Sanlam Primary HealthCare Solutions EDI Routing
Sanlam Primary HealthCare Solutions EDI Routing Code
232
2022 Autumn Medicine Price File Updates
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Sanlam Insurance Medical Fees 2022
Sanlam Insurance Medical Fees
For 2023 Fees Click Here
| 1. Medical examinations | ||
| 1.1 General Practitioners | ||
| Tariff code | Description | Fee |
| A1101 | Standard Medical Report including copies of specialist reports or special investigations. | R 955.00 |
| A1102 | Standard Medical Report without any copies of specialist reports or special investigations | R 764.00 |
| A1103 | Short Medical Report or abbreviated variations thereof | R 381.90 |
| A1105 | Cardiovascular Examination and Report only | R 381.90 |
| A1106 | Three blood pressure recordings during one visit | R 381.90 |
| 1.2 Specialist Physicians | ||
| A2100 | Standard Medical Report including copies of specialist reports or special investigations. | R 1,372.50 |
| A2200 | Standard Medical Report with resting ECG only ( 12 leads ) | R 1,792.90 |
| A2300 | Standard Medical Report with Effort ECG ( resting, post-effort, 3- and 6 mins post recovery tracings ) | R 1,983.90 |
| A2401 | Examination and completion of questionnaire on cardiovascular system | R 823.40 |
| A2402 | Examination and completion of questionnaire on cardiovascular system, including resting 12-lead ECG | R 1,235.30 |
| A2403 | Examination and completion of questionnaire on cardiovascular system, including effort ECG | R 1,464.10 |
| 1.3 Nurses (doctor delegated exams, in fulltime employment of a doctor) | ||
| A1103 | Short Medical Report or abreviated variations thereof | R 381.90 |
| A1104 | Body mass index (BMI) assessment | R 74.60 |
| A1106 | Three blood pressure recordings during one visit | R 381.90 |
| 2. Sample collection (GP’s, Specialists) Collection of blood sample(s) for pathological examination(s), per venesection |
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| A1202 | R 152.90 | |
| 3. Electrocardiograms (GP’s, Specialists) Resting ECG only – 12 leads |
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| A1301 | R 420.20 | |
| A1302 | Effort ECG ( including resting, immediately post-effort, 3- and 6 minutes post-effort tracings ) | R 611.20 |
| 1.1 General Practitioners | ||
| Tariff code | Description 4.1 Lung Function tests (GP’s) |
Fee |
| A1306 | Lung fuction test with vitalometer ( no interpretation or report ) | R 381.90 |
| 4.2 Lung Function tests (Specialists) Lung fuction test with vitalometer ( no interpretation or report ) |
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| A1307 | R 381.90 | |
| 5. Extracts from records/special quesionnaires (GP’s, Specialists) Personal Medical Attendant Report |
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| A1401 | R 458.40 | |
| A1402 | Copies of previous reports | R 305.60 |
| A1403 | Completion of specific reports (eg Diabetes, psychological/nervous disorders questionnaire ) | R 381.90 |
| A1404 | Loan of one or more ECG,s | R 152.90 |
| A1405 | Report for deceased estate | R 458.40 |
| A4104 | Personal Medical Attendant Report for sportspeople by team doctor | R 710.70 |
