Understanding the AMS Scheme Reimbursement Rate (SRR)
Have you ever wondered how Anglo Medical Scheme determines what it will pay for a medical consultation, procedure or medicine?
The answer lies in the SRR. The SRR is the rate that AMS uses as the basis for paying healthcare claims. In simple terms, it is the maximum amount that the Scheme will reimburse for a particular healthcare service, consultation, procedure or medicine.
To calculate the SRR, AMS uses one of several recognised benchmarks, depending on the type of service being provided. These may include negotiated rates with healthcare providers and networks, the regulated Single Exit Price (SEP) for medicines, or the National Health Reference Price List (NHRPL), adjusted for inflation.
What does this mean for members?
If your healthcare provider charges at or below the SRR, your claim will generally be paid in full according to your benefit rules.
This is often the case when you receive treatment from a provider who participates in an AMS network or when you receive treatment that is covered as a Prescribed Minimum Benefit (PMB).
However, some healthcare providers charge more than the SRR. In these cases, the Scheme will pay up to the SRR and you may be responsible for the difference. This difference is known as a co-payment - paid either from your own pocket, or, where your option allows, from your Medical Savings Account.