Medical Savings Account - payment request forms

One of the most frequently asked questions of our Call Centre staff is how to use one's savings in the Medical Savings Account (MSA) if one is on the Managed Care Plan. We dedicated an article to the topic in the 2021 September issue of MediBrief.

Here we detail how to instruct the Scheme to fund additional costs from your MSA.

Find documents and forms

Navigate to the Info Centre on the Scheme website where you will find the most frequently used forms and documents you need to manage your membership. The forms available are the "Application for Special Payments made from the Medical Savings Account" and the "Medical Savings Account once-off payment instruction form".

Which form to use in which instance

MSA once-off payment instruction

• By submitting this form, you are instructing the Scheme to always pay certain services in excess of the Scheme Reimbursement Rate (SRR) in full. Under normal circumstances, the claim would only have been paid up to the SRR and you would have been responsible for any shortfall as an out-of-pocket expense. Obviously, the Scheme will only pay claims if you have available funds in your MSA.
• This form is not applicable to services related to Prescribed Minimum Benefits (PMB) claims.
• This once-off instruction will be in force until you advise the Scheme otherwise.

Application for special payments made from the Medical Savings Account

• This form is a request to the Scheme to consider the payment of a Scheme-excluded service or medicine or the balance of a claim that has exceeded a limit. It is required to be completed each time the member wants an exclusion or limit excess be funded from the funds available in your Medical Savings Account.
• The approval of this application is subject to the funds accrued in previous years and are carried over to your Medical Savings Account (MSA).

There are certain criteria that you need to be aware of before you apply for a special payment from your Medical Savings Account:

• Special payments from your MSA are always subject to an approval process.
• The main member must complete and sign this application form.
• A valid account supplied by your provider after the service was received is needed for you to claim from the Scheme and for the Scheme to consider your special payment.
• This account must be attached to the application form.
• Special payments from your MSA will only be considered for claims where the healthcare provider is registered with the Board of Healthcare Funders (BHF). This means the healthcare provider must have a BHF practice number.
• Special payments from your MSA must be for a valid and recognised medical procedure, treatment or product.
• Scheme exclusions may be considered based on clinical evidence and Scheme Rules.
• If approved, the special payment from your MSA will be made to you, the member, and not directly to the provider, as you are responsible for ensuring payment of medical accounts.
• Special payments will not be approved on quotations, as the Scheme may not fund future expenses and a quotation may not reflect the final account.
• Special payments from your MSA for Prescribed Minimum Benefits cannot be requested.
• Special payments will not be approved if you have a waiting period.

To read more about what can or cannot be funded from your MSA and under which circumstances, please refer to the "MSA Masterclass" article, published in the MediBrief issue of September 2021, or to your Benefit Guide and Scheme Rules.

Published: March 2022.