| 6. Counselling (GP’s, Specialists) HIV Post Test Counselling |
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| A1501 | R 764.00 | |
| 7. Radiology (Specialist Radiologists) X-ray chest PA and lateral |
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| A3101 | R 823.30 | |
| A3103 | X-ray chest PA only | R 640.60 |
| 8. Reports by Specialists Copies of previous reports |
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| A4101 | R 366.10 | |
| A4102 | PMA by a Specialist | R 548.90 |
| A4103 | PMA by a Specialist with copies of previous reports and test results | R 686.10 |
| A1450 | Completion of specific reports (Psychological/Nervous disorders questionnaire) | R 457.30 |
Mediswitch EDI Destination Codes 2022-03-10
MediSwitch Medical Aid Scheme
EDI Destination Codes
2022-03-10
CODE MEDICAL AID SCHEME
| 145 | ACUMEN Pan African Managed Care (Pty) Ltd |
| 027 | AECI MEDICAL AID SOCIETY MEDSCHEME |
| 215 | AECI MEDICAL AID SOCIETY VALUE OPTION Universal Healthcare Administrators (Pty) Ltd. |
| 290 | AFA BROADREACH Medscheme |
| 304 | AFA CORPORATE Medscheme |
| 276 | AFFINITY HEALTH Pan African Managed Care (Pty) Ltd |
| 836 | AFRICAN AND WORLDWIDE MEDICAL ASSISTANCE SERVICES (PTY) LTD Africa Assist |
| 208 | AFROCENTRIC PRIVATE HEALTH INSURANCE (APHI) Afrocentric |
| 700 | AGS HEALTH Pan African Managed Care (Pty) Ltd |
| 224 | ALLIANCE MIDMED MEDICAL SCHEME Private Health Administrators (Pty) Ltd |
| 037 | ANGLO MEDICAL SCHEME Discovery Health Administrators |
| 390 | ANGLOGOLD ASHANTI EMPLOYEES SCHEME Momentum Thebe Ya Bopelo (TYB) |
| 036 | ANGLOVAAL GROUP MEDICAL SCHEME Discovery Health Administrators |
| 771 | ASTERIO MEDICAL INSURANCE Asterio Medical Insurance |
| 042 | BANKMED MEDICAL SCHEME Discovery Health Administrators |
| 043 | BARLOWORLD MEDICAL SCHEME Medscheme |
| 733 | BCIMA (BUILDING AND CONSTRUCTION INDUSTRY MEDICAL AID FUND) Universal Healthcare Administrators (Pty) Ltd. |
| 045 | BESTMED MEDICAL SCHEME Bestmed |
| 048 | BMW EMPLOYEES MEDICAL AID SOCIETY Discovery Health Administrators |
| 595 | BOMAID BOMaid Medical Aid |
| 877 | BOMAID HIV SPECIAL BENEFIT FUND BOMaid Medical Aid |
| 050 | BONITAS MEDICAL FUND Medscheme |
| 571 | BOTSOGO HEALTH PLAN Momentum: HDS Medical Management |
| 081 | BOTSWANA PUBLIC OFFICERS MED AID SCHEME (BPOMAS) Affiliated Fund Administrators Botswana |
| 056 | BP SOUTHERN AFRICA MEDICAL AID SOCIETY Momentum Health Solutions |
| 079 | CAMAF Chartered Accountants Medical Aid Fund (CAMAF) |
| 052 | CAPE MEDICAL PLAN Cape Medical Plan |
| 561 | CARECROSS Carecross |
| 254 | CAREWORKS CAREWORKS |
| 389 | CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) Medikredit |
| 213 | CIGNA MEDICAL SCHEME KENYA (BOTSWANA) Cigna Kenya |
| 129 | COMPCARE MEDICAL SCHEME Universal Healthcare Administrators (Pty) Ltd. |
| 454 | COMPENSATION FUND (IOD) Compensation Fund (IOD) |
| 704 | COMPSOL (IOD CLAIMS) IOD Claims: Compsol |
| 066 | DE BEERS BENEFIT SOCIETY De Beers Benefit Society |
| 570 | DEBT TEC IOD Debt Tec |
| 483 | DEEP SOUTH GOLD MINE Momentum Thebe Ya Bopelo (TYB) |
| 406 | DENTAL RISK COMPANY DRC Dental Risk Company |
