![]() With so much uncertainty for many people regarding their income, Medical schemes have various options to assist members in this time to try ensure members remain covered. Before you consider these options you could also consider: Downgrading your option: Your ability to downgrade may differ from scheme to scheme. Some medical schemes do allow members to buy down to a lower option during the year. This way members can reduce their monthly contributions to the medical scheme without giving up their membership. It is important for members to be mindful that terms and conditions apply to downgrading and these must be checked before a downgrade is requested. Below are the different schemes with a list of options for premium relief. Discovery health
Momentum Health
Fedhealth
PPS & Profmed Hold back termination of medical aid for 90 days due to non-payment. Status of medical aid will be suspended during 90 days. If you need further assistance on your medical aid please contact Namhla or Tammy email:[email protected] tel: (011)658-1333
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![]() Avoid close contact. Don’t go to your doctor’s rooms. So what are your options? Globally, people have been slow to take up consulting doctor using digital and social platforms. But, with COVID-19 now in 100s of countries, the number of people spending time with doctors through screens is increasing just as fast. The number of COVID-19 infections have exceeded 100 000 and are increasing daily. So are the number of people using telemedicine technology. With good reason. Using your computer or smartphone to see a medical professional is not new. Virtual consultations and treatment have been available in most healthcare systems and through medical schemes, including Discovery Health Medical Scheme, for some years. But, given the traditional preference for face-to-face consultations between doctor and patient, virtual consultations and remote care were mainly for the future, for tech-savvy generations. This view is changing fast as the world responds to COVID-19. Dr Peter Antall, the chief medical officer for AmWell, was quoted saying “telehealth is being rediscovered” as health systems are racing to adapt and even develop virtual services that can serve as their front line for patients. (Doctors and patients turn to telemedicine in the coronavirus outbreak). Virtual care is the first line of defence Technology-based consultations and remote contact with patients through virtual platforms are fast becoming the norm. As people connect virtually, healthcare professionals manage overcrowding of consultation rooms, ensure appropriate referral for care, and help prevent the highly infectious COVID-19 virus from spreading. More importantly, virtual care keeps the worried calm, and those who need immediate care are prioritised. “In South Africa, we’re raising awareness and taking appropriate precautions to help to minimise the spread of COVID-19. We must continue to do everything possible to minimise the chance of uncontrolled spread. Applying learnings from around the world in managing COVID-19, show access to and using telemedicine and virtual consultations are of critical importance. It has been an effective healthcare tool to ensure appropriate care while making sure infection rates are controlled by avoiding direct contact with others,” says Dr Noluthando Nematswerani, Discovery Health’s Head of the Centre for Clinical Excellence. The power of social distancing, part of which is offering virtual healthcare, has been invaluable in the success of China (fewer than 50 infections a day) and South Korea (from 900 infections a day to fewer than 200) in containing COVID-19. Promoting virtual consultations prevents medical facilities from becoming overcrowded with people, possibly spreading infection to others. Doctors from around the world agree with this approach and are praising telemedicine technology for helping to successfully manage COVID-19. Virtual consultations through DrConnect: reaching more people virtually Since 2017 Discovery Health Medical Scheme has had a virtual consultation platform called DrConnect. This digital platform, supported by artificial intelligence (AI) machine learning, gives members of the Scheme access to virtual consultations with healthcare providers they have visited in the past 12 months. Through the Discovery app, this platform also offers free trusted medical information from a worldwide network of doctors. “It’s natural that people may be concerned and would want to see a medical professional. Your first choice when any signs or symptoms of COVID-19 are present, should be to stay away from others. Contact your doctor, either telephonically or through virtual consultation channel, like DrConnect (that’s available through Discovery Health Medical Scheme). Accessing virtual consultations, especially now as a measure to contain COVID-19, ensures that people receive the correct care and that we protect the health of others,” says Dr Nematswerani. In response to COVID-19 infections in South Africa, Discovery Health Medical Scheme has a benefit to support the diagnosis and treatment of the illness. Going forward, Discovery