Make the best of your cover by using designated service providers (DSPs)

At TFG Medical Aid Scheme (TFGMAS), we aim to bring you comprehensive healthcare cover. One of the ways we do this is through our DSPs.

What is a DSP and why are they important?

A DSP is a healthcare provider or facility that is contracted with your medical aid, TFGMAS. These providers are carefully selected and they must meet our standards to remain DSPs on our scheme. So, you can always be assured that you are provided with the best treatment.

Why you should consider using a DSP

We encourage you to use our DSP network as much as possible - not only does this assure you that you're getting quality healthcare services, you also won't have any deductibles (amounts you have to pay yourself).

Using DSPs is particularly important in order to cover your Prescribed Minimum Benefit conditions in full.

What are PMB?

By law, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:

• A medical emergency (this is a situation in which immediate medical attention is required to prevent serious harm, injury, or death to a person due to a sudden illness or injury)
• A list of 271 diagnoses
• A list of 27 chronic conditions.

PMB's will be covered if:

• Your medical condition qualifies for cover and is part of the defined lists of PMB conditions.
• The treatment for your conditions matches the treatments outlined in the defined benefits.
• You must use DSPs in our network. This doesn't apply in the case of a medical emergency, but we might request that you are transferred to a hospital or other service provider in our network once you have stabilised.

Important: If you do not use a DSP, we will pay up to 80% of the Scheme Rate for any PMB claim. This means that you will be responsible for the difference between what we pay and what the provider charges for the treatment.

More information

• Find a DSP in your area on our website or call us at 0860 123 077.
• You can also find out more about how cover with a DSP works on your benefit plan. Please refer to page 11 in the TFG Health benefit guide and page 12 in the TFG Health Plus benefit guide or visit www.tfgmedicalaidscheme.co.za and navigate to: Find a Document > Information Guides.