South African Medical Association

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Fedhealth General Practitioner Network Rates for 2021

 

 


Fedhealth General Practitioner Network Rates for 2021

Dear General Practitioner

Fedhealth General Practitioner Network Rates for 2021

Fedhealth is pleased to announce that there will be a 3.4% increase in our Fedhealth General Practitioner (GP) tariff rates with effect from 1 January 2021.

Fedhealth is also pleased to inform you about a few benefit changes that will come into effect from 1 January 2021.

May we also take this opportunity to thank you for the professional services rendered to our members during 2020. We look forward to partnering with you in 2021.

2021 Option Changes

From 1 January 2021, the maxima EXECGRID option will be discontinued.

New Day Clinic Network

From 1 January 2021, a new Day Clinic Network will be introduced and a R2 000 co-payment will apply to the member for the use of a non-network day clinic.

GP Network Reimbursement Model

The Fedhealth GP Network reimbursement model for 2021 will continue to include an enhanced fee in accordance with your REPI² category score as indicated below:

One of the objectives of the Fedhealth GP Network is to protect members from unexpected co-payments. As such, Fedhealth would like to emphasise the importance of billing at the Fedhealth Scheme Rate (R407.70) which you have agreed to by signing the Fedhealth Network Agreement.

For more information, please refer to the Fedhealth and myFED GP Network Practice Guide for 2021 which can be viewed at www.medscheme.com by logging in as a Provider and clicking on communication library > GP Guides.

Billing Process

Your remittance advice will show a comment code 247 against each consultation qualifying for an enhanced fee. The enhanced fee Rand amount will not reflect on each line. The sum total of your enhanced fees is shown as one amount flagged with code 247 and the description “Enhanced fees” at the beginning of each Scheme’s claim line.

For example:
50 (consultations) X R40.80 (enhanced fee) = R2 040.00

Coordination of Care

Fedhealth supports care coordination and considers the GP to be at the heart of this process. Fragmented healthcare results in inefficient, costly treatment for our members and as such Fedhealth believes that GP care coordination is critical to improving the quality of healthcare and lowering overall health expenditure.

Fedhealth beneficiaries on the following options must nominate their treating network GP to coordinate their care by contacting the Fedhealth Customer Contact Centre on 0860 002 153:
 
flexiFED 4GRID, flexiFED 4Elect, flexiFED 3, flexiFED 3GRID, flexiFED 3Elect, flexiFED 2, flexiFED 2GRID, flexiFED 2Elect, flexiFED 1 and flexiFED 1Elect

The benefit also makes provision for two (2) visits per beneficiary per annum, which will be available from the “out of nomination” benefit if a beneficiary needs to see a GP (subject to the GP Network) other than their nominated network GP.

Specialist Network

Fedhealth would like to remind you about the Fedhealth Specialist Network of doctors who have agreed to bill the Fedhealth rate. Your patient/s will therefore not incur any co-payments when visiting these network specialists.

All Fedhealth beneficiaries must consult their network GP before making a specialist appointment, in order for the GP to ensure that the patient is referred to the appropriate specialist for the necessary level of care. In 2021, a co-payment will apply to the member for the voluntary use of a non-contracted provider for cataract surgery.

To determine if the specialist you refer your patient to is a Fedhealth Partner Specialist, please call the Fedhealth Provider Contact Centre on 0861 112 666. For more information on the applicable co-payments per option when a referral is not obtained, please refer to the Fedhealth and myFED GP Network Practice Guide for 2021 which can be viewed at www.medscheme.com. Log in as a Provider and click on communication library > GP Guides.
 
Hospital Network

Members on the flexiFED 4GRID, flexiFED 4Elect, flexiFED 3GRID, flexiFED 3Elect, flexiFED 2GRID, flexiFED 2Elect, flexiFED 1, flexiFED 1Elect and myFED options may only be admitted to a network hospital.

Voluntary use of a non-network hospital will result in a member co-payment. Members on these options also need to pre-authorise any hospitalisation (except for emergencies) in the respective network to avoid a co-payment.

For a list of the network hospitals, please call the Fedhealth Provider Contact Centre on 0861 112 666 or log in at www.medscheme.com.

Independent Clinical Oncology Network

The Independent Clinical Oncology Network (ICON) is the DSP for active oncology treatment. A 40% co-payment may apply if a member accesses an oncologist outside of the ICON network for their active oncology treatment.

This will depend on the plan option and benefit limits. To alleviate out-of-pocket expenses, we urge you to refer your patient to a participating ICON oncologist for their oncology treatment.

You can find an ICON oncologist by logging in to www.medscheme.com and clicking on Networks > ICON, or alternatively please call the Fedhealth Provider Contact Centre on 0861 112 666.

Continuation of the Agreement

You do not need sign or return the Fedhealth GP Network Agreement again. Should you wish to opt out of the agreement, please inform the Scheme in writing via email to nc@medscheme.co.za or fax to 0860 222 453 on or before Thursday, 24 December 2020.
 
Failing which, it shall be accepted that you agree to the contents hereof and are legally bound thereto. You are also welcome to view the Fedhealth Annexure online at www.medscheme.com (log in as a Provider and click on Networks > E-Contracts).

If you have any questions, please call the Fedhealth Provider Contact Centre on:
0861 112 666

Here is to taking care of our members’ health in 2021 and beyond,

Kind regards,
Fedhealth GP Network Management

The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa www.samedical.org

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