Healthcare professionals

Anglovaal Group Medical Scheme believes that members and doctors should be free to choose the rate of payment for medical services. When billed using the Scheme Rate, Anglovaal repays claims directly to the healthcare professional. The member gets direct payment for claims billed higher than the Scheme Rate. You can then settle the claim with the doctor.

We constantly engage with the relevant representative bodies to look at ways of enhancing professional relationships to the benefit of both parties. We look to do this without compromising our fundamental principles.

The healthcare funding industry needs to carefully balance the needs of all the key role players – namely healthcare professionals, members and the scheme.

The Scheme participates in the Discovery Health GP and Premier Rate Specialist Direct Payment Arrangements. You can benefit by using healthcare professionals participating in the payment arrangements because the Scheme will cover their approved procedures in full (within the available limits of your relevant benefits). These providers will not charge you for services provided and claims will be paid directly to the providers, which will be convenient for you. 

Healthcare professionals who participate in the payment arrangements are also the Designated Service Providers (“DSP”) for Prescribed Minimum Benefits and payment will be made as stated. However, if you choose not to use the DSPs, the Scheme will continue to cover the cost of your treatment by such practitioners at up to 100% of the Scheme Rate.

Click here for your In-hospital guide.

Click here for you Out-of-hospital guide.