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Commercial section => Vendor Offers and Promotions => Topic started by: Worth-It on February 19, 2014, 03:20:06 pm

Title: Medical Aid Advice
Post by: Worth-It on February 19, 2014, 03:20:06 pm
Hello Fellow Wild dogs,

My husband Yami ST has introduced me to the WD Forum and I would like to offer my professional services to you. I am a trained and accredited Medical Fund broker that can assist you with advice on your current fund or provide you with quotes and comparisons on others.To understand your medical aid and how it works could be a daunting task and that's where I can shed some light.


I already assisted some of the Wild dogs and gathered that there is a need for more professional advice.

Please feel free to contact me on liesl.cmac@telkomsa.net or 082 924 0841
Title: Medical Aid Advice
Post by: Worth-It on March 05, 2014, 03:08:43 pm
If you are uncertain as to what medical scheme to choose or do not understand what your scheme benefits are, please contact me for assistance.
Title: Medical Aid Advice - The importance of Gap and Co-Payment Cover
Post by: Worth-It on March 10, 2014, 11:28:07 am
GAP and co-payments cover

You are most certainly aware that most medical practitioners (specialists, anaesthetists, etc.) claim private rates for their services. Medical aids however, pay claims in accordance with the fund’s tariffs. Resulting in a difference that needs to be bridged by the medical aid member. This difference can escalate to several thousand Rand. GAP coverage originated in order to overcome this difference and consequently to provide greater peace of mind.

A co-payment will occur when a member undergoes a certain procedure and the medical aid requires a further payment to cover the specific procedure.

Both GAP and co-payment cover has become particularly important. For only R145 for both, per month per family, this can save you a sufficient amount of money should a family member need to be hospitalised. Looking forward to the opportunity to discuss this with you further.
Title: Re: Medical Aid Advice
Post by: Worth-It on March 13, 2014, 03:52:42 pm
Does your medical scheme benefits match your healthcare requirements?

Let me assist you by doing a needs analysis and then considering a medical aid that provides you with options for basic care, chronic disease management and hospitalisation cover in addition to day-to-day costs for optometry, dentistry, medicine and doctor visits.

Please contact me for comparisons, quotations and advice at liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on March 17, 2014, 03:14:02 pm
Are you seeking affordable medical aid cover for your child that is studying? I can offer you a plan for just R395 for students enrolled at a registered institution in South Africa. Contact me on liesl.cmac@telkomsa.net for more information.
Title: Re: Medical Aid Advice
Post by: Worth-It on March 25, 2014, 11:37:20 am
Why are Schemes Penalising members when they apply for membership?

Even though one can argue that you haven’t made use of the healthcare system and have not been a burden on the system, if you are over 35 and join a medical aid for the first time, you are considered a late joiner. You may be penalised according to the specific medical aid’s policies simply because you have not accessed the medical industry before and may have underlying conditions you are not aware of. And in essence be a risk to the scheme.

Later joiner penalties are added to your premium monthly and are calculated on your age and the years without membership. It can range between 5-75% of your monthly premium. However, it is only calculated on your risk portion and not the savings portion of the premium.

In addition, late joiners have not previously added to the medical scheme pool fund and therefore a waiting period may apply or higher rates. Apart from that you will, however, still enjoy the benefits of belonging to a medical aid from then on. The best medical advice is then to become a member of reputable scheme sooner rather than later.

Contact me for quotes, comparisons and advice. Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on March 27, 2014, 05:39:11 pm
Did you know that Medical Aid Scheme's are all categorised into types of options? Do you understand the difference of a "new generation option" vs a "hybrid option' vs a "traditional option" vs a capitation option? Do you know what type of option your medical fund is and how it effect your benefits? Contact me for more information.
liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on April 07, 2014, 01:34:20 pm
Why is having a needs analysis so important? Every family has different requirements when it comes to medical aid. Draw up an list of expenses between doctor consultations, dentistry, medicine, optometry, etc., to see what you have spent most money on in the last 12 months.

That way you can find a few affordable medical aid quotes that reflect exactly what it is you need. There is no point in getting quotes from schemes that don't cover these aspects.

Finding out that what you need is not included in your cover is both frustrating and financially straining. It is, however, something that can easily be avoided. So make sure you find a few affordable medical aid quotes that reflect exactly what it is you need.

Please contact me to assist you in finding a scheme that would cover your family's requirements. liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on June 06, 2014, 10:07:20 am
The Tax Season will be opening soon. Some Medical Schemes have issued the member's tax certificates already. If you have not received your as yet, you can either download it from the Scheme's website, or request it from their call centre.
Title: Re: Medical Aid Advice
Post by: Worth-It on June 18, 2014, 02:11:36 pm


DID YOU KNOW: WHAT IS A DESIGNATED SERVICE PROVIDER OR DSP.

Several funds are already, or starting to make use of Network of Suppliers or Designated Service Provider (DSP). 

Ensure you know which providers, e.g. hospitals, doctors, specialists, etc., form part of your fund's network. Should you make use of suppliers outside of this network the cost implications to yourself could be significant. Most of the times, this cost would also not be covered by your GAP Cover of Co-Payment cover, as you were suppose to use only certain providers.

It remains the member’s responsibility to know which suppliers are specified as part of the fund’s network. Should you require  more information regarding the above, please do not hesitate to contact me.
Title: Re: Medical Aid Advice
Post by: Worth-It on June 23, 2014, 08:47:34 pm
What is a medical emergency?
You rush to the hospital’s emergency rooms with a medical issue you believe needs immediate attention. Treatment is given and you are sent home. However, not before you are presented with the account and told this is for you to settle.

