1 reviews | Active since May 2015
My yearly limit is used to pay my chronic medicine
I am on Paladin Comprehensive cover with Topmed and paying close to R3000 every month, I am a diabetic and this morning my accu-check machine stopped working. I called Topmed to enquire as to whether they will cover the cost of a new machine, i was told no that they would not and subsequently discovered i only have R200 left on my yearly limit (which i was told is used for my drs visits and such as i was told last year when i was diagnosed that the chronic meds will be paid from a separate benefit which i was told was a yearly amount of R30 000) having apparently used over R7000 of my yearly limit. when i asked how this happened because i have not been to the dr in sessions accumulating to R7000, i was told that my chronic meds get paid from my yearly limit, when this runs out then the chronic benefit kicks in but i am left at the disadvantage of having to pay everything for myself going forward, the dr visits, prescriptions not under chronic, the new machine, everything, despite the fact that i have not used my yearly limit basically at all and only pick up my medication. this is unacceptable, i cannot pay this much, use it sparingly and still get abused by this company.
On the Paladin Comprehensive option your day-to-day benefits is a risk benefit. Hence all treatment received out-of-hospital is payable from your annual day-to-day allowance. Once your day-to-day allowance is depleted you will go in a self-funding gap. In your self-funding gap you are required to pay for claims your self and submit it to the Scheme to accumulate towards your Threshold.
Whilst in your self-payment-gap treatment as per your Chronic treatment plan and PMB Chronic Medication will be paid as PMB.
Once your threshold limit is reached, further day-to-day claims will be paid subject to the Limited Extended Cover and benefits limits as stipulated in your benefit summary.
Kind regards
Yolandi Knoetze
On the Paladin Comprehensive option your day-to-day benefits is a risk benefit. Hence all treatment received out-of-hospital is payable from your annual day-to-day allowance. Once your day-to-day allowance is depleted you will go in a self-funding gap. In your self-funding gap you are required to pay for claims your self and submit it to the Scheme to accumulate towards your Threshold.
Whilst in your self-payment-gap treatment as per your Chronic treatment plan and PMB Chronic Medication will be paid as PMB.
Once your threshold limit is reached, further day-to-day claims will be paid subject to the Limited Extended Cover and benefits limits as stipulated in your benefit summary.
Kind regards
Yolandi Knoetze