Health is looking at opening a basic version of DrConnect to a broader segment of healthcare professionals and people. Commenting on this, Dr Nematswerani says, “With more people having access to and using virtual consultations, we can employ this as another method to contain the spread as well as minimise the accompanying health and other environmental effects of COVID-19.” Telehealth platforms are helping experts and medical professionals around the world to map cases and to distribute messages of prevention and appropriate care. Through effective prevention and encouraging virtual care, we can contain COVID-19. Source: Discovery Health ![]() Much debate has taken place around the proposed National Health Insurance Bill (NHI). Discovery’s overall position on NHI is unequivocal. We would like to provide some additional information to answer any questions you may have. Discovery Health is supportive of structural change that assists in strengthening and improving the healthcare system for all South Africans, and we are committed to assisting where we can in building it, and making it workable and sustainable, seeking to ultimately strengthen both the public and private healthcare systems for all South Africans. While the NHI is a huge, complex and multi-decade initiative and a considerable amount of debate and effort will be required to make it workable, in this brief note, we review some of the key issues arising from the NHI Bill and then look at the NHI policy process going forward. The role of medical schemes once the NHI is implemented A central issue is the future role of private healthcare and medical schemes once the NHI is implemented. The NHI Bill states that when the NHI is ‘fully implemented”, medical schemes will not be able to provide cover for services that are paid for by the NHI. Discovery's strong view is that limiting the role of medical schemes would be counterproductive to the NHI because there are simply insufficient resources to meet the needs of all South Africans. Limiting people from purchasing the medical scheme coverage they seek will seriously curtail the healthcare they expect and demand. It poses the risks of eroding sentiment, and of denuding the country of critically needed skills, and is impacting negatively on local and international investor sentiment and business confidence. Crucially, by preventing those who can afford it from using their medical scheme cover, and forcing them into the NHI system, this approach will also have the effect of increasing the burden on the NHI and will drain the very resources that must be used for people in most need. Discovery also believe that limiting the rights of citizens to purchase additional health insurance, after they have contributed to the NHI, would be globally unprecedented and inappropriate. In virtually every other country with some form of NHI, citizens are free to purchase additional private health insurance cover, including cover that overlaps with services covered by the national system. A restriction on choice of medical scheme cover is not dissimilar to limiting the rights of citizens to purchase private education for their children or private security, on the basis that the public system already provides state schooling and security services. Given the substantial harms that this approach of limiting the role of medical schemes will cause, it must surely be strongly justified for good policy reasons. However, we are not aware of any sound policy reason or justification that has been put forward for this approach. Discovery believe that medical schemes will continue to cover all of the healthcare services which they currently cover for the foreseeable future for a number of reasons:
Discovery is already actively engaging with the Department of Health on this critical set of issues, alongside the broader business community, and we will continue to do so in order to ensure that medical schemes and private healthcare remains a critical part of the healthcare system, together with the NHI. The financing of the NHI system The Bill makes no reference to the likely costs of the NHI once fully implemented. Any fundamental change that improves quality and access and seeks to contract with private providers will require substantial additional funding. We understand that National Treasury will soon be publishing a costing document, and that this is likely to be based on an incremental approach to providing NHI benefits. The Bill specifies that payroll taxes and a surcharge on personal income tax could be considered as sources. Such taxes would need to be determined by National Treasury. At the presentation of the Bill, the Minister of Health indicated that no tax changes are envisaged over the 3 year period of the current Medium Term Expenditure Framework. In our view, there are material challenges to raising new revenues to supplement the current government budget for healthcare, and this is unlikely to change in the foreseeable future. This suggests that the rollout of the NHI will be slow unless there is a substantial improvement in the country’s economic prospects. The role of private hospitals and health professionals The Bill envisages that