How does this then work? You had a medical emergency! Emergency rooms are however nothing else than a doctor’s practice attached to the hospital and offering a 24-hour service. Therefore, if you are not admitted to hospital from the emergency rooms and did not stay overnight, the account will be treated as a doctor’s consultation. The account will be claimed from your available day-to-day expenses. Or if you medical savings plan is depleted for the year, this is for your own expense.

The Medical Council describes an emergency medical condition as follows: An emergency medical condition means any sudden and unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide such treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place a person's life in serious jeopardy. An emergency medical condition must be certified as such by a medical practitioner. Emergencies qualify for PMB and must therefore also be registered for PMB treatment. Contact me for any more information on the above.
Title: Medical Aid Advice
Post by: Worth-It on July 01, 2014, 12:58:57 pm
Medihelp
Title: Re: Medical Aid Advice
Post by: Worth-It on August 13, 2014, 11:54:55 am
The tax season is currently in full pursuit and medical fund certificates can be requested directly from your aid. By registering on your medical aid’s website with your membership number you will have access to your tax certificate as well as plenty of other important information pertaining your benefits and claims.
Title: Medical Aid Advice
Post by: Worth-It on August 27, 2014, 06:38:26 pm
Waiting periods and underwriting understood

Ever felt confused by the underwriting process of any Medical Scheme? Here is a more understandable summary.

Each and every member applying to a Scheme will fall into category A,B or C. Each category will in turn have an impact of what waiting period might be applied after the underwriting is completed.

Step1: Calculate the period that the member has been without cover from his previous scheme to the date of enrolment of the new scheme.

Is there a break in cover of 90 days and more (>90days)? If Yes, member will fall intoCategory A
Is there a break of less than 90 days (0-89 days)? If yes, calculate if the previous scheme coverage is up to 24 months or more than 24 months. If it is less than 24 months, the member will fall into Category B.

If more than 24 months, the member will fall into Category C.

Waiting periods for Category A:
General waiting period of 3 months - have to pay premiums but will not be able to claim. Emergencies and Chronic conditions will not be covered.
Condition-specific waiting period of 12 months - any current condition being treated or diagnosed will be excluded for 12 months.

Waiting periods for Category B:
Condition-specific waiting period that was unexpired from the previous scheme may be continued at new scheme.
Emergencies and Chronic conditions will be covered.

Waiting period for Category C:
General 3 month waiting period
Emergencies and Chronic conditions will be covered

Please do not hesitate in contacting me should you require quotes, comparisons or Advice on Medical Aid or GAP Cover
Title: Medical Aid Advice -Announcing Products for 2015
Post by: Worth-It on September 17, 2014, 07:51:00 pm
It is that time of the year where most of the Schemes will announce their 2015 product offerings during the course of September and October. And soon after that, you will be notified of the new products and premiums for 2015.

As medical aid member, you should again reconsider your medical aid options. You need to reflect on the last year’s medical events and decide whether it is best to remain on your current plan, upgrade, downgrade, or if necessary even consider a different Scheme in totality.

This could be a daunting task, but you are not alone in this decision process. As a trained and accredited medical aid broker, I am here to assist with advice on your current plan or to provide you with quotes on new schemes you would like to evaluate.

Should you not currently have GAP and Co- payment cover, now would be a fitting opportunity to reassess these products. These products are of cardinal importance and could literally save you and your family thousands of Rands.

Please contact me on liesl.cmac@telkomsa.net

Title: Medical Aid Advice-student plans for 2015
Post by: Worth-It on September 25, 2014, 11:51:26 am
Do you have an 18 year old child that will be studying in 2015? I can offer you a student plan from as little as R330.00 per month with Hospital and Day-to-Day cover through a network of Service Providers. Please contact me for a free quote. Contact me on liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on October 08, 2014, 09:11:07 pm
What to Consider When Changing Your Medical Aid Scheme
Posted on September 18, 2014 by admin in Medical News.

If you are thinking about changing your medical aid scheme, consider the quality of care you are currently receiving, the benefits that go with your medical scheme and the price you are paying for services. One thing to consider is that you should never choose a plan based on extra offers concentrating on services that are unrelated to medical care and benefits. For instance, do not change your plan simply because you can get a special discount when you travel. Instead, choose a scheme that fits your personal budget and features benefits designed to maintain healthy lifestyles for yourself and your family.

You Need to Make Sure You Only Belong to One Scheme

South African law dictates that you cannot legally belong to more than one medical aid scheme at the same time. So, you need to do research to ensure that the plan you choose provides you, your spouse and your children with the care you expect at a cost you can afford to pay. One medical scheme may include special benefits you need or a list of preferred doctors and hospitals that your current plan does not include. Before changing your health plan, consider all your options carefully.

Please contact me should you have any queries or want to compare your current scheme with other schemes. I also have most scheme's 2015 premiums and plan offerings! Liesl.cmac@telkomsa.net
Title: Medical Aid Advice
Post by: Worth-It on January 27, 2015, 05:09:58 pm
MEDICAL AID ADVERT
Title: Re: Medical Aid Advice
Post by: Casting from Turd on February 24, 2015, 06:57:44 am
Morning

I am looking for a hospital plan
Title: Re: Medical Aid Advice
Post by: Worth-It on May 20, 2015, 09:47:11 pm
Questions To Ask Yourself Before Choosing A Hospital Plan. (Posted on May 15, 2015 by Kirstie Ricketts in Medical Services)

Hospital Plan - When it comes to choosing a medical scheme such as a hospital plan, there is no quick way to deciding which option is the perfect choice for you. You need to remember that what works for some people might not work for you. Make sure you do not make a hasty decision and rather take time to weigh your options and see who has the best solution for you.

