Admed provides the solution

Admed is a specially designed product which provides cover for the shortfall, or gap, in the event of hospitalisation involving surgery or medical treatment, as well as for certain procedures performed on an outpatient basis. The shortfall, or gap, is defined as the amount by which the actual cost charged by the medical practitioner (e.g. anesthetists, surgeons, other specialists and GP’s) exceeds the Medical Scheme Tariff.

Admed will pay the difference between the amounts charged by the medical practitioners and the Medical Scheme tariff to a maximum of 4 times the Admed-tariff.

AdmedPulse is a specially designed product which provides cover for the shortfall, or gap, in the event of hospitalisation involving surgery or medical treatment, as well as for certain procedures performed on an outpatient basis. The shortfall, or gap, is defined as the amount by which the actual cost charged by the medical practitioner (e.g. anesthetists, surgeons, other specialists and GP’s) exceeds the Medical Scheme Tariff.

AdmedPulse will pay the difference between the amounts charged by the medical practitioners and the Medical Scheme tariff to a maximum of 4 times the Admed-tariff. Where a procedure falls within the defined list of covered procedures, the minimum benefit is the greater of the gap calculated above and the defined minimum benefit for the particular procedure.

“Admed Tariff” means a tariff table published by Guardrisk Insurance Company Limited made up of procedure codes as previously published by the Council for Medical Schemes and appropriate tariffs as determined by Guardrisk Insurance Company Limited for each procedure code.

Demarcation between Medical Scheme Business and Insurance Business