Plan information
Summary of the benefits available on the Anglovaal Group Medical Scheme
The Hospital Benefit
The Hospital Benefit covers you if you are admitted to hospital and the Scheme has confirmed your admission and treatment.
More information on your Hospital Benefit
The Insured Procedures Benefit
The Insured Procedures Benefit (IPB) covers a number of (mainly) outpatient procedures or items, such as audiology including hearing instruments, ambulance services (when you are not admitted to hospital) and external appliances including artificial limbs and medical apparatus, such as glucometers. Each item has a limit to its cover. These limits apply to your family and they apply every year.
More information on your Insured Procedures Benefit
Cover for chronic conditions
You are also covered for medicine for chronic conditions:
The Chronic Illness Benefit is a benefit that covers medicine for a specified list of chronic conditions.
Although a condition may be defined as chronic, we may not be able to cover it from the Chronic Illness Benefit.
You are covered for approved medicine and treatment for a defined list of chronic conditions including HIV and AIDS.
More information on medicine and chronic conditions
The Medical Savings Account
We pay for your day-to-day medical expenses
The Medical Savings Account is an amount that we give you at the beginning of the year to pay for day-to-day medical costs, like doctor visits, x-rays and dentist visits.
The full amount is available to you at the beginning of the year. You pay towards it as part of your monthly contribution to the Medical Scheme. By the end of the year, you will have paid the full amount back to your Medical Savings Account.
We pay your day-to-day expenses from the available money in your Medical Savings Account. For certain items and conditions we pay from the Insured Procedures Benefit (see above) up to the limit, and then from your Medical Savings Account, if there are funds available.
More information on your Medical Savings Account
Important tips when claiming
You can follow these steps when claiming from the Scheme:
- Send your claims within four months, otherwise we will consider them expired and not pay them
- When sending claims, please make sure the following details are clear:
- Your membership number
- The service date
- Your doctor’s details and practice number
- The amounts charged
- The relevant consultation, procedure or NAPPI code and diagnostic (ICD-10) codes
- The name and date of birth of the patient
- If paid, attach your receipt or make sure the claim says ‘paid’
- Remember to always keep copies of your claims for your records
- To see the status of your claim, you can log in and go to the Claimstracker