Ask yourself the following questions before choosing a hospital plan:

Am I currently healthy?
What amount am I willing to spend on a medical scheme?
Will I be able to cover my other non-hospitalisation expenses?
Will I be adding dependants onto my medical scheme? If yes, how much will this cost?
What hospital procedures will my medical scheme cover?
Which hospitals will I be able to go to?
What fund tariff will the hospital plan pay?

It is also important to keep the following issues in mind:

Even if your hospital plan covers 100% of your hospital bill, if the bill if higher you will have to pay anything over the agreed tariff.

There are minimum benefits that all medical scheme members are entitled to no matter what scheme you are a part of.

Medical schemes are vitally important as an accident can happen at any time and none of us are immune to all diseases.

Title: Re: Medical Aid Advice
Post by: Worth-It on May 20, 2015, 09:53:34 pm
Why choose Profmed medical scheme?

The landscape of the private healthcare sector in South Africa is one of constant change. All medical schemes vying for new members face an overwhelming uphill battle, especially in tough economic times.

So how does a medical scheme ensure growth? By offering benefits that appeal to their target market. At Profmed, we have embraced that principle by designing benefits to suit the lifestyle of graduate professionals. With a range of five tailor-made options to choose from, our members have access to the following benefits:
•   Unlimited hospitalisation
•   No deposits required on admission to hospital
•   No network hospitals
•   Primary healthcare benefit to the value of R 1500 per family available on the hospital-only options
•   Rich maternity benefits with lenient underwriting on pregnancy
•   Rich oncology cover on all options
•   Private wards offered on selected options
•   Preventative care benefits on all options that include early detection tests for high-risk diseases (diabetes, cardiac diseases, etc.),
        immunisations (children, influenza, pneumococcal and HPV) and cancer detection tests (breast cancer, prostate cancer and cervical cancer)        International travel medical assistance cover to the value of R3 million per beneficiary per journey
•   Sabbatical benefit to ensure that members who resign from Profmed due to extended overseas travel, contract work or studies, are re-instated as Profmed members without underwriting being applied upon their return to South Africa
•   Students rates from as low as R531 per month in 2015
•   SADC region: Profmed members have access to all of the Scheme’s benefits whilst residing or working in the SADC region. The SADC region includes Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe
•   Multiply Wellness Programme, which gives our members access to discounts and packages on selected health and lifestyle products, gym fees, airfares, movie tickets and holidays, and accommodation deals. The Base Multiply product is available to all Profmed members at no cost, whereas the Full Multiply package is available at a monthly fee
•   The Medical Aid Products Bonus: Members with a Profmed Medical Aid benefit and a PPS Provider Policy will receive a share of the profits of PPS’s medical scheme administration business. The full benefit is available at retirement from age 60 or prior to death and the funds can be withdrawn tax-free.

As the largest restricted medical scheme for professionals in South Africa, Profmed offers quality and affordable medical cover, and the above are excellent reasons why Profmed should be THE medical scheme of choice for select graduate professionals
Title: Re: Medical Aid Advice
Post by: Worth-It on May 20, 2015, 10:07:16 pm
Quick facts on Medical Schemes in SA -Compiled by Susan Erasmus

Many medical scheme members are baffled by scheme rules and regulations. Here are 20 quick facts on medical schemes in South Africa which might answer some of your questions.

Many medical scheme members are baffled by scheme rules and regulations. And by constant changes to benefits and contributions.

Here are some quick facts on medical schemes in South Africa which might answer some of your questions:

1) A person may not legally belong to more than one medical scheme.

2) You do not need to apply for medical scheme membership through a broker: you can apply directly to the scheme.

3) A minor may become a medical scheme member with the assistance of a parent or guardian, and provided the contributions are paid.

4) If you have terminated your membership of a medical scheme, you will be covered until midnight of the last day of the month in which you paid your final membership contribution.

5)Employers do not have to subsidise an employee’s contributions to a medical scheme.

6)Medical schemes are not allowed to pay out no-claim bonuses or rebates.

7)If a medical scheme principal member dies, his/her dependents may continue to be members provided the contributions are paid.

8)An employer may insist that a permanent employee belongs to a medical scheme as a condition of employment.

9)Medical schemes may not refuse membership to an applicant, but they may charge late-joiner penalties or waiting periods before claims can be made for specific conditions.

10)Claims must be submitted within four months of the treatment date, otherwise they will not be paid out.If you have money in your savings account, you may not withdraw it in cash. It can only be paid out when you terminate your membership.

12)Claims should be paid out within 30 days of receipt of the claim.

13)Medical schemes are non-profit organisations.

14)Medical schemes have to hold surplus or accumulated funds equal to 25% of the total annual contributions by members.

15)Medical insurance products are not governed by the rules of the Medical Schemes Act.

16)A scheme may terminate someone’s membership if contributions are not paid, or if the member has withheld crucial medical information on their application forms, or if they have submitted fraudulent claims.

17)Schemes may expect members to use Designated Service Providers (DSP's). These could include doctors, specialists and hospitals.

18)At least half of the Board of Trustees of a medical scheme must be elected or appointed from the ranks of members.

