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What is a Medical Savings Account?

An MSA is a benefit account established in the name of the principal member concerned.

How is the Medical Savings Account calculated?

The MSA is calculated using a fixed percentage of the total contribution.

What is paid for from a Medical Savings Account?

Medical expenses for out-of-hospital services are paid from an MSA if available on the chosen option.

When do Medical Savings Account funds become available?

These funds are available from the beginning of the year or prorated if the Scheme was joined during the year.

Do all Bestmed plan options have a Medical Savings Account?

No, not all plan options have a Medical Savings Account. The Pulse and Beat1 options do not include a Medical Savings Account.

Why do I have specified day-to-day benefits if I have a Medical Savings Account?

You first utilise the Medical Savings Account. Once it is depleted, you will have access to your day-to-day benefits on specific plan options.

What happens when my Medical Savings Account runs out?

On Beat4, Pace1, Pace2 and Pace3 your day-to-day benefits will become available.

Can I use the money in the Medical Savings Account to fund co-payments?

No, the MSA does not fund co-payments.

Do I lose the money if I don’t use it?

No, you don’t lose it. It becomes a part of the following year's savings or will be added to your vested savings, depending on your benefit option.

Do I earn interest on the money in my Medical Savings Account?

Yes. The Scheme allocates the net interest received on Medical Savings Account invested funds to members with positive savings balances.

What if I never use my Medical Savings Account?

The money will be transferred for you to use the following year. If you resign your membership with Bestmed and choose not to join another scheme, or if you join a scheme without a savings option, the money will be paid to you. If you join a scheme with a savings account, the money will be transferred into the new scheme's medical savings account if a principal member joins another scheme with an MSA option.

What is vested savings?

Vested savings are accumulated savings from previous years.

What is paid from vested savings?

Members may request payment of services such as co-payments, certain excluded medicine items and fees above Scheme tariff to be paid from their vested savings, depending on their benefit option.

May vested savings be used to pay for additional benefits?

Yes. Members may apply to the Scheme to use their vested savings to pay for additional benefits, such as tinted glasses.

What may not be paid from vested savings?

Costs relating to PMB services, or the self-payment gap, cannot be paid from vested savings.

How do I access vested savings?

Members can give permission to pay for claims from the vested savings account. Some claims are automatically paid from vested savings.

What happens if a member terminates their Scheme membership?

The principal member will receive the balance of funds, including interest earned.

What is a co-payment?

A co-payment is the portion of a claim payable by the member directly to the healthcare provider.

When do co-payments apply?

  • If medicine is prescribed/selected for the treatment of a CDL, PMB or non–CDL condition and is not listed on the formulary
  • If the prescribed/selected medicine costs more than the Mediscor Reference Price (MRP)
  • A formulary co-payment on non-CDL conditions is applicable, depending on the chosen plan option
  • When the provider charges a higher dispensing fee than what the Scheme reimburses

Please note that according to the Council for Medical Schemes (CMS), co-payments may not be deducted from your savings account or vested savings account or reimbursed to you. The co–payment percentage varies according to the different benefit options. The table below highlights the different co–payments applicable per Scheme option for the CDL, PMB and non–CDL conditions:

BENEFIT Non-formulary co-payment for CDL and PMB medicine Formulary co-payment for Non-CDL conditions Non-formulary co-payment for Non-CDL conditions
BEAT1 / BEAT1 N 40% N/A N/A
BEAT2 / BEAT2 N 40%
BEAT3 / BEAT3 N 40% 20%
BEAT4 30% 10% 25%
PACE 1 35% 10% 30%
PACE 2 30% 10% 25%
PACE 3 25% 10% 20%
PACE4 20%
10% 15%
PULSE 1 40% N/A N/A
PULSE2 25% 10% 20%