Medical Aid Fund

Building Industry Medical Aid Fund

Overview

What is a medical aid fund?

It is a fund to which a large number of people contribute to help with unexpected medical expenses when needed.

The unique nature of the Building industry medical aid fund

It is a “pay as you go” fund that recognizes that members may have periods of unemployment from time to time.  If an employee does not qualify for a benefit for one day or more then it is his responsibility to purchase the medical aid benefit, either via his Employer or directly from the BIBC.

 It also has a low contribution rate and limited benefits which are designed specifically for the building industry in the Western Cape.The Fund has been in existence since 1970, and, even though it does not fall under the Medical Schemes Act, it meets that Act’s minimum financial requirements.

How do I qualify for medical aid?

You must be an artisan in the building industry. You must have made at least 16 weekly (80 daily) contributions and thereafter complete a registration form.

What happens when I qualify for benefits?

You will have to come into our office to register; you will need your Identity Book, marriage certificate and birth certificates of your children. An explanation of the benefits will be explained to you.

A medical aid card will be issued with your name, address and dependants. Your card needs to be updated on a regular basis with your next benefit date on condition that your benefit contributions are up to date.  You need to phone or visit our offices for a new date.

What is difference between the benefit date and the date of service?

The benefit date is the date on your medical aid card and indicates the date up until when you are entitled to benefits.The date of service is the actual date that you went to the doctor, dentist, pharmacist etc.

How do I submit a claim?

All accounts received from your doctor, dentist, pharmacist, and hospital etc., can be forwarded to the Fund for payment. All you need to do is sign the account, write your holiday fund number on it and submit it by hand, post or fax.

Are there any limitations on benefits?

 The benefit limits include the following: 2016-2017 Benefit Year

 The fund only covers 90% of the scale of benefits and the remaining 10% is for the members’ own account.

  • An overall maximum of R58,000 per year per family.
  • Medicine  – R8,000.00 per year per family. The member will be required to pay a R5.00 levy on all medicine dispensed.
  • Dental Benefits - R5,000 per year per family.
  • Optical benefits – R3,200 per year per family.
  • Private hospitals cover is limited to a R1,800 ward fee per day and a R3,600 theatre fee.
  • Cover is for 90% of cost of materials whilst in hospital and the remaining 10% is for the members’ own account.
  • We allow R1000.00 OTC (over the counter) medicine per family per year and there is no R5.00 levy to be paid.

 

 

The benefit limits include the following: 2015-2016 Benefit Year

  • The fund only covers 90% of the scale of benefits and the remaining 10% is for the members’ own account.
  • An overall maximum of R54, 000.00 per year per family.
  • Medicine  – R7,500.00 per year per family. The member will be required to pay a R5.00 levy on all medicine dispensed.
  • Dental Benefits - R4,800 per year per family.
  • Optical benefits – R3,000 per year per family.
  • Private hospitals cover is limited to a R1,650 ward fee per day and a R3,300 theatre fee.
  • Cover is for 90% of cost of materials whilst in hospital and the remaining 10% is for the members’ own account.
  • We allow R1000.00 OTC (over the counter) medicine per family per year and there is no R5.00 levy to be paid.

 

 

BIMAF rates per Month?

Benefit Year: 2016-2017

Pensioners:   R486.00                     Voluntary:       R1598.40

Benefit Year: 2015-2016

Pensioners:   R450.00                      Voluntary:       R1480.00

 

Attachments:
Download this file (BIMAF RULES.pdf)BIMAF RULES[ ]179 kB