(Source: the Council for Medical Schemes)



 
Title: Re: Medical Aid Advice
Post by: Worth-It on May 20, 2015, 10:21:28 pm
The Benefits of Integration
Title: Re: Medical Aid Advice
Post by: Worth-It on June 22, 2015, 05:48:54 pm
NEW AND EXCLUSIVE TO CMAC ONLY - STRATUM ELITE

A GAP COVER WITH LOADED BENEFITS ; LOTS OF "ADD-ON'S" AT A DISCOUNTED PREMIUM OF ONLY R182 PER FAMILY PER MONTH!





Title: Re: Medical Aid Advice
Post by: Worth-It on June 29, 2015, 01:20:39 pm
AN EXCELLENT REASON TO JOIN MOMENTUM HEALTH TODAY!!
Title: Re: Medical Aid Advice
Post by: Worth-It on September 22, 2015, 03:57:00 pm
Medical Aid Schemes are launching their products of 2016 during September and October. It is that time of the year when you as medical aid member should again reconsider your medical aid options.
You need to reflect on the last year’s medical events and decide whether it is best to remain on your current plan, upgrade, downgrade, or if necessary even consider a different fund in totality.
As a trained and accredited medical fund broker I am here to assist with advice on your current fund or to provide you with quotes on new funds you would like to evaluate.

Please contact me on Liesl.cmac@telkomsa.net or 0829240841
Title: Re: Medical Aid Advice
Post by: Worth-It on October 06, 2015, 04:32:42 pm
ACCIDENT AND EMERGENCY COVER FOR ONLY R99 PER MONTH!!
Title: Re: Medical Aid Advice
Post by: Worth-It on October 07, 2015, 09:33:42 pm
Dear Member,

As we enter the last phase of 2015, you will once again have to decide upon the option changes of your Medical Aid Scheme.

Scheme Announcement for 2016 increases and benefits. Most Schemes have announce their increases, benefits and changes for 2016. It will be communicated to you, the member shortly. If you do not receive this in the next few weeks, please feel free to contact me.

SARS Personal Income Tax. The tax season is currently in full pursuit with the closing date of end November rapidly approaching. If you still have to submit your tax, your medical fund tax certificates can be requested from your fund’s call centre or download it from your fund’s website.

Option Changes – Remember the deadline. It is very important to submit all necessary documentation prior to the deadline provided. No changes will be accepted after the deadline.

Know your benefits. I would like to encourage you to take the necessary time in your busy schedule to become more familiar with your fund’s new products and changes for 2016.  Be aware and know the effects of changes implemented for 2016 as these have consequences for both you and your dependants.

Proof of income. Members on income based options need to provide proof of income on an annual basis. Should you neglect to do this, your fund will upgrade you to the highest option from 1 January 2016. Normally the submission of documents pertaining to proof of income have a different deadline date to the documents of option changes. Please make sure you are aware of this and submit your documents timeously.

Network suppliers. Several funds are already, or starting to make use of network suppliers. Ensure you know which providers, e.g. hospitals, doctors, specialists, chronic medicine providers, etc., form part of your fund's network. Should you make use of suppliers outside of this network the cost implications to yourself could be significant. It remains the member’s responsibility to know which suppliers are specified as part of the fund’s network.

“Silly Season”. This time of the year is called “silly season” for a reason. Many of us now enter the busiest time of the year at our companies. Be aware that you fund’s administration and call centre will also be challenged with the increased amount of work and therefore all the processes will take longer than usual to complete. Most Fund Administration offices close for a period of time over the Holiday Season. Make sure that you allow for this delay and submit your documents in a timely manner.

Your Scheme’s Website. Your fund’s website allows for convenient accessibility to information, register for additional useful information and services. Several funds also allow access to your fund's details via an app, developed for both iPhone and Android.

Scheme contact information:
Bestmed   www.bestmed.co.za (http://www.bestmed.co.za) 0860 002 378

Bonitas   www.bonitas.co.za (http://www.bonitas.co.za) 0860 002 108

Discovery Health www.discovery.co.za (http://www.discovery.co.za) 0860 998 877

Fedhealth   www.fedhealth.co.za (http://www.fedhealth.co.za) 0860 002 153

Keyhealth   www.keyhealth.co.za (http://www.keyhealth.co.za) 0860 671 050

Medihelp   www.medihelp.co.za (http://www.medihelp.co.za)   0860 100 678

Medshield   www.medshield.co.za (http://www.medshield.co.za) 0860 002 120

Momentum Health   www.momentum.co.za (http://www.momentum.co.za) 0860 117 859

Profmed   www.profmed.co.za (http://www.profmed.co.za) 0860 679 200

Spectramed www.spectramed.co.za (http://www.spectramed.co.za) 0861 497 497

Cura Gap Cover   www.curaadmin.net (http://www.curaadmin.net)   086 155 3553

Stratum Gap Cover   www.stratumb.co.za (http://www.stratumb.co.za)   086 111 3499

Gap and Co-Payment Cover. Both GAP and co-payment cover have become necessities. It can save yourself a sufficient amount of money in the case of a dependant being hospitalised. If you do not have a Gap Cover, I want to encourage you to consider it.
Please contact me for documentation, advice or quotations on Medical Funds or GAP Cover you should need to make decisions for your 2016 medical fund options.
Title: Re: Medical Aid Advice
Post by: Worth-It on September 26, 2016, 02:45:13 pm
Discovery has announced their 2017 Contributions. Please do not hesitate to contact me for more information.
Title: Re: Medical Aid Advice
Post by: Gene on September 26, 2016, 02:48:47 pm
SUB, WILL TAKE WHEN I RETIRE NEXT YEAR
Title: Re: Medical Aid Advice
Post by: Worth-It on September 26, 2016, 02:50:00 pm
MOMENTUM HEALTH HAS ANNOUNCED THEIR 2017 CONTRIBUTIONS
Title: Re: Medical Aid Advice
Post by: Worth-It on September 26, 2016, 02:52:59 pm
PROFMED HAS ANNOUNCED THEIR 2017 CONTRIBUTIONS.
Title: Re: Medical Aid Advice
Post by: Worth-It on September 26, 2016, 03:05:23 pm
Medical Aid Schemes are launching the 2017 contributions and benefit changes during September and October.

