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Designated Service Provider (DSP)

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Providers you can go to

If you need to visit a general practitioner, specialist, radiologist, dentist, hospital or optometrist for medical services, find out what the rules are so that you will be covered and get the correct care.

Find out what the rules are about visiting healthcare providers

Rules: Visiting healthcare providers
General practitioners
Where can you go?
You need to visit general practitioners (GPs) in the POLMED GP Network.
Rules, conditions and penalties
You are allowed two visits to a GP who is not part of the network for emergency or out-of-town situations.
Benefits
GP consultations are paid for from your out-of-hospital benefit.
Pharmacies
Where do you go?
For chronic medicine, please make use of Clicks and MediRite Pharmacies, as well as Medipost and Pharmacy Direct for courier pharmacies. You can go to any pharmacy for acute medicine.
Rules, conditions and penalties
If a beneficiary does not obtain his or her chronic medicine from one of the above-mentioned pharmacies, a 20% co-payment will apply.

Hospitals
Where can you go?
Aquarium Plan members need to be admitted to a POLMED designated service provider (DSP) hospital to avoid a co-payment.
Rules, conditions and penalties
All admissions to hospitals, day clinics and out-patient units must be pre-authorised. A penalty of R1 000 will be imposed if pre-authorisation is not obtained. In the case of emergency, the Scheme must be notified within 48 hours or on the first working day after an admission.
Benefits
All products and services received in hospital are paid from the in-hospital benefit category, provided pre-authorisation is obtained. Important: Managed healthcare protocols are applied.

Radiologists
Where can you go?
You can go to any radiologist.
Rules, conditions and penalties
Pre-authorisation is required for specialised scans. In case of emergencies, the Scheme must be notified within 24 hours or on the first working day afterwards. If you do not obtain pre-authorisation, the Scheme will impose a co-payment of R500 per procedure.
Benefits

  • Radiology (basic)
  • Radiology (specialised)
Specialists
Where do you go?
You need to visit specialists in the POLMED Specialist Network.
Rules, conditions and penalties
Before visiting a specialist you need to be referred by a general practitioner (GP). The Scheme will impose a co-payment of up to R1000 if the specialist’s account does not reflect the referring general practitioner’s information.

The co-payment will be payable by the member to the specialist and is not refundable by the Scheme. (This co-payment is not applicable to the following specialities/disciplines: Gynaecologists, psychiatrists, oncologists, ophthalmologists, nephrologists (chronic dialysis), dental specialists, pathology, radiology and auxiliary services.)

However, the Scheme will not cover the cost of audiology tests if there is no referral from the GP/ear, nose and throat (ENT) specialist.
The Scheme will allow two specialist visits per beneficiary per year without a GP referral to cater for those who require annual and/or bi-annual specialist visits. POLMED would like to encourage members to make use of the POLMED Specialist Network where possible.
Benefits
Specialist consultations are accrued towards members’ in- and out-of-hospital benefits.

Optometrists
Where can you go?
POLMED has contracted eye care network Preferred Provider Negotiators (PPN) optometrists.

Rules, conditions and penalties
PPN optometrists charge PPN rates, which are up to 75% lower than the rates charged by optometrists outside the PPN network for certain lens prescriptions.
Benefits
Find out more about the optometry benefit under “Optical” in the guide to your health.

POLMED makes use of designated service providers (DSPs); these are groups of providers that charge POLMED rates. To access some benefits, it is required to visit these providers.