TFG Medical Aid Scheme to be administered by Discovery Health (Pty) Ltd from 1 January 2012
Discovery Health (Pty) Ltd administers 13 medical schemes at the moment. We’re pleased to let you know that from 1 January 2012, Discovery Health will also be administering TFG Medical Aid Scheme.
To ensure that healthcare providers and members of TFG Medical Aid Scheme experience a seamless transition in claiming under the new administrator, we include information about where you need to send claims for the members of TFG Medical Aid Scheme from 1 January 2012.
To identify themselves as valid members, members will carry membership cards issued by Discovery Health, branded with TFG Medical Aid Scheme logo. This is a typical example:
Submitting claims to TFG Medical Aid Scheme
Claims with a service date up to 31 December 2011
You can send claims with a service date up to 31 December to Metropolitan Health Group (MHG) as you have always done. You will have four months to send claims with a service date until the end of December 2011 to the Scheme. Any claims received after this will not be paid.
Claims with a service date from 1 January 2012
Please send claims for members of TFG Medical Aid Scheme to Discovery Health from 1 January 2012. You will need to use the member’s new membership number, which is printed on the newly issued membership cards.
Planned hospital admissions
Discovery Health will transfer all approved hospital admissions of members for 2012 to its administration database.
Reimbursement of claims for members of TFG Medical Aid Scheme
The Scheme will reimburse all GP’s in the GP network at the network rate, although TFGMAS benefits will apply. TFGMAS has also adopted the Premier Rate Payment Arrangement for 2012. TFG Medical Aid Scheme has also adopted the Discovery Health Rate as their rate of reimbursement of all claims with certain exceptions which will continue to be covered at the specific TFGMAS tariff.