As member of a Medical Scheme, you need to reflect on the last year’s medical events and decide whether it is best to remain on your current plan, upgrade, downgrade, or if necessary even consider a different fund in totality.

As a trained and accredited medical fund broker I am here to assist with advice on your current fund or to provide you with quotes on new funds you would like to evaluate.

Please contact me on Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on September 26, 2016, 03:15:38 pm
Gap and Co-Payment Cover.

Have you ever had to fork out your own funds to cover the differences between medical aid rates and private rates after a hospital event?  Gap Cover is an insurance product designed to protect medical aid members from additional unbudgeted costs during hospitalisation.

Most Gap Cover products now also offer other benefits as well, like oncology benefits, casualty benefits and premium waivers on both the medical scheme contribution and the gap policy.

If you have taken out a Gap Cover policy a few years ago, it might be time to review your Gap Cover together with your medical scheme option, as your needs might have changed.

Seeing that it has become a necessity, almost compulsory to have gap cover, I strongly suggest you consider it if you do not have it currently.

For as little as R245 per month, Gap Cover can save you an enormous amount of money and stress.

Please contact me for quotes on Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: zetman on September 26, 2016, 03:28:40 pm
Liesl is  the most clever Dog regarding medical aids  :sip:
Please support her and give her a chance
Title: Re: Medical Aid Advice
Post by: Stirrr on October 11, 2016, 04:41:23 pm
Hi Liesl,

What has changed now that Liberty has been taken over by Bonitas. I joined Liberty last year, and i got the correspondence over the last few months that they will be amalgamating with Bonitas.

I looked on Hello Peter, and they have got the most complaints that i saw. Should i look at something else now as i dont like changing schemes.

Regards

LR
Title: Re: Medical Aid Advice
Post by: Worth-It on November 15, 2016, 05:14:16 pm
This is a summary of the Stratum Elite Gap Cover

Stratum Elite – R245 per family (This product is available to CMAC-members at a R75 discount – normal price:  R320) 


Why Gap cover?

This product is designed to provide additional cover (up to 500%) for the tariff shortfalls on doctors and specialists accounts for in-hospital procedures.  Never assume that your medical scheme will pay hospital and –related accounts in full.  Medical schemes pay specialists and hospital procedures at 100% of scheme tariffs, but the rates are much higher, resulting in a shortfall between the claim amounts and the scheme tariffs.  You are responsible for the short-payment.

Some medical schemes also charge co-payments for certain in- and out-of-hospital procedures.

Stratum Elite provides the following benefits:

•   Additional hospital cover of 500%
•   Co-payment benefit
•   Once-off-payment of R30 000 when diagnosed with cancer for the first time.
•   Oncology benefit and oncology optimiser - included in the monthly premium of R255
•   Sub-limit benefit of R30 000 per event to a maximum of R60 000 per beneficiary.
•   R10 000 Casualty benefit (Hospital ER):  Accident; “Immediate treatment is required for physical injury resulting from an external force outside your body, due to impact with someone or something”.
•   Trauma counselling benefit: “When witnessed or affected by an act of physical violence or an accident resulting in serious bodily injury or upon the diagnosis of a dread disease”.
•   Accidental death benefit:  R10 000 principal insured / R5 000 spouse.
•   Stratum policy premium waiver for 12 months in the event of death, permanent disability or forced retrenchment of premium payer.
•   Medical scheme contribution waiver benefit for 6 months (maximum R4 500 per month) in the death or permanent disability of premium payer.

Waiting periods

The following waiting periods will apply:

•   3-month general waiting period
•   6 month pre-existing conditions, diagnosed conditions prior to enrolment
•   10 months on birth related claims
•   10 months’ condition specific on the following 10 conditions only (unless due to an accidental event when immediate treatment is required)
   Hysterectomy
   Joint replacements
   Nasal and sinus
   Cardiac (relating to the heart)
   Spinal
   Hernia repair
   Endoscopic procedures
   MRI & CT scans as well as specialised radiology
   Dentistry
   Cataract

•   Cancer cover will be granted to pre-existing cancer patients – after a 3-consecutive year remission period.

•   Mental health, depression and stress related conditions are a policy exclusion.


Please do not hesitate to contact me should you require more information or want to join Stratum
Title: Re: Medical Aid Advice
Post by: Worth-It on November 15, 2016, 05:26:28 pm
This is a summary of the Sirago Ultimate Gap Cover benefits


Sirago Ultimate:  individual =  R229 (This product is available to CMAC members at a R61 discount – normal price:  R290)  
Sirago Ultimate:  Family = R249 (This product is available to CMAC members at a R80 discount – normal price:  R329)

SPECIAL CONCESSION FOR CMAC MEMBERS!!! NO WAITING PERIODS IF YOU HAVE EXISTING GAP COVER  FOR 12 MONTHS OR MORE.

Why Gap cover?