the NHI Fund will contract on a voluntary basis with private hospitals and health professionals to supplement the current public sector delivery system. For the foreseeable future, we expect that the NHI will contract with some GPs to supplement primary care services, and also that it will contract for certain high priority services to address specific gaps in public sector provision. If this is achieved, it will already be a significant step forward. Beyond that, we expect that the vast majority of NHI services will continue to be delivered by public sector clinics and hospitals, and that private hospitals, specialists and other providers will continue to be funded by medical schemes. South Africa is blessed with a committed, highly skilled and world-class healthcare professional community. These professionals work hard, provide excellent care and are committed to our country. We will work hard to defend their rights to fair remuneration, to an optimal working environment that promotes sustainability and ideal patient care, and to retaining and supporting them within our broader healthcare system. The NHI Bill Process The NHI Bill has been tabled in Parliament and is now in the hands of the Portfolio Committee on Health, which will hold formal hearings in early 2020. Discovery is actively participating in a direct engagement process between Business Unity South Africa and the Department of Health to discuss a number of issues of common interest, including the NHI. There is also a parallel process within NEDLAC, offers further opportunities for business, labour and government to engage on the final content of the Bill. We expect the Bill to be finalized sometime during 2020 at the earliest. Concluding remarks While the NHI Bill certainly raises some serious concerns, we recognize the need for structural change to improve healthcare for all in SA. We believe this should leverage the strengths of the key elements of the current public and private healthcare systems, and we remain confident that the final outcome will be rational and workable. Discovery is committed to playing its role in building a positive future - for our members, South Africa’s healthcare professionals, and for all South Africans. Frequently asked questions ![]() Did you know,that you can request extended chronic or acute medication when you are travelling out of South Africa for more than a month or up to 6 Months. This benefit is only available if you will be travelling more than a month or up to 6 months. Discovery will review the request only when you need the extra supply of chronic or acute medication because you will be outside the borders of South Africa for longer than one month or up to and no longer than six months. Please note the maximum period for extended supply of medicines Discovery will consider Months. The request will be declined if its longer than Months If you change Medical aid plan, cancel membership or if the membership is suspended during the period for which the extended medication is approved, member will be liable to pay the cost themselves. How to activate this benefit or what you need to do!
Source: Discovery ![]() 1.Claiming from Medical Aid Daily Claims The day to day claims, like your Gp, Specialist, buying medication will be covered from your MSA Benefit, however if you are using a hospital plan, day to day is not submitted. Hospital claims. This is any claim that has been authorized for hospital stay, this can be a day or more than, so this will be paid from the hospital benefit Documents required to submit claim Valid invoice, not older than 3 months which must include, - Dr Details, Practice number, service date, ICD10 Code and Procedure code - Details of the patient i.e Name, surname and date of birth, Medical aid number Where to submit Medical Aid claim
2.Claiming From Sirago Any claims that needs to be submitted to Sirago has to submitted to your medical aid before claiming from the Gap Cover. Gap cover will only pay if it’s a valid claim which is based on one of the following:
Documents required to submit claim -Complete claim form -Invoices -Hospital statement -Medical aid statement, reflecting all the invoice or providers that has shortfall Where to submit
![]() Sirago has some great great updates and additions in 2020 which are:
Below are the benefit comparison update for Ultimate Gap cover & Plus Gap cover for 2020: ![]()
o Physiotherapy consultations and treatment o Biokineticist consultations and treatment o Dietician consultations and treatment o A smoking cessation programme o Blood tests o X-rays
o New moms will also be able to access vouchers offering up to 70% off baby products at Baby City 2020 Contributions The Fund announced that the increases for 2020 range from just 6.2%, with an average increase on risk contributions of 9.4% and an average increase of 9.9%. The increases were as follows:
Click here to download the 2020 product brochure Please contact Namhla or Tammy in our Health and Wellness Department, email [email protected], if you have any queries about Bonitas Source: Bonitas |
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January 2025
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