To Pay Or Not To Pay?

Everything You Need to Know About Co-payments

You have your medical aid card tucked away in your wallet and you’re ready to take on the world no matter what. But, when it comes to payments, do you understand when you need to make a co-payment and when are you fully covered by your Bestmed benefits?

Here’s what you need to know:

Mediscor References Prices (MRP)

The Mediscor Reference Price (MRP) is the maximum price a medical scheme provider will pay for a certain treatment. Bestmed uses this MRP to set the generic reference price for its medicine. The MRP is applicable to all medicine claims including formulary and non-formulary, chronic, over-the-counter and acute medicines.

What is a formulary?

A medicine formulary is a list of medicines, both generic and brand name, which is compiled and maintained by a committee of independent practicing physicians and pharmacists. The list takes into account the cost effectiveness and affordability of the medicine which is available for treatment.

Who benefits from the formulary?

As a Bestmed member you have access to treatment for a defined list of chronic medical conditions which are available on the following benefit options:

  • Chronic Disease List (CDL) conditions – available on all benefit options.
  • Prescribed Minimum Benefit (PMB) conditions – available on all benefit options.
  • Additional Chronic (non-CDL) conditions – available on selected benefit options only.

Find a detailed list of the conditions that we cover here.

What is a co-payment?

When you choose a medicine that is not on the formulary or that costs more than the MRP it means you may have to pay the difference between the price of your preferred medicine and that of the MRP – this is called a co-payment.

If the pharmacy where you are getting your medicine from is not on our Designated Service Provider list you might also have to make a co-payment as they will charge a higher dispensing fee than what we reimburse.

How much can I expect to pay?

How much your co-payment is depends on your specific circumstances: which medication you’ve opted for, which hospital you are going to and the specialist you’re using. Your co-payments, and the percentage you’re responsible for, will also depend on the benefit option you are on.

How to avoid making co-payments:

  • Use formulary listed medicines.
  • Use generic medicines with prices which fall within the MRP.
  • Use a Designated Service Provider who doesn’t charge a higher dispensing fee.

At Bestmed we provide a range of affordable medical aid membership options with several unique core benefits which will suit your pocket best. See which one will suit your lifestyle best.

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