This product is designed to provide additional cover (up to 500%) for the tariff shortfalls on doctors and specialists accounts for in-hospital procedures.  Never assume that your medical scheme will pay hospital and –related accounts in full.  Medical schemes pay specialists and hospital procedures at 100% of scheme tariffs, but in reality the rates are much higher, resulting in a shortfall between the claim amounts and the scheme tariffs.  You are responsible for the short-payment.

Some medical schemes also charges co-payments for certain in- and out-of-hospital procedures.

Sirago Ultimate provides the following benefits:

•   Additional hospital cover of 500%
•   Co-payment benefit
•   Once-off-payment of R10 000 when diagnosed with cancer for the first time.
•   Cancer cover – R400 000
•   R6 000 Casualty benefit (Hospital ER):  Accident; “Immediate treatment is required for physical injury resulting from an external force outside your body, due to impact with someone or something”.
•   Sub-limit enhancer:  R100 000 (limited to R20 000 per event)
•   Appliance benefit:  R5 000
•   Specialist consultation fee:  R5 000 (R1 000 per claim – max 3x claims per beneficiary)
•   Accidental death benefit:  R10 000 principal insured / R10 000 spouse  /  R5 000 child.
•   Medical scheme contribution waiver benefit for 6 months (maximum R3 500 per month) in the death or permanent disability.

Waiting periods

The following waiting periods will apply:

•   3 month general waiting period
•   10 month pre-existing conditions  (diagnosed conditions prior to enrolment).
•   10 month waiting period for pregnancy and confinement.
•   Policy specific exclusions:  0 - 6 months:  no benefit / 7 – 10 month:  50% benefit  /  Full benefit from month 11.
   Myringotomy and Grommets
   Adenoidectomy
   Tonsillectomy
   Hysterectomy (except where malignancy can be proven)
   Spinal, Back, Neck and joint related procedures (repairs, scopes and joint replacement etc.) except in the case of an accident
•   6 month waiting:  Death, total permanent disability and premium waiver.

•   Cancer cover will be granted to pre-existing cancer patients – after a 3 consecutive year remission period.

•   Mental health, depression and stress related conditions are a policy exclusion.

•   Professional- and hazardous sport are a policy exclusion

Please read the attach brochure and policy wording for more detailed information or contact me for further assistance.

CONTACT ME ON LIESL.CMAC@TELKOMSA.NET for Medical Aid or Gap Cover advice


Title: Re: Medical Aid Advice
Post by: Kameel on February 01, 2017, 12:39:40 pm
Received excellent service from Liesl to help me move to a new medical aid.  :)
Dankie vir al jou raad, hulp en moeite met my vrae. :thumleft:
Do yourself a favour and give her a call.
Title: Re: Medical Aid Advice
Post by: Worth-It on March 29, 2017, 02:56:30 pm
Advise, Quotes, Comparisons on

Gap Cover
Medical Insurance
Travel Insurance
Trauma and Emergency Cover

Please email me on Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on March 29, 2017, 02:59:18 pm
Cost effective Medical Insurance that offers day-to-day benefits. For more information please email me on Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on March 29, 2017, 03:04:52 pm
EVAC24 ONLY PROVIDES COVER BASED ON ACCIDENTS

This policy is available at R99 per month.

Cover provided for husband, wife and 3 children (children until age 18)
Maximum entry age – 16 - 65
No waiting periods.No Medical tests required

The stated amounts per benefit will be payable per EVENT – this is not an annual benefit:
•   Member admitted to hospital through ISOS call centre due to injuries after an accident – R100 000 available for this EVENT.
i.e.:  from admission to discharge the actual claims amounts to R60 000.  The member can utilise the remaining portion for follow up surgery, directly related to the first event. Member again has R100 000 available for a next hospital EVENT – not relating to the first event

Benefits include:
•   R100 000 private hospital cover
•   R  35 000 medical transportation (ambulance, helicopter or fix wing planes)
•   R    1 000 hospital cash back (after 24 hours – maximum 90 days)
•   R  10 000 Emergency Rooms and Casualty Units at a hospital (for stays shorter than 24 hours)
•   R100 000 Permanent accidental disability
•   R100 000 Accidental death cover
•   R  50 000 Repatriation – transportation of departed to location verified by next of kin.

Please note the following exclusions (par.16 of policy wording):

•   Strains and sprains (as per par.5 of attach policy wording)
•   Sport as a professional – hang-gliding or micro lighting accidents, or organised sporting events.

Please contact me for more information on Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on April 24, 2017, 10:12:58 am
Never assume that your medical scheme will pay hospital and –related accounts in full.

 Medical schemes pay specialists and hospital procedures at 100% of scheme tariffs, but in reality the rates are much higher, resulting in a shortfall between the claim amounts and the scheme tariffs.  You are responsible for the short-payment.

Let me assist you in choosing the correct Gap Cover to compliment your Scheme's shortfalls.

Contact me on Liesl.cmac@telkomsa.net or 0829240841
Title: Re: Medical Aid Advice
Post by: Operator on April 24, 2017, 10:25:20 am

Never assume that your medical scheme will pay hospital and –related accounts in full.

 Medical schemes pay specialists and hospital procedures at 100% of scheme tariffs, but in reality the rates are much higher, resulting in a shortfall between the claim amounts and the scheme tariffs.  You are responsible for the short-payment.

Let me assist you in choosing the correct the correct Gap Cover to compliment your Scheme's shortfalls.

