How are Optometry and Dental benefits processed and paid on the Managed Care Plan?

On the Managed Care Plan (MCP), the majority of day-to-day benefits are currently paid from your available Medical Savings Account (MSA) funds. Starting January 2024, members of the MCP are not only given a substantial increase for the dental healthcare services benefit, but also a dedicated benefit for optometry (eye care) services.

A reminder: for dental healthcare services, you have an annual family limit from which the Scheme pays your dental claims. Claims for dentists are reimbursed at 100% of the Scheme Reimbursement Rate (SRR) and for specialists at 125% of the SRR. Should your provider charge more than the SRR, you can instruct the Scheme to pay the additional costs from your available MSA funds. Once the limit is depleted, payments will automatically process from your available MSA.

From January 2024, a new benefit for optometry will be available as well. For examinations, a benefit valued at R470 is provided. If your optometrist charges more, you can instruct the Scheme to pay the excess from your available MSA. Additionally, for lenses, frames and contact lenses, a family limit of R4 230 will be introduced from January 2024. Once this limit is reached, any remaining costs will automatically be paid from your available MSA at the SRR.

To further enhance your lenses and frames benefit, take advantage of the 20% discount offered by optometrists in the Discovery Health Optometry Network to members of the Anglo Medical Scheme.

Instructions for paying costs from your MSA

For additional funding from your MSA, there are two forms to complete:

1. Application for special payments made from the Medical Savings Account: Use this form to request the Scheme's consideration for payment of a claim balance exceeding a limit, in some instances charges above the Scheme Reimbursement Rate, or for the payment of a Scheme excluded service or medicine, from available MSA funds. Complete this form whenever you need additional payment or exclusion payment from your MSA. PMBs are excluded from this process.
2. MSA once-off payment instruction: Use this form if you want the Scheme to always pay costs exceeding the SRR from your available MSA. This instruction remains valid until you advise the Scheme otherwise. Access both financial forms in the Info Centre on www.angloms.co.za, under 'Find documents' in the app, call us on 0860 222 633 or WhatsApp us on 011 292 8797.

Published November 2023