January 2024

Newsflash Re: 2024 Scheme Rates, Codes and Prices Guide for EMC Network Doctors

Dear Healthcare Provider

We would like to take this opportunity to wish you and your staff a happy, healthy, and prosperous new year. We look forward to your continual support in partaking in EMC2 projects including the Learning Portfolio for 2024. 

To note that there remains no reference price list (RPL). Various medical schemes and administrators are obliged to set up their tariffs independently.

In terms of the Competition Commission guidelines, organized doctor groupings like EMC do not negotiate or prescribe tariffs. It is up to the individual practices to make their own decision regarding tariffs and/or medical scheme contracts.

Most of the major administrator scheme tariffs have been updated. Increases in tariffs for 2024 are around 4.8% – 6%. A summary of the main administrators-driven fee increases is included in this newsflash below:

  1. Summary of main fee rates from schemes and administrators for 2024
  2. B. Summary of rates pertaining to the affordable market, and medical schemes for 2024   
  3. D. Summary of commonly used codes for insurance medical examinations and procedures for 2024

The blank tariffs for those schemes is still to be received at the date of publication; where received, we have inserted the percentage increase.

Provider Manuals for 2024 are uploaded onto the EMC² portal. Click on the link below to access. 

Provider Manuals 2024 Download Page – EMC Online

To note that practices need to check on their respective administrator or scheme portals like for example, the Discovery Health partner zone, to check on rates specific to different options and consultations.

Kind Regards

Practice Management


For any queries or assistance with practice management application challenges OR if you require the final Tariff update when it completed, please email geraldine@emconline.co.za 

EMC2 CGM MEDEDI customers, please look out for the medical tariff emails or log into the CGM Customer Portal with your customer number for a full list of updates. Alternatively, please call 0861 633 334 or email help.za@cgm.com for assistance.

Disclaimer:  The information is presented as received. EMC accepts no liability for any incorrect information or loss incurred for this information.  It is the practice’s responsibility to check with the relevant schemes and PMA vendors for the correct tariffs.

A. SUMMARY OF MAIN FEE RATES FROM SCHEMES AND ADMINISTRATORS 2024

1. SCHEMES ADMINISTERED BY MEDSCHEME

Schemes administered by Medscheme

Name

Tariff 0190 – 0192

AECI Network – Comprehensive Option

5%

Enhanced fee: REPI 1

 

                           REPI 2

 

AECI Value and Comprehensive Select Dispensing

5%

AECI Value and Comprehensive Select Non-Dispensing

5%

Barlow World

6.5%

Bonitas Network

6.5%

Enhanced fee REPI 1

 

                             REPI 2

 

Bonitas Bonstart and Bonstart Plus – Non-Dispensing

R 458.60

Bonitas Bonstart and Bonstart

Plus – Dispensing

R 543.80

Fedhealth 

R 479.30

Enhanced Fee REPI 1

R 47.90

                          REPI 2

R 24.00

GEMS – Emerald, Onyx & Ruby

 

Enhanced fee: Repi 1

 

                              Repi 2

 

GEMS – Tanzanite One and Beryl – Dispensing

 

Level 1

 

Level 2

 

Level 3

 

GEMS – Tanzanite One and Beryl – Non-Dispensing

 

Level 1

 

Level 2

 

Level 3

 

Horizon

Horizon Care Cross         

5.6%

MBMed

R 481.00

Enhanced Fee REPI 1

R 106.00

                              REPI 2

R 40.00

Medipos – Network

5.5%

Medshield Network Doctors

R540.00

Medshield Network Doctors Enhanced Fee

R595.00

Medshield MediPhila Dispensing

R520.00

Medshield MediPhila Dispensing Enhanced fee

R565.00

Medshield MediPhila  Non Dispensing Enhanced fee

R437.00

Medshield MediPhila  Non Network

 R403.00

Nedgroup

 

Enhanched fee

 

Parmed

6.5%

Polmed – Network

6.0%

Polmed – Category 1 – Network

R 547.80

Polmed – Category 2 – Network

R 520.90

Polmed – Category 3 – Network – 5.3%

R 485.60

Polmed – Non-network – 5.3%

R 427.10

SABC

6.5%

Samwumed Contracted

5%

 

2. SCHEMES ADMINISTERED BY DISCOVERY HEALTH

Schemes administered by Discovery Health 0190 – 0192

SCHEME NAME

Dispensing

Non-Dispensing

Anglo Medical Scheme Managed Care Option

R572.40

 

AngloVaal Group Medical Scheme

R572.40

 

Bankmed – Core, Traditional, Comprehensive & Plus

R572.40

 

Bankmed Basic and Essential

R447.80

R330.10

BMW Employees

R572.40

 

Discovery Health Other

R572.40

 

Discovery Health Executive

R696.30

 

Engen Medical Benefit Fund

R572.40

 

Glencore Medical Scheme

R572.40

 

LA Health Medical Scheme

R572.40

 

Malcor

R572.40

 

Remedi Medical Scheme

R572.40

 

Fee-for-service model

R477.20

R363.20

Semi-capitation Model

R238.70

R181.60

Retail Medical Scheme

R572.40

 

SAB Medical Aid

  

TFG Medical Aid Scheme – Health Plus Option

R572.40

 

Tsogo Sun Medical Scheme

R572.40

 

UKZN Medical Scheme

R572.40

 

Discovery Non-Network Doctors

 

Bankmed Plans

  

Discovery All

  

Netcare Medical scheme

R476.50

 

Lonmin Medical scheme

R483.30

 

Practices need to log in to the health professional zone on www.discovery.co.za and look up the specific tariff codes and rates under the INFORMATION drop down menu for capitation rates linked to Discovery Keycare, Primary Care, FlexiCare and other options


