Prescribed medicine
Prescribed medicine
Prescribed medicine is non-chronic medicine. In other words, you generally do not take it for a long time and the condition it is taken for clears up.
This section explains how Naspers Medical Fund covers prescribed medicines in 2012
MMAP:
Maximum Medical Aid Price (MMAP) is the lower average cost available in the market for a specific classification of medicine. In most cases it is also the lower average generic price. We will pay for medicine up this price. If there isn’t a MMAP price, we will use the Fund Medication Rate to pay for the medicine.
We cover approved chronic medicine from the chronic medicine benefit limit and up to the Fund Medication rate, also referred to as the MMAP (Maximum Medical Aid Price). If you choose a medicine that costs more than the MMAP, we will still provide cover from the chronic medicine benefit limit, but there may be co-payments due by you.
For a chronic condition being recognised as a Prescribed Minimum Benefit (PMB) and prescribed in accordance with the conditions set out in the Medical Schemes Act, the Fund will not apply any limits on the benefit amount payable.
Prescribed medicine is paid from the day-to-day benefits
N Option Plus
We pay prescribed medicines from the money available in your day-to-day benefits. This could be your Medical Savings Account or Above Threshold Benefit.
We pay medicines up to the MMAP or the Fund Medication Rate.
N Option Basic
Prescribed medicine is paid from the day-to-day limit and is subject to the overall annual limit.
We pay medicines up to the MMAP or the Fund Medication Rate.