Overview

Designated Service Provider (DSP)

When you use the services of a Designated Service Provider (DSP), all claims, including Prescribed Minimum Benefits, are paid in full. This means you will not have to make out-of-pocket payments when using the services of these providers.

These Designated Service Providers are specific providers of healthcare services, for example General Practitioners and Specialists, who have agreed to provide services to TFG Medical Aid Scheme members according to certain agreed rules. The Scheme pays these providers directly.

Cover for non-network providers

If a GP or specialist that is not a Designated Service Provider sees you in hospital, we will cover you up to 100% of the Scheme Rate.

If you are treated Out-of-Hospital by a non-network provider, we will cover you up to 80% of the Scheme Rate on TFG Health Plus and up to 100% of the Scheme Rate on TFG Health.

You may have a co-payment if your provider charges above these rates.

In certain instances you will not have to pay co-payments or deductibles 

The Scheme will still pay the Prescribed Minimum Benefit claims in full if you have involuntarily obtained the services from a provider other than a Designated Service Provider, if:

  • it was an emergency, for hospital admissions
  • the service was not available from the Designated Service Provider or would not have been provided without unreasonable delay; or
  • there was no Designated Service Provider within a reasonable distance from your place of business or residence.

The Scheme’s designated service providers for the diagnosis, treatment and care costs (which may include medicine) for Prescribed Minimum Benefit (PMB) conditions are:

Specialist ServicesThe Premier Specialist Network
General Practitioners’ ServicesThe Discovery GP Network
Chronic MedicineAny pharmacy willing to charge dispensing fees at the Scheme’s Medicine Rate.
Drug and alcohol rehabilitationSANCA, Nishtara or RAMOT
Renal care, including dialysisNational Renal Care

Where the Scheme has appointed a Designated Service Provider (such as these listed above), non PMB's will only be paid in full if the services are obtained at the DSP.