DHMS Base Scheme Consultations Rates

DH GP Network VCONS and VCONM Rates
DH Medical VCONS and VCONM Rates
DH GP Network Medical Consultation
SFM GP network Medical Consultations Rates
VBM GP network Medical Consultations Rates
DH Medical Modifier 0084 and Related Codes
DH Medical RCF
KeyCare GP codes
KeyCare Direct Payment Arrangement Medical Consultation Rates
KeyCare Specialist Agreement RCF
SFM GP Network Medical RCF
VBM GP Network Medical RCF
DH Medical Association Procedure Rates
DH GP Network Medical Procedures
KeyCare Specialist Network Medical Procedures
Medical Modifiers Jan 2023
SFM GP Network Medical Procedures
VBM GP Network Medical Procedures Rates

3.SCHEMES ADMINISTERED BY MOMENTUM HEALTH

Schemed Administered by Momentum

NAME

0190 – 0192

Primary Care Network

Comment

BPMAS

R 497.90

 

 

Fishmed

R 483.10

 

 

Golden Arrow

R 491.40

 

 

Health4Me

R 473.60

 

 

Impala

5.2%

 

Rates available on Provider Portal

Imperial – Budget Option 

R 499.75

 

 

Medimed

5.0%

Medisave Essential Option

Rates available on Provider Portal

Momentum Health

R 447.55

Ingwe Option

 

Moto Health

R 472.50

Custom and Essential Options

 

PG Group

R 478.80

 

 

Pick N Pay Medical Aid

R 491.95

Primary Option

 

Rhodes University Medical Scheme (RUMed)

5.0%

 

Rates available on Provider Portal

Sisonke Health Pride

5.0%

Pride and Diversity Options

Rates available on Provider Portal

Suremed Health

5.0%

 

Rates available on Provider Portal

Thebemed

5.2%

 

Rates available on Provider Portal

Transmed Prime Plan

R 481.25

 

 

Wooltru Healthcare Fund

R 498.35

Network Option

 

4. SCHEMES ADMINISTERED BY UNIVERSAL HEALTH

Schemes administered by Universal

 

NAME

0190 -0192 – Dispensing and NON-dispensing to network pharmacy

Non-Dispensing

BUILDING & CONSTRUCTION (BCIMA)

  

COMPCARE / SELFMED

R 496.00

R 343.00

Massmart

R 496.00

R 343.00

Old Mutual Staff

R 496.00

R 343.00

Thebemed

  

Tiger Brands

R 496.00

R 343.00

Transmed Link Plan

R 496.00

R 343.00

Umvuzo Health (Fee For Service)

R 524.50

 

Universal Health and Accident Plan

R 496.00

R 343.00

Universal Workplace Health plan

R 496.00

R 343.00

Witbank Coalfields

R 496.00

R 343.00

5. OTHER SCHEMES

Other Schemes

Name

0190 -0192

Affinity Health Dispensing

 

Affinity Health Non-Dispensing

 

Building Industry M.A.Fund

 

Bestmed

 

Cape Medical Plan

 

CAMAF – Network doctors

 

CAMAF – Network Choice only

 

De Beers Benefits Society

 

EssentialMed (Dispensing)

R 466.00

EssentialMed (Non-Dispensing)

R 424.00

Get Savvi (Dispensing)

 

Get Savvi (Non-Dispensing)

 

Key Health

 

Medihelp

 

NBCRFLI – Dispensing

 

NBCRFLI – Non-Dispensing

 

Profmed

 

Sizwe- Hosmed

 

Spectramed Contracted

 

Unity Health – Dispensing

 Rates available Next year

Unity Health – Non-Dispensing

 Rates available Next year

Clothing workers Sick Fund

 

Randwater Medical Aid

 

B. SUMMARY OF 2024 RATES PERTAINING TO THE AFFORDABLE MARKET OPTIONS & PRIMARY CARE OPTIONS

Name

% Increase

Dispensing Network

Non-dispensing

Boncap

   

Primecure

6%

  

KeyCare GP Network

   

Fee-for-service model

 

R477.20

R363.20

Semi-capitation model Fee-for-service component Primary Member

 

R238.70

R181.60

    

Flexicare GP Network

   

Fee-for-service model

 

R447.20

R363.20

Semi-capitation model

 

R238.70

R181.60

Practices need to log in to the health professional zone on www.discovery.co.za and look up the specific tariff codes and rates under the INFORMATION drop down menu for capitation rates linked to Discovery Keycare, Primary Care, FlexiCare and other options

 

C. SUMMARY OF INSURANCE TARIFFS, CODES AND FEES

A1101

Standard Medical Report including copies of specialist reports or special investigation

 

A1102

Standard Medical Report without any copies of specialist reports or special investigations

 

A1103

Short Medical Report or Abbreviated variations thereof

 

A1105

Cardiovascular Examination and report only

 

A1106

Three blood pressure recordings during one visit

 

Sample Collections:

A1202             Collection   of   blood   sample(s)   for   pathological examination(s) per venesection 

Electrocardiograms:

A1301

Resting ECG only – 12 leads

 

A1302

Effort ECG

 

Lung Function Tests:

A1306             Lung function test with vitalometer (no interpretation or report)                           

Extracts from records/special questionnaires:

A1401

Personal medical attendant report

 

A1402

Copies of previous records

 

A1403

Completion of specific reports / Diabetes etc.

 

A1404

Loan of one or more ECG(s)

 

A1405

Report for deceased estate

 

A4104

Personal medical attendant report for sports people by team doctor

 

Counselling:

A1501

HIV Post-test counselling

 
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