Overview
The Optical Benefit covers healthcare services in respect of eyes, vision, visual systems and the processing of
visual information.
This document will explain the Benefit for 2018 and provide details on how the benefit works for your specific
Plan.
Terms used in the document:
Term Meaning
Day-to-day benefits These are the funds available in the Medical Savings
Account or under the Above Threshold Benefit
Scheme Rate This is the rate at which Bankmed will pay
Healthcare Professional accounts
Optometry Benefit on your Plan
Core Saver Plan
We pay for optical benefits from your available funds in your Medical Savings Account up to 100% of the
Scheme Rate at Bankmed network optometrists.
Plus Plan
A limit of R4 050 is available per person for the year. We pay up to 100% of the Scheme Rate for Bankmed
network optometrists. This limit applies to claims paid from your Medical Savings Account or Above Threshold
Benefit. This is not a separate benefit; you need to have funds in your Medical Savings Account or have
reached your Above Threshold Benefit, before we pay up to this limit.
If you join the Scheme after January, you won’t receive the full R4 050, because it is calculated by counting
the remaining months of the year.
The optical cover includes professional services, cover for prescription lenses, contact lenses and readymade
readers (via optometrists only). We pay up to 100% from available savings for Frames and Lens add-ons.
Frames and extras do not accumulate towards reaching the Annual Threshold and are not covered as an Above
Threshold Benefit.
You get a discount
You obtain a 20% discount on your frames and eyeglass lenses when you visit an optometrist in the Bankmed
Optometry Network. The discount is immediate at point of sale and will help you preserve your Medical Savings
Account.
The discount is available on the following Bankmed Medical Scheme Plans:
Core Saver Plan
Plus Plan
The discount is only applicable to hardware items such as frames, eyeglass lenses and their add-ons. The
discount is not available for contact lenses and professional services such as consultation and eye examination
fees.
Visit [Link] to find a participating optometrist in the Bankmed network.
How the discount is calculated
The 20% discount is calculated on the Optical Assistant Rate, which will be the Bankmed “in-network” rate.
Example: R1 000 = Optical assist Rate, Bankmed rate would be R1 000 – 20% = R800
The Optical Assistant Rate is a guide used by optometrists for billing purposes.
What to do when you pay cash
For cash payments, you receive the discount immediately and you pay the amount after the 20% discount has
been deducted. Once you have paid, you must submit the invoice and proof of payment to us and we will pay
the claimed amount as reflected on the invoice.
Who we are
Bankmed Medical Scheme (referred to as ‘the Scheme’), registration number 1279. This is a non-profit
organisation, registered with the Council for Medical Schemes. Discovery Health (Pty) Ltd (referred to as ‘the
administrator’) is a separate company and an authorised financial services provider (registration number
1997/013480/07). Discovery Health is responsible for the administration of Bankmed Medical Scheme.
Complaints process
You may lodge a complaint or query with Bankmed Medical Scheme directly on 0800 BANKMED (0800 226
5633) or address a complaint in writing directly to the Principal Officer. Should your complaint remain
unresolved, you may lodge a formal dispute by following Bankmed Medical Scheme’s internal disputes process.
Members, who wish to approach the Council for Medical Schemes for assistance, may do so in writing to:
Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco
Park, Centurion, 0157 or via e-mail at complaints@[Link]. Customer Care Centre: 0861 123
267/website [Link].
Bankmed Medical Scheme. Registration number 1279.
