Latest member news

Announcements

Year End Update

Benefits and Contributions 2019 Dear Member It is said that each year goes faster and faster, and I have found […]

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Announcements

CMScript – Council for Medical Scheme’s Newsletter

CMScript is an e-newsletter published by the Council for Medical Schemes on Prescribed Minimum Benefits or PMBs. Each issue looks at a different disease and it covers treatment and care.

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View all member news

Member Information

Member Guide

Downloadable pdf guide for everything Topmed members need to know

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How to Claim

A guide on how and where to submit claims for payment

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Chronic Conditions and Formulary

Find out what chronic conditions your option covers, as well as view the formulary for each condition. To view the […]

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Other Benefits

Prescribed Minimum Benefits
Chronic Benefit
Ambulance Service
Crisis Counselling and Referral Hotline ER24
International Business & Leisure Travel Insurance
Optical Benefit
Prosthesis Benefit
Wellness Benefit
Deductibles and Co-payments

Care Programmes

Mental Wellness Programme

Find out what the signs and symptoms of Depression are and what benefits the programme offers.

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Lifestyle Management Programme

Find out more about the benefits of the Lifestyle programme and how to register.

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HIV / Aids Programme

Overview and benefits of the programme and how to register.

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Oncology Disease Management Programme

Benefit overview of the Oncology Programme and how to register for benefits.

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Diabetes Management Programme

Diabetes can be managed and our programme will help you to do so, Find out more about the benefits of the programme.

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Maternity Programme

Understand how and when to register for the TopBaby Maternity Programme in order to access this benefit.

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FAQs

How will I know when my claim has been settled?
What is the deadline for submission and payment of a claim?
What must I do in the case of an emergency?
What is pre-authorisation (PAR)?
What happens to my savings balance at the end of the year?
What happens if my contributions fall into arrears?
When are my membership contributions payable?
When can I change my option?
What is a condition-specific waiting period?
What is a general waiting period?
How to submit a claim


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Preferred providers

Pharmacy Network

Topmed members can choose between a courier pharmacy or a network pharmacy. Login to find a pharmacy close to you or contact our Client Services Department on 0860 002 158 for assistance.

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GPs & Specialists

Please login to access a list of DSP GPs & specialists or contact our Client Services Department on 0860 002 158 for assistance

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Hospital Network

Please login to access the Hospital Network list or contact our Client Services Department on 0860 002 158 for assistance.

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Download our free app

Get easy access to emergency and key contact details, information regarding your option, statements, benefits, savings balances and other great features.

Resolving problems & queries

The following table illustrates how to log a telephonic or email query, problem or complaint in the most effective manner.

Call Client Services
0860 00 21 58

Claims payment and accounts
Benefits
Contributions
New cards
Underwriting
Contact details
Designated Service Provider
Formularies

Call a Dedicated Wellness Nurse
0860 00 21 58

Health Advice
HIV
Maternity Programme
Fortitude
Ex-Gratia
Medical Queries
Protocol for PMB
Chronic Benefit
Investigation and Procedures

For Escalated Queries

Operations Manager: 0860 00 21 58

Administrator’s Chief Executive Officer: 0860 00 21 58

Disputes and complaints may also be posted to queries / complaints at Topmed, P.O.Box 1462, Durban, 4000 or via email to info@topmedms.co.za. It is important to follow the process depicted above as it will provide you with a response in the shortest possible time.

Should you feel that your concerns are not being addressed, you may also contact the Principal Officer at principalofficer@topmed.co.za.

If your issues are not resolved through the above process, members may also appeal via the Council for Medical Schemes on complaints@medicalschemes.com.