a) Membership number

b) Date of Birth

c) Dependant Code

d) Patient First Name

A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition.

If you choose not to use the DSP selected by your scheme, you may have to pay a portion of the bill as a co-payment. This could either be a percentage co-payment or the difference between the DSP’s tariff and that charged by the provider you went to.

Medical schemes have to ensure that it is easy for beneficiaries to get to the DSPs. If there is no DSP within reasonable distance of your work or home, then you can visit any provider and the scheme is obliged to pay.

When you suffer an emergency condition, or are involved in an accident, you may go to the nearest healthcare facility for treatment, even if it is not a DSP. Your scheme will have to cover the costs.

Schemes also have to ensure that the DSPs of their choice can deliver the services needed and without members having to wait unreasonably long. Where a DSP is unable to accommodate or treat a member, the medical scheme remains liable for all the costs of treating the PMB condition at a non-DSP.

The State’s healthcare facilities can be, but are not necessarily, DSPs. Before they can be listed as such, schemes have to make sure that their beneficiaries can get to the facilities and that the required treatment, medication and care are available and accessible.

Treatment at DSPs can be handled in two ways:

1. Schemes can insist that you go to a DSP as soon as your condition is diagnosed, in which case they cover the costs from the start. Treatment at a DSP will be covered in full by the medical scheme under the PMB conditions when delivered according to scheme protocols and formularies.
2. If your benefit option allows for this, you can be treated by the doctor of your choice. If you choose to use a provider of your choice for these services, the scheme may apply a co-payment, as registered in their rules.

Liberty Medical Scheme Name Changed to LMS Medical Fund

Date:  1 August 2016

LIBERTY /PRIMECURE LIBERTY

1. SCHEME NAME CHANGE

Effective 1 August 2016, the Liberty Medical Scheme, administered by VMed, will be undergoing a name change and will be known as the LMS Medical Fund.

Effective 1 August 2016, claims will be routed to Medscheme via VMed.

Refer to the table below for the option name change.

Benefit options and member benefits remain exactly the same until the end of the year. Members will be entitled to the same benefits they have chosen for the 2016 benefit year until the end of the year.

OLD OPTION NAME NEW OPTION NAME EXISTING OPTION CODE LIBERTY HL DD PROCEDURE & CONSULT LMS HL DD PROCEDURE & CONSULT LIHHL 685995

2. NEW MEMBERSHIP CARDS

Due to the Brand Agreement with Liberty being terminated at this stage, members will receive proof of membership and an innovative electronic LMS Medical Fund membership card.

The e-card contains all membership information, including details of all beneficiaries. Membership numbers will remain the same through the transition period ensuring providers and members are not inconvenienced through the process.

Members have been requested to destroy their current membership cards after 31 July 2016 and make use of the new LMS Medical Fund e-card or proof of membership. Providers are strongly urged to accept the e-card.

LMS Contact Details: General Enquiries: lms.enquiries@medscheme.co.za  Claims: lms.3rdparties@medscheme.co.za  Website: www.lmsmedfund.co.za.

PRIME CURE LIBERTY

Effective 1 August 2016, the Liberty Medical Scheme, administered by Prime Cure, will be undergoing a name change and will be known as the LMS Medical Fund.

Claims should still be submitted on the existing Prime Cure options listed below:

SUBMITTING OPTION NAME OPTION CODE MULTI – MANAGED PRIME CURE GP HL OPTION MPCHG 605398 MULTI – MANAGED PRIME CURE SP HL OPTION MPCHS 605401

courtesy of Best PMA