| 040 | DISCOVERY HEALTH DOH WESTERN CAPE Discovery Health Administrators |
| 125 | DISCOVERY HEALTH MEDICAL SCHEME Discovery Health Administrators |
| 460 | DOCTOR HEALTH 1 |
| 687 | DOH COVID 19 |
| 226 | DOMESTICARE Carecross |
| 695 | EEB COMBINED National Health Group |
| 683 | EEB ESSENTIAL National Health Group |
| 289 | EMERGING MARKET HEALTHCARE Emerging Market Healthcare |
| 269 | ENGEN MEDICAL BENEFIT FUND Discovery Health Administrators |
| 776 | ESSENTIAL EMPLOYEE BENEFITS (EEBS) National Health Group |
| 516 | ESSENTIAL MED Essential Med |
| 873 | ESSENTIALMED CORPORATE Afrocentric |
| 690 | EVANDER GOLD MINE Momentum Thebe Ya Bopelo (TYB) |
| 160 | FEDHEALTH MEDICAL SCHEME Medscheme |
| 837 | FEMA MEDICAL SCHEME FEMA |
| 779 | FISHING INDUSTRY MEDICAL SCHEME (FISHMED) Momentum Health Solutions |
| 489 | FOOD WORKERS MEDICAL BENEFIT FUND Food Workers Medical Benefit Fund |
| 083 | FOSCHINI GROUP MEDICAL SCHEME DISCOVERY HEALTH ADMINISTRATORS |
| 470 | FURNMED Eminent Wealth Consult Pty Ltd |
| 184 | GAUTENG PROVISIONAL GOVERNMENT (IOD) Gauteng Provisional Government |
| 518 | GENESIS MEDICAL SCHEME Genesis Medical Aid |
| 241 | GENRIC MEDICAL INSURANCE Pan African Managed Care (Pty) Ltd |
| 504 | GETSAVVI Blackbird Group (Pty) Ltd |
| 181 | GLENCORE MEDICAL SCHEME Discovery Health Administrators |
| 363 | GOLDEN ARROW EMPLOYEES MEDICAL BENEFIT FUND Momentum Health Solutions |
| 918 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS BERYL OPTION) Metropolitan Health Group |
| 875 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS EMERALD OPTION) Metropolitan Health Group |
| 925 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS ONYX OPTION) Metropolitan Health Group |
| 926 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS RUBY OPTION) Metropolitan Health Group |
| 917 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS TANZANITE ONE) Metropolitan Health Group |
| 597 | HAIRDRESSING SICK BENEFIT FUND CAPE TOWN Hairdressing Sick Benefit Fund |
| 018 | HARMONY HEALTH SERVICES Afrocentric |
| 421 | HEALTH SQUARED MEDICAL SCHEME Agility |
| 472 | HEALTH4ME Momentum Health Solutions |
| 684 | HERITAGE HEALTH MEDICAL AID FUND Janus Investments (Pty) Ltd |
| 444 | HORIZON MEDICAL SCHEME Medscheme |
| 439 | IMPALA MEDICAL PLAN Momentum Thebe Ya Bopelo (TYB) |
| 364 | IMPERIAL MOTUS MED Momentum Health Solutions |
| 221 | IMPILO CARE OPTION Universal Healthcare Administrators (Pty) Ltd. |
| 407 | IMPROVED CLINICAL PATHWAY SERVICES Improved Clinical Pathway Services |
| 510 | KEYHEALTH PPS Healthcare Administrators (PPSHA) |
| 525 | LA HEALTH Discovery Health Administrators |
| 099 | LIBCARE MEDICAL SCHEME Liberty Health Administrators |
| 008 | LIBERTY BLUE MEDICAL SCHEME Liberty Health Administrators |
| 945 | LONMIN MEDICAL SCHEME Discovery Health Administrators |
| 302 | MAKOTI COMPREHENSIVE AND PRIMARY Enablemed |
| 104 | MALCOR MEDICAL SCHEME Discovery Health Administrators |
| 255 | MALCOR OPTION D Enablemed |
| 247 | MAMOTH HEALTH PLAN Mamoth Employee Benefits (Pty) Ltd |
| 898 | MASSMART EMS Universal Healthcare Administrators (Pty) Ltd. |
