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In previous weeks, we shared information on PSMAS mandate, products, and services. One then wonders, if I join PSMAS, where do I get services from? If I do get the services, will I be asked to pay shortfalls and co-payments and why?
Others may also want to know what else is there to benefit from a PSMAS membership.
This week, we will therefore look at these and other related issues in detail.
Access to healthcare services
PSMAS has a network of service providers also known as Premier Express Network. Premier Express Network is a list of over 1 000 preferred service providers that PSMAS has entered into agreement with to provide service to its members.
These service providers include general practitioners, specialist practitioners, hospitals, both private and public, diagnostic services, pharmacies and dental practitioners.
Providers on Premier Express Network are distributed countrywide across all provinces.
The network also include government hospitals, local clinics and mission hospitals.
Although PSMAS recommends that its members use the network, members are also free to seek services from other providers outside the network, however, they could be required to pay cash upfront.
If this happens, PSMAS reimburses the member after their claim form is presented and approved in accordance with the Society’s guidelines.
It takes between 4 to 6 weeks for a claim reimbursement process to be complete.
To access the Premier Express Network members can WhatsApp 0783 183 530, Call 08688002635 or visit our Facebook Page @PSMAS Zimbabwe and Twitter Page @PSMASZim. They can also download it via https://bit.lypsmasproviderslist.
Shortfalls and co-payments?
Generally, the rate of subscription determines the level of shortfall or co-payment one may meet. The benefits increase as the subscription increases i.e. the higher the subscription, the higher the benefits.
In medical aid, there is something called a tariff. A tariff is a specific threshold according to which the medical aid fund is willing to reimburse for healthcare treatment and services rendered to the member.
When service providers charge more than this threshold, members can experience shortfalls.
However, the vast majority of PSMAS network providers do not charge shortfalls. If they do, they will be minimal.
Since subscriptions determine benefits and ultimately level of shortfalls and co-payments, PSMAS members who afford are encouraged to consider higher plans as this also translates to greater benefits.
Healthy living
Besides facilitating access to healthcare services for its members, PSMAS also encourages and offers prevention programmes to all its members through its Premier Lifestyle Programme.
This programme encourages healthy living through prevention, early diagnosis, and disease self-management.
It further makes available a wide range of health and wellness services to all members such as cervical cancer screening for women and prostate cancer screening for males aged 40 and older.
Furthermore, PSMAS runs routine screenings for non-communicable diseases such as diabetes and blood pressure.
Online Reporter