We answer your questions about cover on the TFG Health Benefit Plan

Must my selected GP be in the KeyCare GP Network?

Yes - You and your dependants must select GPs who are in the KeyCare GP Network to make sure your GP visit is paid in full.

Do all members of my family have to select the same GP?

No - Each family member may select their own “primary” GP, or you can have the same “primary” GP for the whole family, but choose them before your first consultation.

Am I only allowed to have one selected GP per family member?

Sometimes you might want to see a doctor close to your office, other times close to home or school. We would like to offer the option of a second GP, so each member of the family can select two GPs. Your second GP will be known as your “secondary” GP.

What should I do to find the details of the GPs who are contracted on the KeyCare GP Network?

  • Go to our website www.tfgmedicalaidscheme.co.za and log in with your username and password.
  • Click on TFGMAS and then on Find a healthcare professional. Search by healthcare professional name or by area.

What should I do next to ensure my GP visit is covered by the Scheme? How do I “nominate/allocate” a primary and secondary KeyCare Network GP?

Once you have found a GP on the network list that you would like to choose, it is important that you:

  • Send us an email with the details of your chosen GPs to service@discovery.co.za and that you include:
    • Your membership number;
    • Full names and practice numbers of your primary and secondary GP (where applicable);
    • Names and practice numbers of the primary and secondary GP for each of your dependants.

It is important to know that your selected GP will be assigned to your membership from the first of the month following the month in which you send us the details of your chosen GPs.  For example, if you choose your GP in February 2019, they will only be allocated as your GP from 1 March 2019.  You can thereafter book a GP visit, but you will only be fully covered from your Scheme benefits from the 1st of March. If you need to see the GP immediately you may still consult with your chosen GP. This consultation will be paid from your out-of-area benefits.

If you cannot access the Find a healthcare professional tool on the website, please call our call centre on 0860 123 077 and we will guide you through the process of choosing a GP.

How will you cover my medicine at my chosen GP?

  • You will need to enquire with your GP whether he/she is a dispensing GP or a non-dispensing GP.
  • A dispensing GP must give you the medicine and may not give you a prescription.

A non-dispensing GP must give you a prescription for medicine that is on the prescribed medicine list. This is an extensive list and as such it is not feasible to be published.  Your GP will know whether the medication he/she has prescribed is on the prescribed medicine list.  Please be sure to ask your GP whether the medicine is on the list.  Any prescribed medicine that is not on the list, will have to be paid from your own pocket.

What happens when I am on holiday or out of town?

We allow each member of your family to have four out-of-area GP visits. This applies only in South Africa. We pay these claims up to 100% of the Scheme Rate. From the fifth visit, if you visit a different doctor other than your chosen GP, we will no longer pay for your visit to a non-network GP. It is therefore very important that you visit your selected GP and keep these four visits for when it’s really necessary.

What if I need to change my selected GP?

You can change your selected GPs up to three times in a calendar year. There is no prescribed period within which to do so, although it is important to ensure your GP is selected and activated against your membership, before visiting the GP for the first time. If the need arises to visit your GP before you have allocated a GP, you must contact us to make the necessary adjustments. You will need to provide the name of the newly selected GP and their practice number to us to allocate him/her to your records for purposes of processing your claims correctly.