| 038 | MASSMART HEALTH PLAN Universal Healthcare Administrators (Pty) Ltd. |
| 180 | MB MED Medscheme |
| 542 | MEDIBUCKS EDCON Medibucks Administrator |
| 543 | MEDIBUCKS SAVINGS ACCOUNT Medibucks Administrator |
| 562 | MEDICAL SOCIETY Affinity Financial Services (Pty) Ltd |
| 418 | MEDICALL HEALTH Medicall Healthcare Network Providers |
| 617 | MEDICLINIC DOH WESTERN CAPE Medscheme |
| 256 | MEDIHELP Medihelp |
| 265 | MEDIMED MEDICAL SCHEME Momentum Thebe Ya Bopelo (TYB) |
| 250 | MEDIPOS MEDICAL SCHEME Afrocentric |
| 540 | MEDSCHEME ESWATINI MSO |
| 111 | MEDSHIELD MEDICAL SCHEME Medshield Administrators |
| 754 | MEDSTART MEDICAL SCHEME MEDSTART |
| 535 | METROPOLITAN HEALTH LESOTHO Momentum: HDS Medical Management |
| 628 | MIDI MEDICAL MIDI Medical Group |
| 362 | MMED OPTION OF THE NASPERS MEDICAL FUND Discovery Health Administrators |
| 237 | MOMENTUM HEALTH AFRICA Momentum: HDS Medical Management |
| 822 | MOMENTUM MEDICAL SCHEME Momentum Health Solutions |
| 089 | MOMENTUM MOZAMBIQUE SCHEME PLA SAUDE Momentum: HDS Medical Management |
| 940 | MOTO HEALTHCARE Momentum Health Solutions |
| 292 | MSO INTERNATIONAL MSO |
| 206 | NAMIBIA HEALTH PLAN Medscheme Namibia |
| 600 | NAMIBIA IND MEDICAL AID Medscheme Namibia |
| 182 | NATIONAL BARGAINING COUNCIL FOR PRIVATE SECURITY Pan African Managed Care (Pty) Ltd |
| 214 | NATIONAL HEALTH GROUP National Health Group |
| 010 | NBCRFLI WELLNESS FUND HEALTH PLAN Pan African Managed Care (Pty) Ltd |
| 016 | NEDGROUP MEDICAL AID SCHEME Medscheme |
| 067 | NETCARE MEDICAL SCHEME Discovery Health Administrators |
| 073 | NETCAREPLUS SOLUTIONS ACCIDENT AND TRAUMA NetcarePlus Administrators |
| 312 | NETCAREPLUS VOUCHER NetcarePlus Administrators |
| 624 | NUFAWSA SICK BENEFIT SOCIETY Eminent Wealth Consult Pty Ltd |
| 012 | OLD MUTUAL STAFF MEDICAL AID SCHEME Universal Healthcare Administrators (Pty) Ltd. |
| 468 | ONEPLAN MEDICAL INSURANCE Oneplan Medical Insurance |
| 142 | OPMED Opmed (NIA) |
| 055 | ORACLE HEALTH ESWATINI MSO |
| 143 | PARMED MEDICAL AID FUND Medscheme |
| 650 | PEPKOR EXECUTIVE PLAN OPTION (EEBS) National Health Group |
| 146 | PG GROUP MEDICAL SCHEME Momentum Health Solutions |
| 376 | PICK N PAY MEDICAL SCHEME Momentum Health Solutions |
| 266 | PLATINUM HEALTH Platinum Health |
| 703 | POLMED (IOD CLAIMS) Medscheme |
| 219 | POLMED Medscheme |
| 417 | PPN AECI Medscheme |
| 432 | PPN CARECROSS Carecross |
| 457 | PPN MEDIMED Momentum Thebe Ya Bopelo (TYB) |
| 419 | PPN POLMED Medscheme |
| 154 | PROFMED PPS Healthcare Administrators (PPSHA) |
| 627 | PROSPERITY LIFE ACCIDENT PROTECTOR Prosperity Health Namibia |
| 626 | PROSPERITY LIFE PRIMARY PROTECTOR Prosperity Health Namibia |
| 359 | PROSPRITY LIFE Prosperity Health Namibia |
| 474 | PROTEKTA Momentum Thebe Ya Bopelo (TYB) |
| 342 | PULA MEDICAL AID FUND Affiliated Fund Administrators Botswana |
| 084 | PULAMED Affiliated Fund Administrators Botswana |
| 818 | RAND MUTUAL ASSURANCE Rand Mutual Assurance |
| 607 | RAND WATER MEDICAL SCHEME Rand Water Board |
| 632 | REEBOKRANT WORKERS TRUST Universal Healthcare Administrators (Pty) Ltd. |
