![]() DID YOU KNOW: Digital cards give you access to your Discovery Health Medical Scheme membership card in a digital format on your smartphone device. This is a safe and secure way to store, access and view your details. It serves the same purpose as the plastic cards except they are always kept up to date in real time with your membership status. As a Discovery Health Medical Scheme member, you can use your digital card when you visit a healthcare professional as they will use your details on the card to identify you and confirm your Discovery Health Medical Scheme membership. Your digital Discovery Health Medical Scheme membership card does not replace your plastic Discovery Health Medical Scheme membership card; it offers you a digital solution to carry your card. If you have an iPhone or iPod Touch, you can also store this card on the Passbook app. For more information, click here or contact a Daberistic healthcare consultant on 011-658 1333.
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Medical aid is a necessary yet expensive purchase in South Africa. Due to the public healthcare system unable to cope with the public demand, people who can afford it or who work for larger employers will choose private healthcare. They buy medical scheme products to cover such healthcare expenses.
Since medical aid is expensive, it is important for a member to understand its benefits, in order to make the best use of it when needed. As each new year begins medical aid members start with a clean slate, with new benefits and replenished savings available. If you manage your medical expenses correctly you can avoid out-of-pocket expenses and limit the possibility of running out of benefits. 1. Read up on your medical aid plan Take the responsibility of understanding your medical aid plan. Visit the medical scheme's website, find your specific medical aid plan information and read through it. Check out the FAQs. If your medical scheme creates YouTube videos on your specific plan and benefits, watch these videos. The more you understand your medical aid plan, the better you are in a position of making use of benefits provided for by the plan. 2. Speak to your Healthcare Advisor Medical aid plans are complex. A medical aid plan has many details, terms and conditions. Many members will struggle to make sense of it. A Healthcare Advisor with suitable qualification, training and years of experience can simplify matters for you and answer your specific questions. 3. Find a GP on your medical aid's network Using network doctors is an invaluable tool to make your medical aid last longer as it means you won’t be charged more than a specific amount. 4. Always use partner networks Medical schemes negotiate preferential rates with providers who have partnered with them. This means if you use a network hospital, doctor or pharmacy you will not be charged more than the rate agreed with the scheme. This will also help you to avoid co-payments, deductibles and additional out-of-pocket expenses. 5. Ask your pharmacist Buy over-the-counter medicine to treat less serious ailments and consider using generic medicine which is cheaper but effective. Pharmacists are able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask! 6. Going to hospital - get the facts Talk to your doctor or specialist before being admitted to hospital. Check what they are going to be charging and what your scheme will cover. If there is a large difference, don’t be afraid to approach your doctor to see if they are prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers who are on your scheme’s network that will charge you a better rate. 7. Remember to pre-authorise Pre-authorisation is required for all hospital admissions to ensure your stay will be covered. Always ask if there are any co-payments or sub-limits that will apply and what you can do to avoid these. For planned procedures, it’s also worth checking with your scheme if you will obtain better cover by using contracted providers or having the procedure performed in the doctor’s rooms or a day clinic. 8. ICD-10 codes If you need to undergo an operation, ask your surgeon for the codes that will be charged. This will include the procedure codes and those for any other products that will be needed, this all helps with pre-authorisation and ensuring the costs will be covered. 9. Chronic health conditions Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers. With thanks to: www.w24.co.za ![]()
Please contact Namhla or Ellen in our Health and Wellness Department, email [email protected], if you have any queries about Bonitas Source: Business Tech ![]() If you are a medical aid holder and would like an option upgrade from 1 January 2019,please note that all option upgrades have to be submitted by latest 30 November 2018 to us as your Broker. This applies for the following service providers:
To submit your upgrade option please contact Namhla or Ellen or in our health and wellness department email :[email protected] tel no: (011) 658 - 1333 ![]() It’s now time to review your medical aid scheme cover for 2019. This means you have a window within which you can switch to a different plan for the new year. This window usually closes at the beginning of December (depending on your current provider), so don’t delay collecting the necessary information. This is not a decision to be rushed. Why do I have to decide now? Medical aid providers allow you to switch plans once a year (at the end of the year) without penalties or consequences. If you want to save on premiums or you need to increase benefits, now is the time to do it. What if I want to change providers altogether? If you are unhappy with your medical aid provider, you can switch to another at any time of the year. But before you do, consider the following: Waiting Periods Medical Aids by law must accept anyone who applies to join their scheme. To protect themselves from older or sickly members that join without having contributed to the risk pool, they usually impose a waiting period of between 3 and 12 months. Waiting periods will apply if 1) you have not been a member of another South African medical aid for the past three months or more, 2) if you change medical schemes before 2 years of being covered with your previous medical aid provider and 3) if you have a pre-existing medical condition. Finding out about any waiting periods is extremely important before deciding to change providers. Late joiner penalty As an additional means to manage the risk of older or sickly members joining without having contributed to the risk pool, medical schemes (according to the Medical Schemes Act) are entitles to add a late joiner penalty to your premium if you were not part of a medical scheme before 01 April 2001. The late joiner penalty is calculated (using a prescribed formula) based on the number of years that you were not on a registered South African medical scheme. The late joiner fee can range between 5% and 75% of the total contribution, depending on the number of years that you were not covered by a medical scheme. How do you know that you are in the right medical scheme? Understanding how your medical benefits work is a daunting task for most. For example, your scheme might cover you for 100% of hospital costs at the medical fund rate. You might think that this means all in-hospital costs will be covered. Unfortunately, many uninformed South Africans are left with an enormous hospital bill for making use of a specialist that charges more than the medical fund rate. This is just one example of what could be overlooked when selecting the right benefits for yourself and your family. Here are a few tips to follow and questions to ask when reviewing your current or future medical plan: Do you understand the various benefits and their associated costs? Before you make any decisions, you need to familiarise yourself with certain medical terms and jargon. Understanding these terms could save you money. You may be paying for something you don’t need, or perhaps you aren’t properly covered for something you do need. Now is the time to find out. Here are the “Top 5” terms you should understand before reviewing your medical aid for 2019: Exclusions This is very important as it tells you exactly what is not covered. Be aware that this can change from year to year. Just because something was covered in 2018, does not mean it is automatically covered in 2019. Make sure to check this to avoid any nasty surprises when you try to claim. Co-payments Most medical schemes apply co-payments that you need to fork out before undergoing certain procedures. These are different depending on the scheme and plan you select and are also subject to change. Co-payments can apply for in- and out- of hospital procedures. Check this detail in your medical plan brochure, especially if you have identified any upcoming medical events for 2019. Prescribed Minimum Benefits (PMB’s) and chronic medication In terms of the Medical Schemes Act, regardless of the benefit option, you have selected, there is a defined list of benefits/treatments for which all Medical Aid schemes in South Africa have to provide cover for. This includes covering the costs related to the diagnosis, treatment and care of an emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions. Important to note when it comes to chronic medication, is that schemes can impose preferred providers and sometimes only pay for generic versions of medication. This essentially means that you need to get your medication from the medical scheme’s appointed service provider or you will need to fund a co-payment out of your own pocket for your chronic medication. If you have a persistent condition, check if it is listed as a chronic condition and then check that the medication you use is also covered. Some medical schemes have additional chronic conditions that they cover over and above the 25 that they are obligated by law to cover. These additional conditions could change, so again if you were covered this year, don’t assume it will be covered in 2019. Rather do a double check to avoid surprise expenses. Preferred provider networks Most Medical Schemes have service provider networks with whom they have negotiated rates to contain costs. These networks include pharmacies, GP’s, specialists and hospitals. If your healthcare provider is not one of these network providers, you will be liable for a co-payment. Coverage Coverage can vary dramatically from one scheme to the next. It can also change from year to year. These changes are usually announced with the annual price increases. Most schemes pay claims, at between 100%-300% of their own Medical Scheme Rate. There are two things you need to do here; 1) find out if your doctor charges Medical Scheme Rates and 2) negotiate rates with specialists prior to treatment. If they charge above Medical Scheme Rate, and the procedure was not considered by your scheme to be an emergency, you may be liable for the difference in costs between what the specialist charges and what your