Contact me on Liesl.cmac@telkomsa.net or 0829240841

I recently took out this product through Liesl and  it was without a doubt one the best value for money products out there.
If you compare, others don't even come close.  :deal:
Title: Re: Medical Aid Advice
Post by: brianw on June 13, 2017, 04:29:02 pm
 :sip:
Title: Re: Medical Aid Advice
Post by: Worth-It on July 24, 2017, 10:15:32 am
In recent news, there was a court ruling about Medical Scheme Savings accounts. Please read the Judgement below. (With thanks to Discovery Health for the article)

On Tuesday, 6 June 2017, the Constitutional Court ruled on the matter of Genesis Medical Scheme versus the Registrar of Medical Schemes and the Council for Medical Schemes. The judgement found in favour of Genesis Medical Scheme, ruling that funds accumulated in members’ medical savings accounts (MSA) can be considered as part of the Scheme’s reserves.

The judgement has three main implications for schemes and their members. The judgement will have a positive impact on scheme solvency particularly where schemes have large amounts of MSA funds. This is because the MSA funds can now be counted as assets in the solvency calculation. The judgement may also have a positive impact on scheme investment returns, because schemes may now be able to invest some of the MSA funds in higher returning investments. Both these developments will be positive for scheme members since they will reduce pressure on premium increases to some extent.

The judgement also allows schemes to elect whether to pay interest on positive MSA balances. Discovery Health Medical Scheme will continue to pay market-related interest on members’ MSA funds until further notice.

The judgement has no impact on how members’ day-to-day claims are processed from their MSA, though. Medical schemes will continue to refund members who have a positive balance in their MSA if they leave the scheme.

In theory, the judgement implies that if a scheme is liquidated, funds in members’ MSAs would form part of the liquidation and would not be available to members. Members of Discovery Health Medical Scheme should rest assured that they face absolutely no risk from this change. Discovery Health Medical Scheme is currently in an extremely strong financial position, and is by far the strongest medical scheme in the country.

The Scheme has accumulated reserves of R14.2 billion and a solvency level of 26.3%, well above the statutory level of 25%. Global Credit Ratings recently reaffirmed the credit rating of the Scheme as AA+, the highest rating possible for an open scheme in South Africa. Discovery Health Medical Scheme remains the only open scheme in South Africa to achieve this credit rating and has sustained this rating for 15 years in a row.

Please do not hesitate to contact me should you have any questions, require comparisons or quotations on Medical Aid options, Gap Cover, Emergency/Trauma Cover or Travel Insurance. Email: Liesl.cmac@telkomsa.net or 0829240841
Title: Re: Medical Aid Advice
Post by: Worth-It on July 24, 2017, 10:17:49 am

Never assume that your medical scheme will pay hospital and –related accounts in full.

 Medical schemes pay specialists and hospital procedures at 100% of scheme tariffs, but in reality the rates are much higher, resulting in a shortfall between the claim amounts and the scheme tariffs.  You are responsible for the short-payment.

Let me assist you in choosing the correct Gap Cover to compliment your Scheme's shortfalls.

Contact me on Liesl.cmac@telkomsa.net or 0829240841

I recently took out this product through Liesl and  it was without a doubt one the best value for money products out there.
If you compare, others don't even come close.  :deal:
Title: Re: Medical Aid Advice
Post by: Worth-It on September 13, 2017, 09:13:44 am
The 2017 Tax Season is in full swing. Contact me to obtain your Medical Aid Tax Certificate from your scheme.

Liesl du Plessis
Liesl.cmac@telkomsa.net
0829240841

I am a Medical Aid Specialist. I manage and solve your everyday medical aid frustration
Title: Re: Medical Aid Advice
Post by: Worth-It on September 13, 2017, 01:59:26 pm
2018 will be an exciting year for Discovery Health!! Many enhancements added to their plans, like Maternity benefits and free Vitality Move to all Discovery Members.

Best of all - only an average  7.9% increase on their premiums.

Contact me to discuss your options. Liesl.cmac@telkomsa.net


Title: Re: Medical Aid Advice
Post by: Worth-It on October 10, 2017, 05:16:26 pm
Dear  Momentum Client,

!!!!!Average Increase - 8.3%!!!!!

Changes to Health Options :

Enhanced Maternity Benefit on all options
Introducing new Income Bands on Access Option
No cuts in benefits.
Introducing: Impact as a new Option
     

Multiply 2018

Launching SafeDayz.
Revised Healthy Heart Score.
Introducing New Multiply Visa Card - cash backs.
Multiply Money App.
New Partners - Emirates, Curves, GoHealthClub, FitVault.
New Website.
Parcel tracking and delivery.
Instant Vouchers.
Discounts for Multiply members - up to 60% off on Life products, 30% on Insure etc.
Introducing Multiply for Corporate Groups


HealthReturn and HealthSaver :

Booster money more accessible.
Booster money included in Retirement benefit
Multiply Visa Card - (Healthsaver card) - can be used at Vets and Providers (use HealthReturns, HealthSaver and Multiply).
Changes to HealthReturns Value.

Deadline for option changes are 20 Nov 2017. Please contact me NOW to assist you with your option.
Liesl.cmac@telkomsa.net or message/call me on 0829240841
[/b]
Title: Re: Medical Aid Advice
Post by: Worth-It on October 10, 2017, 05:25:35 pm
Dear Bonitas Member,

!!!!8.7% average increase announced for 2018!!!!