| 645 | REGULAR FORCE MEDICAL CONTINUATION FUND (RFMCF) PPS Healthcare Administrators (PPSHA) |
| 161 | REMEDI MEDICAL AID SCHEME Discovery Health Administrators |
| 257 | RENAISSANCE HEALTH MEDICAL AID FUND Prosperity Health Namibia |
| 608 | RETAIL MEAT TRADE Retail Meat Trade |
| 946 | RETAIL MEDICAL SCHEME Discovery Health Administrators |
| 581 | RHODES UNIVERSITY MEDICAL SCHEME (RU MED) Momentum Thebe Ya Bopelo (TYB) |
| 780 | ROSHMED HOSPITAL SCHEME Riskaid (Digidata) |
| 179 | SA BREWERIES MEDICAL AID SOCIETY Discovery Health Administrators |
| 176 | SABC MEDICAL AID SCHEME Medscheme |
| 611 | SAMWUMED SAMWUmed |
| 232 | SANLAM PRIMARY HEALTHCARE Essential Med |
| 118 | SAPS WELLNESS Metropolitan Health Group |
| 175 | SASOLMED MEDICAL SCHEME Momentum Health Solutions |
| 022 | SEDMED MEDICAL SCHEME SEDMED Medical Scheme |
| 631 | SHEMHEALTH Pan African Managed Care (Pty) Ltd |
| 188 | SIBANYE GOLD Momentum Thebe Ya Bopelo (TYB) |
| 116 | SISONKE MEDICAL SCHEME Momentum Thebe Ya Bopelo (TYB) |
| 178 | SIZWE HOSMED MEDICAL FUND 3Sixty Health |
| 958 | SMOLLAN HEALTH REJUVE WELLNESS |
| 614 | SPES BONA Spes Bona |
| 072 | SUREMED HEALTH Momentum Thebe Ya Bopelo (TYB) |
| 240 | SWAZIMED Private Health Administrators (Pty) Ltd |
| 769 | THEBEMED MEDICAL SCHEME Momentum Thebe Ya Bopelo (TYB) |
| 228 | TIGER BRANDS MEDICAL SCHEME Universal Healthcare Administrators (Pty) Ltd. |
| 194 | TRANSMED MEDICAL FUND Momentum Health Solutions |
| 229 | TRANSMED STATE PLUS NETWORK OPTION Universal Healthcare Administrators (Pty) Ltd. |
| 778 | TRUCARE Universal Healthcare Administrators (Pty) Ltd. |
| 944 | TSOGO SUN GROUP MEDICAL SCHEME Discovery Health Administrators |
| 920 | UMVUZO HEALTH MEDICAL SCHEME Umvuzo Health Medical Scheme |
| 233 | UMVUZO HEALTH STANDARD AND ULTRA OPTION Universal Healthcare Administrators (Pty) Ltd. |
| 381 | UNITED GENERAL INSURANCE (SWAZILAND) GETMED Swaziland |
| 484 | UNITY HEALTH Ambledown Financial services (Pty) LTD |
| 401 | UNIVERSAL HEALTH AND ACCIDENT PLAN Universal Healthcare Administrators (Pty) Ltd. |
| 431 | UNIVERSAL WORKPLACE HEALTH PLAN Universal Healthcare Administrators (Pty) Ltd. |
| 197 | UNIVERSITY OF KWAZULU NATAL MEDICAL SCHEME Discovery Health Administrators |
| 552 | WATCH TOWER Universal Healthcare Administrators (Pty) Ltd. |
| 286 | WCMAS: YEBO MED OPTION Witbank Coal Medical Aid Society |
| 998 | WESMART MEDICAL SCHEME Pan African Managed Care (Pty) Ltd |
| 201 | WITBANK COALFIELDS MEDICAL AID SCHEME Witbank Coal Medical Aid Society |
| 845 | WITBANK COALFIELDS MIDMAS OPTION Witbank Coal Medical Aid Society |
| 855 | WITBANK COALFIELDS NTSIKA OPTION Witbank Coal Medical Aid Society |
| 202 | WOOLTRU HEALTHCARE FUND Momentum Health Solutions |
| 028 | YARONA SAPS |
When do Medical Aid claims go stale?
STALE CLAIMS
In terms of the Medical Schemes Act, all claims must be submitted within four months from the last day of the month in which the service was provided.
Claims that are not submitted and received within this period will be regarded as stale and ineligible for medical scheme benefits.
The member remains fully responsible for the settling of the claim.
Send us your inquiry:
