Medical aid co-payment applied: what to ask your scheme
Your medical scheme says part of the cost is yours to pay. What a co-payment means, and the questions to put to the scheme in writing before you accept it.
The scheme says part of the cost is yours to pay under its rules.
The wording to look for
- “a co-payment has been applied”
- “co-pay”
- “deductible”
Questions to put to your scheme in writing
- Which rule provides for the co-payment applied to this claim?
- How was the amount calculated, and against what base?
- Does that co-payment apply where the service is a Prescribed Minimum Benefit, and how was that assessed?
- Please provide the co-payment schedule for my option as it stands this year.
Only you can answer these
- Whether the co-payment was disclosed to you before the service.
Paste your rejection notice and build the letter. It is read on your own device and never uploaded.
See every reason a South African medical scheme gives.
Pryse is not a law firm and does not act for you. Nothing here is a determination of your rights or legal advice, and no registered scheme rule is quoted. The questions ask your scheme to provide its own.