Capitation contracts

ECIPA Healthcare is contracted to the following to render primary healthcare services via its GP members:
Medimed Essential Option (link to the Medimed website below)
https://www.medimed.co.za/medisave-essential/

Medimed Essential Option: How the ECIPA Healthcare capitation fee system works?

• Ecipa provides Medimed Medical Scheme with the ECIPA Dr list of members.
• Medimed makes the above list available to all individuals who are on the Medimed Essential Option.
• The individual (our patients) then selects his or her own GP.
• Medimed compiles a patient list per ECIPA Dr and emails this to each ECIPA Dr i.e. you should receive your patient list on a regular basis.
• Your staff must ensure that they make a note on the patient’s file that the particular patient has selected you. Staff need to actively manage this process and always check if a specific patient is on your list.
• Each ECIPA Dr will receive a capitation fee based on the number of patients that have selected the Dr. This fee is deposited by Medimed (Momentum TYB is the administrator for Medimed) into the Dr’s bank account in the 3rd week of every month.
• Each ECIPA Dr is required to submit claims to Medimed whenever Medimed Essential Option patients are consulted, even though the capitation fee paid is a fixed fee per month. This is a statistical requirement and essential; Medimed will penalise Ecipa for low claims submission.
• If an ECIPA Dr sees a Medimed Essential Option essential patient who is not on the Dr’s list, the ECIPA Dr can see the patient (known as 2nd opinion visit) and send a claim to Medimed – a fixed fee apart from the capitation fee (the amount is stipulated by Ecipa) will be paid to the Dr for these consultations. Please note that the patient has a limited number of 2nd opinion visits per year i.e. it is not unlimited.