and home-based care in lieu of hospitalisation across all benefit options
It was previously communicated to members that the above-mentioned benefit is subject to specific sub-limits (set per option) and was restricted to services rendered by DSPs only. These limitations have now been removed. No sub-limit will apply and members are not required to make use of DSPs, but the service should still be pre-authorised by the Scheme.
(Rules 1.2.21 on the Beat range, 2.2.22 on the Pace range and 3.2.22 on the Pulse range.)
Back and neck rehabilitation programme
Rule 1.4.6 on the Beat range, 2.4.6 on the Pace range and 3.4.7 on the Pulse range have been rewritten to address the misunderstandings concerning the programme, and when it will be approved and paid by the Scheme as part of preventative benefits. The emphasis is on the fact that it will only be paid from scheme benefits if it is approved in lieu of surgery. In all other cases, the cost will be paid from available benefits as per the member’s chosen option.
Haematinics on the Pulse 1 option will be funded as part of the Minimum Prescribed Benefits.
The updated CMS-approved Rules are attached for your ease of reference, and can also be found on the Bestmed website under Scheme Rules 2021.