Issue link: https://www.hub.camaf.co.za/i/1512927
2024 ALLIANCE PLUS & ALLIANCE NETWORK 13 2024 ALLIANCE PLUS & ALLIANCE NETWORK Do I need to have my medical or surgical appliance prescribed by a medical practitioner or can I just purchase it? You may not just purchase the appliance - it must be prescribed by a medical practitioner, whether you purchase the appliance from a pharmacy, Orthotist or Prosthetist. For details of monetary limits consult the Benefit Brochure. What happens to unused benefits at year end - other than MSA? Benefits run from January to December of each year. Any unused "risk" benefits are forfeited at year end and new benefits are allocated on 1st January each year. If I have not incurred any claims is there a possibility of a "no claims bonus" or any kind of refund? No - unlike the short term insurance industry, where this practice is common, medical schemes are governed by the Medical Schemes Act which does not allow this practice. As all medical schemes are "not for profit" organisations, all money in excess of the annual budget remains in the reserves of the scheme and is used for the benefits of members in paying claims. REQUIRED REFERRALS FOR ALLIANCE NETWORK What must I do to see a specialist? You must be referred by your nominated network GP. Please ensure that your referring GP name and practice number appear on the specialist account or it will be rejected. Do I need to obtain another GP referral for subsequent or follow-up visit(s) to the same specialist for the same condition? No, you only need to obtain a nominated network GP referral to see a specialist for the first visit. For any subsequent or follow-up visits relating to the same condition, the specialist claim should simply reflect the initial referral GP name and practice number. What is the time limitation for a referral? There is no time limitation for a referral if you are treated for the same condition. If your condition requires extended treatment with repeat or follow-up visits, your initial referral will remain valid throughout your treatment period. What if my treatment extends to the next benefit year? The referral from your nominated network GP can be carried over from one benefit year to the next, if the same condition requires extended treatment with repeat or follow-up visits. Please check that your nominated network GP is still on the network for the new year. What if I visit the same specialist for a new condition? You must obtain a new referral from your nominated network GP for other visits to the same specialist for treatment of a new condition. How often do I need to obtain a referral to a gynaecologist when I'm pregnant? You only need to obtain a referral to see a gynaecologist for the first visit. For any subsequent follow-up visits to the same gynaecologist relating to that pregnancy, the claim must simply reflect the initial referral GP name and practice number. What if I decide to change my gynaecologist during my pregnancy? Your claim for your new gynaecologist must have your nominated GP referral. What other referrals are required for Alliance Network members? • Out of hospital radiology and pathology - by a specialist or a nominated network GP. • Supplementar/auxiliary health practitioners like physiotherapists, occupational therapists, etc - by a specialist or a nominated network GP. • Acute medication - by a nominated network GP. • External appliances - by a specialist or a nominated network GP. Please consult your benefits brochure for any other referrals that may be needed on your option. BACK TO CONTENTS PAGE