Your Bankmed Optometry Benefit Explained

The Bankmed Optometry Department will extensively monitor utilisation by Healthcare Professionals and members, and manage the optical benefits for members on the Core Saver, Traditional, Comprehensive and Plus Plans.

All optical benefits are subject to clinical necessity according to the Optometry Benefit Management Programme and the limits that apply to your Plan.  Benefits are limited to the Scheme Rate for spectacle lenses and contact lenses. You can choose either glass or plastic spectacle lenses.

How it works

Bankmed members receive optometry services and material, like spectacles and contact lenses, at a preferred and discounted rate from any optometrist within the Optometry Network. You will receive services and items at a guaranteed reduced rate. The Bankmed Optometry Network incorporates 97% of all optometry providers in South Africa, making it more likely that your chosen optometrist is a member of this network. To find an optometrist, contact our Optometry Management Department by calling 0800 BANKMED (0800 226 5633) and selecting the option for optometry when prompted to do so. Kindly ensure you have your membership number ready when calling us.   

Items that may not be covered by Bankmed

Not all items prescribed by your optometrist may be covered. Some of these items include:

• Sunglasses and spectacles with a tint exceeding 35%.
• Lens additions and/or luxury (branded) lens add-ons that are not clinically essential. Benefits for extras or lens additions are subject to pre-authorisation.
• You have a 24-month rolling limit between spectacle claims.  In other words, if you claimed for spectacles in April 2019, the next time you can claim for spectacles is April 2021.  Spectacles submitted during this rolling 24-month cycle will not be funded.
• Benefits are limited to either spectacles or contact lenses (not both).
• Requests  for new spectacles within the rolling 24-month cycle require a motivation and the additional benefit will be provided only if there is a clinical necessity.

Your role

As an informed member, you can contribute to reducing healthcare costs.  The next time you require eye care, kindly ensure the following:

• Before you consult with your optometrist, confirm your available benefits.  Please contact our Optometry Management Department by following the instructions above. The Optometry Management Department will be able to assist you with benefit queries.
• Before placing the order for the spectacles, please speak to your optometrist about the cost of the items and find out if there are any items they plan to claim for, but that will not be covered by Bankmed.  If necessary, please ask your optometrist about the uncovered services/items and whether they are all necessary.  By doing this, you can be sure that you are prepared for any co-payments and shortfalls that could be incurred.

Should you have any further questions in this regard, please feel free to call us on 0800 BANKMED (0800 226 5633) and select the option for optometry when prompted to do so.