AMS reminders A-Z
This first edition of 2023 provides you with a few important reminders. Please inform yourself about the topics below. More information to each topic is available in your Benefit Guide or here, on www.angloms.co.za.
B Benefits - familiarise yourself with your available benefits for 2023 and which medical costs AMS is funding. Find them in your 2023 Benefit Guide or here, on www.angloms.co.za after selecting your plan.
C Claims are your payment requests to the Scheme for qualifying healthcare services. Find out what information needs to be included on your claims and how we process and pay them. Read more here, on www.angloms.co.za > select your plan and navigate to 'How to submit a claim' (under the contributions table).
D Day clinics are the preferred place of service for certain surgical or diagnostic procedures (e.g. cataracts, colonoscopies, gastroscopies) etc. By choosing day clinics, you avoid hospital co-payments. Read more on this page about day clinics.
E Ex gratia (Latin) means 'by virtue of grace' or 'by favour'. It is a discretional benefit where the Scheme may consider funding in cases of financial hardship and/or in cases of exceptional clinical circumstances. Read more on the Ex Gratia application form.
F Frail care benefits are only available on the Managed Care Plan. Medically related frail care services, where clinically appropriate, will be funded according to Scheme protocols. Only claims received from a Board of Healthcare Funder registered facility or Registered Nurse providing services at home, will be considered for payment. Authorisation is required. Find more information about the Frail Care benefit on your benefit overview page or in your 2023 Benefit Guide on page 72/73.
G Generics are medicines with the same active ingredients as original brand-name medicines, usually at a lower cost. Read more about generics here.
H Hospitalisation must always be authorised. On the Value Care Plan, you need to use Prime Cure hospitals, you have a Family Hospital Limit and private hospital sublimit*. On the Standard Care Plan, you need to use a facility on the network to avoid co-payments, but you have an unlimited hospital benefit*. On the Managed Care Plan, you have an unlimited hospital limit* and you can use any hospital; co-payments for non-PMB conditions apply.
*Claims paid at SRR (see below). Read more here, on www.angloms.co.za > select your plan and navigate to the hospitalisation benefit.
I International claims. There are certain rules for paying international claims on the Standard and Managed Care plan. Before you travel, please learn about them, and take out travel insurance. More information here why travel insurance is important.
J Joining the Scheme is, according to our Rules, only possible for active employees of our participating employers. If you want to add beneficiaries to your membership, you need to do so during the first 30 days of them becoming part of your family (e.g. birth, marriage or when you join the Scheme). If you retire and leave the Scheme, or terminate your membership as a retiree, you cannot re-join. Read more about adding new dependants to your membership or why you cannot re-join once you left as a pensioner.
K Keep your details up to date! It is your responsibility to inform us if your contact details are hanging. If we cannot contact you, it might affect our ability to service you and to provide benefits. Update your details here or call us on 0860 222 633.
L Limits - some benefits are subject to annual limits. Track your benefit usage on your statement or by logging onto the AMS website or app.
M Medical emergencies are not any emergency situation. They are clearly defined in the Medical Schemes Act (as per below article). You can also read more here on medical emergencies.
N Networks of healthcare providers are put in place to manage cost through agreed rates so we can keep contributions low.
O Oncology (cancer) benefits, after authorisation and registration on the Oncology management programme, will be paid against specific rules and limits. On the Value Care Plan, they are allocated to your available Family Hospital Limit unless PMB; services to be obtained from a state facility. The Standard Care Plan has a limit per beneficiary per 12-month period for treatment with a 20% co-payment once the benefit is depleted; hospitalisation in network facility. Benefits on the Managed Care Plan are unlimited if PMB. Find more information on the Oncology benefits on the Standard Care Plan and the Managed Care Plan. Value Care Plan member can call 0861 665 665.
P Prescribed Minimum Benefits (PMBs) are the benefits all schemes have to pay for a set list of conditions. You need to register the condition to qualify for benefits and might need to use a Designated Service Provider. Read more about PMBs on page 1-2 of your 2023 Benefit Guide.
Q Queries on any of these topics? Call us on 0860 222 633!
R Retirement approaching? You can stay on AMS if you retire from one of our participating employers. Discuss with your HR department how it will affect your subsidies and contribution payments. Read up about the different stages of your membership
S SRR stands for Scheme Reimbursement Rate and is the set rate the Scheme pays for services rendered by healthcare providers. This rate is what the Scheme considers to be affordable for its membership and might be lower or higher than what the provider charges.
Learn more about the SRR.
T Travel insurance is highly recommended when you go overseas for you to be covered for medical emergencies. According to our Rules, we cannot pay providers outside South Africa.
Read this article to understand why travel insurance is necessary.
U Upload your claims on the Anglo Medical Scheme app, in the member area of www.angloms.co.za or email them to claims@angloms.co.za.
Submit your claims here.
V Vitality is not a Scheme product, but you may join this wellness programme offered by our administrator independently. Read more about Vitality and how you can save with our administrator
W www.angloms.co.za is the Scheme website and provides you with detailed information on all of these topics, as well as a member self-administration area.
X XXX - protect your personal information! We do everything in our power to protect your personal information; please play your part and be mindful where and how you share it.
Find out how we protect your information.
Y Your responsibilities as a member are to know and comply with the Scheme Rules.
You can find the Scheme rules here.
Z Zero co-payment wanted? There are ways to avoid most co-payments for medicine or healthcare services. Call us for assistance. Read up about how to spend less on medicine.
Published: January 2023.