2016 Medical Aid Tariffs
Please be advised that the prices or increases are provided as a guideline and are not updated by the Medprax data.
Carecross GP Tariffs
ProcedureCode / Description / Tariff 2016
Dispensing / Scripting
0190 / New and established patient: Consultation/visit of new or establish patient of an average duration and/or complexity / R298.00
0191 / New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity / R298.00
0192 / New and established patient: Consultation/visit of new or established patient of a long duration and/or complexity / R298.00
- This fee includes the complete of a chronic application form.
ONECARE HEALTH GP Tariffs
ProcedureCode / Description / Tariff 2016
Dispensing / Scripting
0190 / New and established patient: Consultation/visit of new or establish patient of an average duration and/or complexity / R423.00 / R311.00
0191 / New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity / R423.00 / R311.00
0192 / New and established patient: Consultation/visit of new or established patient of a long duration and/or complexity / R423.00 / R311.00
- This fee includes the complete of a chronic application form.
Liberty Medical Scheme
The current LMS (Liberty Medical Scheme) rate has increased by 6% for all practices with whom the Scheme does not have a direct tariff negotiation agreement in place.
Bankmed
General Practitioner (GP) Tariff Increase
Provider Fee and Reimbursement StructureScheme plans / Non-contracted practitioner Scheme Rate / Bankmed contracted practitioner
IPA affiliated / Non-IPA affiliated
Core Saver, Traditional, Comprehensive and Plus / R323.40 / R383.04 / R352.28
Post-hospital GP Consultation
Within 30 days of discharge from hospital (excluding day cases)
Scheme plans / Non-contracted practitioner Scheme Rate / Bankmed contracted practitioner
IPA affiliated / Non-IPA affiliated
Core Saver, Traditional, Comprehensive and Plus / R323.40 / R383.04 / R352.28
Higher remuneration for value added consultations
Scheme plans / Non-contracted practitioner Scheme Rate / Bankmed contracted practitioner
IPA affiliated / Non-IPA affiliated
Completion of Personal Health
Assesment (PHA) / No / R226.91 / R226.91
HIV Counselling and Testing
(HCT) / No / R266.39 / R266.39
Pap Smear / No / R393.75 / R373.75
Fedhealth Family Practitioner (FP) Network Rates for 2016
The Fedhealth FP Network reimbursement model for 2016 will continue to include an enhanced fee in accordance with your REPI2 category score as indicated below:
Family Practitioner Consultation Rates (0190 – 0192)Fedhealth FP network consultation Fee R319.20
Enhanced consultation fee for REPI2 category 1 FP Network Practices R 31.90
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 16.00
2016 Tariff Increases for Schemes administered by Metropolitan Health Risk Management
Scheme / Tariff increase for 2016BP Medical aid Society / 6%
Engen Medical Benefit Fund / 6%
Fishing Industry Medical Scheme (Fishmed) / 6%
Golden Arrow Employees Medical Benefit Fund / 6%
Imperialmed / 6.1%
Medipos / 6%
Metropolitan Medical Scheme / 6%
MotoHealth Care / 6%
PG Group Medical Scheme / 5.5%
Pick n Pay Medical Scheme / 6%
South African Breweries Medical aid / 6%
Transmed / 5.5%
Wooltru Healthcare Fund / 5.4%
AECI Family Practitioner (FP) Network Scheme Rates for 2016
The AECI FP Network reimbursement model for 2016 will continue to include an enhanced fee in accordance with your REPI2 category score
Family Practitioner Consultation Rates (0190 – 0192)AECI FP network consultation Fee R321.90
Enhanced consultation fee for REPI2 category 1 FP Network Practices R 96.60
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 32.20
MedihelpNecesse – 3 reimbursement categories for out of hospital consultations
Prescribing Doctors / Dispensing DoctorsIPA PROVIDER / NON-IPA PROVIDER / IPA PROVIDER / NON IPA PROVIDER
CAT 1 / R283.00 / R249.00 / R367.00 / R333.00
CAT 2 / R254.00 / R243.00 / R339.00 / R322.00
CAT 3 / R226.00 / R220.00 / R333.00 / R316.00
NBCRFLI and Affinity Health – General Dispensing Practitioner Rates
Codes / In Rooms Procedures / 2016 Rates0910 / Consultation/visit of new or established patient / R297
0191 / Consultation/visit of new or established patient / R297
0192 / Consultation/visit of new or established patient / R297
0197 / Licenced dispensing medical practitioners / R297
EEBS – General Dispensing Practitioner Rates
Codes / In Rooms Procedures / 2016 Rates0910 / Consultation/visit of new or established patient / R300
0191 / Consultation/visit of new or established patient / R300
0192 / Consultation/visit of new or established patient / R300
0197 / Licenced dispensing medical practitioners / R300
Transmed Private Network Plan
Tariff Item / Reimbursement Model / 2016 Reimbursement Rate
GP consultation : Metropolitan Network / 103% of Scheme Rate / R325
GP consultation : Metropolitan Non-Network / Scheme Rate / R315.90
Transmed Medical Fund – Private Network Plan
BP Medical Aid Society
BP Medical Aid SocietyTariff Item / Reimbursement Model / 2016 Reimbursement Rate
GP consultation : Metropolitan Network - IPA / 110% of Scheme Rate / R367.82
GP consultation : Metropolitan Network – non IPA / 105% of Scheme Rate / R349.80
GP consultation : non-network / 80% of Scheme Rate / R267.12
Imperialmed
ImperialmedMedical Aid SocietyTariff Item / Reimbursement Model / Budget Option
2016 / Scheme
Pmt to GP / Member
Pmt to Gp
GP consultation : Metropolitan Network - IPA / 110% of Scheme Rate / R358.20 / R309.36 / R48.84
GP consultation : Metropolitan Network – non IPA / 105% of Scheme Rate / R341.90 / R293.06 / R48.84
GP consultation : non-network / Scheme Rate / R325.60 / R276.76 / R48.84
Gems
The following fees will be applicable to REO network doctors 2016
Family Practitioner Consultation Rates (0190 – 0192)GEMS REO FP network consultation Fee (Scheme Rate) R326.70
Enhanced consultation fee for REPI2 category 1 FP Network Practices R 46.60
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 21.10