above threshold benefit
Managed care is used by medical schemes to reduce costs, while still keeping the quality of care high, and these can be done through provider networks, provider oversight, drug formularies, chronic condition programmes, and pre-authorisation mechanisms. While managed care programmes
Medical expenses such as doctor, specialist and hospital costs are not regulated, and service providers are entitled to charge fairly for their services. However, the Department of Health has issued a price guideline (known as the Reference Price List (RPL))
