Medihelp has limits on certain day to day benefits such as an overall day to day limit of R2130 and physiotherapy for example is subject to a sub-limit of R1460 per annum.
Medihelp despite the R1460 limit being reached for physiotherapy, continue to allocate any PMB benefits for physiotherapy treatment against my family's overall day to day limit.
I enquired from Macdonald who says that is just how their system works.
How can something that is paid from risk or PMB be allocated and used against overall day to day benefits?
Future physiotherapy treatment will exceed R2130 and Medihelp is effectively saying then that my overall day to day benefits will exceed the R2130 limit.
Surely, if something is being paid from risk/PMB, then it cannot accumulate against the day to day benefits. I suggest Medihelp consult standard practices in the Medical industry in this regard.
Furthermore, kindly consult the Medical Schemes Act whereby any PMB treatment may not be paid, and therefore, allocated against any savings or day to day benefits.
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