Poor chronic cover

<p>As per membership guide page 38, section 36.5 chronic medication will be covered at 100% the Scheme's medicine reference price for Bankmed pharmacy Network. If not a DSP, only covered at 80% which means you will have a 80% deductible. My 9 month old son was diagnosed with gastro-oesophageal reflux disease and needs to use Nexiam 2.5mg on chronic. I was informed that, even though I'm using Bankmed DSP (Clicks) a 30%+ deductible will still apply. The whole point of the DSP is that Bankmed and the service provider have negotiated and agreed to the tariffs that Bankmed pays. Nowhere in my membership guide's terms and conditions mention is made of 30% deductible. This is misrepresentation by the scheme. I can't believe the number of complaints and queries I have had to lodge since Discovery took over as administrator in January 2016. Majority of my claims I have to query and adjustments need to get loaded to pay the claims correctly/in full. I have never had this much issues with any medical aid in 15 years of being on a medical aid. I used to deem Bankmed as one of the top scemes in the country but they are now one of the bottom ones which is really a pity - it never used to be like this. I am willing to escalate this to the Ombudsman if necessary. When I wanted answers, the chronic department merely referred me to the call centre, and they are unable to explain the above to me. This is not acceptable. There is also nothing I can do about the fact that no generic medicine is available for this product.</p>