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Benefiting Plans

Receiving Benefits at the Health Service Providers
a) In a normal situation, the patient first presents his Beneficiaries’ card to the BEPHA Staff at Health Service Provider.

  • If he has completed his annual contribution and waiting period;
  • He receives a treatment form freshly stamped for validity which permits him to be covered and his BEPHA card is withheld by the BEPHA staff (the staff refers to the beneficiary folder present at the partner Health Facility to confirm the above condition).
  • During consultation and laboratory the treatment form is properly filled by the health personnel in charge.
  • After consultation, laboratory and before receiving medicines the BEPHA members/dependants, in possession of the guarantee letter and/or treatment form as the case may be, submit this letter to the hospital pharmacist/cashier who bills the prescription item by item and hands the treatment form to the beneficiary who takes the form to the BEPHA Staff present at the Health Unit. The BEPHA staff then crosschecks the pricing, checks for any irregularities and validates then returns the Treatment Form to the beneficiary who instead of having to pay the full amount of the fees merely pay 25 per cent of the bill plus uncovered expenses. The remaining 75 per cent of the cost will be taken care of, by BEPHA. The patient (member/dependent) makes sure he is given a receipt for the amount he has paid.
  • When the beneficiary has paid the balance and receives his drugs, he signs the Treatment Form which should have been completely filled and drops it with the BEPHA Staff present and collects his BEPHA card.

For surgeries
When feeling ill, the member/dependent should take his BEPHA card to the hospital and present it before consultation. In case of surgery the member/dependent should bring his BEPHA card to the BEPHA Office to collect a guarantee letter. The BEPHA Staff will verify the beneficiary card presented by the member/dependant and in particular scrutinize for correctness and completeness.
Members/dependants who have not paid their premiums completely or are still observing their waiting period shall not be issued a guarantee letter.
The BEPHA member/dependant should see the staff of the hospital or health unit and the staff of the Health unit will equally make sure that the bearer of the guarantee letter is the rightful person and entitled to claim health services. He then affixes the Guarantee Letter to a Treatment Form and same procedure as the case for minor risk followed.
- The Guarantee Letters and treatment forms are returned to the BEPHA Office to testify that the patient actually has been treated.
b) In the case of emergency, for a beneficiary who is up-to-date with his premium and hasn’t got his BEPHA card with him, and a BEPHA Staff is not present, a call should be made to the BEPHA Office to confirm his adhesion, he should be attended to and given a maximum of twenty four hours to produce his BEPHA card for extraction of necessary information used in his treatment form.

 

MODERATOR TICKET
This is the share of the cost of a covered health service that is not borne by BEPHA. This is always expressed in percentage. And in our case, it is 25% of the health service, to be paid by the Beneficiary on the spot: that is, before leaving the Health Unit.

 

CEILING
This is the highest amount, of the 75%, to be borne by BEPHA for any particular service given to its Beneficiaries. e.g. Surgical Operation is 75% up 70,000 FCFA.

 

DRUGS
BEPHA covers Generic and Essential drugs, but not Brand-name drugs.

  • Generic Drug: A medicine designated by the name of its main active ingredient and not by its commercial name. e.g. Paracetamol, Flagyl, etc.
  • Essential Drug: A medicine selected by the World Health Organization (WHO) or the Regional Special Fund for Health (RSFH) for its importance in preventing or treating a ]disease that occurs with high frequency in a given country or region.
  • Brand-name Drug: A pharmaceutical substance protected by a patent and sold under a brand name chosen by the manufacturer. e.g. Efferalgan, Flagentile, etc. Such drugs are usually more expensive than when they are in their Generic composition.