National Health Reference Price List and Medical Scheme Rates (NHRPL & MSR Rates)

UPDATE: In July 2010 the National Health Reference Price List (NHRPL) was declared null and void by the Gauteng High Court. Currently prices are calculated according to the Reference Price List (RPL).

At some point in our lives, every one of us has to consider medical aid rates - whether it is when choosing which medical aid scheme will best meet our individual health needs, or when deciding which medical practitioner to consult or whether to ask for a generic medicine.

Understanding how medical aid tariffs are calculated can be difficult, particularly for people who are not familiar with medical aid jargon and acronyms such as BHF, NHRPL, ICD-10 and PMB, and MMAP®. Each of these terms has a specific meaning that is useful to know when navigating information offered by medical practitioners and medical aid providers.

Medical aids pay out according to Medical Scheme Rates (MSR), which differ from scheme to scheme. The MSR of Selfmed's plans are set according to each plan's benefits and level of cover:



Medical aid rates in South Africa

Until recently, South Africa had three tariff structures: the Board of Healthcare Funders (BHF) tariff list, the Health Professions Council of South Africa (HPCSA) ethical medical rates and the NHRPL. In January 2004 the BHF tariff was discarded, and in December 2008 the HPCSA stopped publishing its suggested rates; therefore, only NHRPL rates are currently used. Read on to learn more about how medical aid tariffs are regulated and to understand how this change affects you.

Board of Healthcare Funders tariff list

National Health Reference Price List (NHRPL)

What does this mean for medical aid members?

What are ICD-10 codes and how do they affect consumers?

What is MMAP©

Maximum Medical Aid Price (MMAP®) is a pricing reference model for pharmaceutical products. The MMAP listing is owned and maintained by Medikredit and guides the maximum amount medical schemes will pay for interchangeable multi-source pharmaceutical products (generics).

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