2017 Medical Aid Tariffs

Please be advised that the prices or increases are provided as a guideline

AECI Family Practitioner (FP) Network Scheme Rates for 2017

Note: The 6.3% increase in AECI FP tariff rates as well the below changes for participation Family Practitioners on the AECI Network.

The AECI FP Network reimbursement model for 2017 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 R342.20
Enhanced consultation fee for REPI2 category 1 FP Network Practices R102.70
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 34.20

Bestmed GP Tariffs for the Pulse1 option

Procedure
Code / Description / Tariff 2016
Dispensing / Scripting
0190 / New and established patient: Consultation/visit of new or establish patient of an average duration and/or complexity / 233.00
0191 / New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity / 233.00
0192 / New and established patient: Consultation/visit of new or established patient of a long duration and/or complexity / 233.00

Bonitas Family Practitioner Rates

The Bonitas FP Network reimbursement model for 2017 will continue to include an enhanced fee in accordance with your REPI2 category score as indicated below:

Family Practitioner Consultation Rates (0190 – 0192)
Bonitas FP network consultation Fee R338.20
Enhanced consultation fee for REPI2 category 1 FP Network Practices R 41.30
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 20.70

Fedsure Family Practitioner Rates

The Fedsure FP Network reimbursement model for 2017 will continue to include an enhanced fee in accordance with your REPI2 category score as indicated below:

Family Practitioner Consultation Rates (0190 – 0192)
Fedsure FP network consultation Fee R336.40
Enhanced consultation fee for REPI2 category 1 FP Network Practices R 33.60
Enhanced consultation fee for REPI2 category 2 FP Network Practices R 16.80

Medscheme administered schemes

Scheme / % Increase / Scheme / % Increase
Aeci Medical Aid Society / 6.3% / Nedgroup Medical Scheme / 6.0%
Barloworld Medical aid / 6.0% / Old Mutual Staff Medical Aid Fund / 5.8%
*Bonitas Medical Fund / 6.4% / Parmed Medical Aid Scheme / 5.3%
Fedhealth / 5.4% / SABC Medical Scheme / 6.0%
Horizon Medical Scheme / 7.1% / Samwumed / 6.0%
MBMed Medical Fund / 6.00% / Sasolmed Medical Aid Scheme / 6.0%

*The Bonitas scheme rate increase applies to network FP’s only: the Boncap FP Network scheme rate is 6.0%.

Medshield Family Practitioner Network

Practitioner / Codes / Fees
Scheme Rate (Non Network Practitioners) / 0190, 0191, 0192 / R316.00
Network Practitioner Fee / 0190,0191,0192 / R352.00 (316.00 = 36.00)
Network Enhanced Fee (Network Practitioner Fee + Enhanced network practitioner fee / 0190,0191,0192 / R26.00 (R352 + R26 = R378)
Health Risk Assessment / 07343 / R316.00

MomentumPrimary Care and Carecross GP Tariffs

Procedure
Code / Description / Tariff 2017
Dispensing / Scripting
0190 / New and established patient: Consultation/visit of new or establish patient of an average duration and/or complexity / R316.00
0191 / New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity / R316.00
0192 / New and established patient: Consultation/visit of new or established patient of a long duration and/or complexity / R316.00

ONECARE HEALTH GP Tariffs

Procedure
Code / Description / Tariff 2017
Dispensing / Scripting
0190 / New and established patient: Consultation/visit of new or establish patient of an average duration and/or complexity / R448.00 / R329.00
0191 / New and established patient: Consultation/visit of new or established patient of a moderately above average duration and/or complexity / R448.00 / R329.00
0192 / New and established patient: Consultation/visit of new or established patient of a long duration and/or complexity / R448.00 / R329.00
  • This fee includes the complete of a chronic application form.

Polmed

The GP tariff rate will increase by 6% for both Network and non-Network doctors for consultation codes, namely 0190, 0191 and 0192 which is R376.00 and R348.00 respectively.

All other GP procedure codes will increase by 6% for both Network and non-Network doctors.

Universal Networks.

GP Consultation Reimbursement Fees

Category / Description / 2017 fee (Incl Vat)
Category A / Dispensing doctors : Consultation fee including acute medication / 351.00
Category B / Non-Dispensing doctors : Consultation fee including acute medication dispensed by Universal Network Pharmacy / R351.00
Category C / Non-Dispensing doctors : consultation fee excluding acute medication (consultation only) / 243.00

Network Providers

2017 Procedures reimbursable over and above the Consultation Fee

Procedure
Code / Procedure
Description / Bestmed / Onecare / Universal
Network / Momentum
Network
0300 / Stitching of a wound / 169.90 / 176.85 / 387.00 / 347.55
0301 / Stitching of an additional wound / 84.80 / 88.43 / 81.00 / 77.70
0307 / Excision and Repair by direct suture / 327.30 / 341.08 / 483.00 / 463.05
0255 / Drainage of a subcutaneous abscess and avulsion of a nail / 242.30 / 252.65 / 282.00
0887 / Limb Cast / 357.80 / 164.23 / 427.00 / 386.40
0259 / Removal of a foreign body superficial to facia / 533.10 / 252.65 / 404.00 / 386.40
1232 / Electrocardiogram : without effort / 113.70 / 112.00 / 140.00
1233 / Electrocardiogram : With and without effort / 165.00 / 164.23 / 189.00
2133 / Circumcision : Clamp procedure / 513.10 / 534.36 / 578.55