medical scheme has agreed to cover. Of course, if you have taken out gap cover, any of these in-hospital expense shortfalls will be covered. What does 2019 look like? Do you have a medical condition now that you anticipate will drain you financially? Or are you anticipating a medical event like childbirth or dental treatment? Maybe you’ve been putting off a knee replacement or other surgery, but it can’t go unattended any longer. If this is the case, you should consider upgrading your plan and should at very least be adding gap cover, which will cover any payment gaps between what your medical aid pays out and what specialists charge you while in hospital. Could a doctor network benefit you? Most medical aids have their own network of doctors and hospitals. If the network is convenient for you to use, then changing to a ‘network’ plan could mean substantial discounts on your monthly medical aid premium. If saving money is a major priority for you, then find out if the medical scheme provider you are currently with has a network and if they are in your area, then if they are acceptable to you, consider downgrading your option. How long did your savings account last this year? Did you run out of savings halfway through the year? Or maybe you have a surplus left over. You need to calculate how much you spent on out of hospital and day to day medical expenses in 2018. This way you will know if you should be seeking a plan with a bigger savings portion. If you have a surplus, this will carry over to next year, which may allow you an opportunity to downgrade to a plan with a smaller savings portion. This is most probably the most time-consuming part of reviewing your medical options for next year. You will need to look at all your slips and bank statements to calculate how much you need for unforeseen/seasonal illness. You may find your major costs are during the winter months. Knowing this upfront will allow you to plan better and perhaps put aside additional money into secondary savings account so that you have funds available when your medical savings account runs dry. How much is your medical aid increasing premiums by? Unfortunately, medical aid premium increases are usually above inflation and in many instances more than annual salary increase rates. This means that your medical aid contribution is one of your biggest expenses, right up there with home loan repayments/rent and vehicle repayments. Whether or not you can still afford your current plan is a major factor in your decision for 2019. This alone may force you to downgrade. Before you do, carefully consider the loss of benefits and the risk you are taking. You may find there are other items in your budget you should rather be cutting out, especially if you have identified future medical events in 2019. Please contact Namhla or Ellen in our Health Department, email [email protected] , to find out about different Medical aid options Source: Medicalaid.co.za ![]() Dear Discovery Health Clients Discovery has instructed that brokers no longer are able to change the banking details on behalf of clients using the Discovery form. Members are now required to change details by themselves on the Discovery websites. The only people that will be allowed to use the paper form is:
Benefits of updating your banking details online
How to update your banking details on our website
You can register or log in to the website on www.discovery.co.za. Please contact Namhla or Judy in our Health Department, email [email protected] , to find out about different Medical aid options Source: Discovery Prescribed Minimum benefit is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the plan they have selected. The aim is to provide with continuous care to improve their health and well-being and to make healthcare more affordable. PMB’s are feature of Medical Schemes act, in terms of which medical aid schemes have to cover the costs related to the diagnosis, treatment and care of • Any emergency medical condition • A limited set of 270 medical conditions ( defined in the Diagnosis treatment pairs) • 25 chronic conditions ( Defined in the Chronic Disease list) Did you know as a medical scheme member, you have cover for over 26 PMBs Already, you can find out more about these PMBs by • Visiting the council for Medical Schemes PMB page for a definition of an emergency medical condition • Access the Council What are emergency conditions? An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or surgery. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts or even death. In an emergency it is not always possible to diagnose the condition before admitting the patient for treatment. However, if doctors suspect that the patient suffers from a condition that is covered by Prescribed Minimum Benefits, the medical scheme has to approve treatment. Schemes may request that the diagnosis be confirmed with supporting evidence within a reasonable period of time. Is pregnancy a PMB condition? When you fall pregnant, your pre-existing PMB conditions remain covered in full, as well as any PMB condition that you may develop during pregnancy, however you need to be covered by the medical aid or coming from another medical aid with no break of more than 90days. To see if your condition qualifies for PMB cover please contact Namhla in our Health Department email [email protected] , tel (011)658 -1333 Source: Namhla Zwane |
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January 2025
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