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:
- Summary of main fee rates from schemes and administrators for 2024
- B. Summary of rates pertaining to the affordable market, and medical schemes for 2024
- 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 |