Changes to be applied from 1 January 2018:
•   A separate benefit for contraceptives will be added to all options
•   Newborn hearing screening tests will be covered on all options (in or out of hospital)
•   Screening for congenital hypothyroidism will be covered for newborns on all options
•   The family limit for the Wellness Extender will increase by 15% and children under 18 will no longer be required to complete the Health Risk Assessment to
        access the benefit
•   Out-of-hospital tests and specialist consultations for PMBs paid from risk on Standard, Standard Select and Primary
•   Pap smears for women over 21 years will be extended to Bon Essential and BonCap
•   Mammogram screenings for women over 40 will be extended to BonSave and Primary
•   Bone Density Screenings (available on BonClassic and BonComprehensive) will now be available to men aged 70 and over
•   A generous dentistry benefit package paid from risk will be added to BonFit
•   An unlimited terminal healthcare benefit on all options
•   The corneal graft limit on BonComprehensive, BonClassic, Standard, Standard Select, BonComplete and BonSave will increase from
         R22 000 to R30 000
•   The sublimit for specialised drugs for retinal disorders will increase from R42 000 to R50 000 on BonComprehensive, BonClassic and Hospital
         Plus

•   An internal prosthesis benefit of R30 000 per family (excluding joint replacement prosthesis) will be introduced to BonSave and Primary
•   The Bonitas Mental Health Programme will be available as a managed care initiative to members on specific plans


Deadline for Option Changes is 30 November 2017. Contact me NOW to assist you.
Liesl.cmac@telkomsa.net or message/call me on 082 924 0841
Title: Re: Medical Aid Advice
Post by: Worth-It on October 10, 2017, 05:38:52 pm
Dear Medihelp Member,


!!!!!!Average increase 7.6%!!!!!! (Lowest increase in the industry)

Medihelp Health print enhanced
Pregnancy and Baby benefit enhanced
Medihelp MultiSport benefits
MHelp App enhanced with SOS tracking, e-cared, more detailed member statements and member guides.
Introducing MedGap (Guardrisk) with discounted rates to Medihelp Members and seamless claim process.


Dimension Prime Range
5.7% increase in benefits across all options
Non-PMB Cancer benefits introduced to all options
Reduction in co-payments for endoscopic procedures if done in Day-Clinics
Dietician benefit added
Preferred Provider for Dental replaced with Dental Risk Company
Added Hospitals to the list of Network hospitals

Dimension Prime 1
Endoscopic co-payment removed

Dimension Prime 2
Savings increased from 12% to 15%
Maternity benefit increased to 8 pregnancy consultations.
Day-to-day benefit removed and replaced with insured benefits

Dimension Prime 3
Radiology and Pathology benefit now combined with increased Gp/Specialist benefit.

Dimension Elite
Enhanced Non-PMB Chronic benefit
Enhanced Non-PMB Joint Replacement benefit

Unify
Increase in Preventative Care Benefits
Minor Dental benefit added (impacted teeth only)
                             
The deadline for option changes is 15 December 2017. Contact me NOW to assist with your option changes.
Liesl.cmac@telkomsa.net or message/call me on 0829240841
Title: Re: Medical Aid Advice
Post by: Worth-It on October 12, 2017, 07:40:51 pm
Medical Scheme Specialist. I manage and Solve your daily Medical Scheme frustrations.
Title: Re: Medical Aid Advice
Post by: vjseven on October 13, 2017, 12:53:33 am
Ek is in die mark vir ander medies.... sal later bel....
Title: Re: Medical Aid Advice
Post by: Worth-It on November 01, 2017, 05:09:19 pm
HAVE YOU REVIEWED YOUR GAP COVER IN THE LAST 3 YEARS?

As time went by, Gap Cover products evolved and changed to compliment the ever changing shortfalls on the Medical Aids. In the beginning, Gap Cover only addressed the “GAP” created by providers, charging private tariffs. And perhaps co-payments charged by your scheme for specific procedures done.

These days, being still named a Gap Cover, these products offer many more benefits such as Limit Enhancer, Cancer Cover, Trauma Cover, Premium Waivers and many others. So in essence, you will get far more worth for your money when moving to one of these new products.

As you currently still have one of these old products, I suggest you please contact me to discuss alternatives for 2018. 


If you currently still have one of these old products, I suggest you please contact me to discuss alternatives for 2018.
[/color]
Title: Re: Medical Aid Advice
Post by: Worth-It on November 21, 2017, 11:20:24 am
I manage and solve your medical aid frustration
Title: Re: Medical Aid Advice
Post by: Worth-It on February 06, 2018, 10:02:35 pm
A BIG thanks to all my excisting and loyal members that keep referring my services.
Title: Re: Medical Aid Advice
Post by: Sláinte Mhaith on February 06, 2018, 10:33:59 pm
.
Title: Re: Medical Aid Advice
Post by: Worth-It on March 20, 2018, 05:32:16 pm
2017 has been a GREAT year!!! Thanks to all my loyal members for referring me to your friends and family
Title: Re: Medical Aid Advice
Post by: Worth-It on March 20, 2018, 05:37:21 pm
Company Profile
Title: Re: Medical Aid Advice
Post by: Worth-It on April 17, 2018, 08:11:25 pm
Dear Member,

As you are aware, The Minister of Finance announced a Valued Added Tax (VAT) rate increase for the first time in many years in his recent budget speech. As of 1 April 2018, the effective VAT rate will rise from 14% to 15% on most goods and services. Your Medical Aid and Gap Cover Premiums are directly impacted by this change.

However, GOOD NEWS from some schemes like Discovery, Bestmed and Bonitas, is that they are absorbing the increase for the rest of 2018 and no change will be made to their premiums.

Schemes and Gap covers communicated the news to their members, so you would have received information from your service provider.

Please do not hesitate to contact me should you have any questions in this regard


LIESL DU PLESSIS
MEDICAL AID SPECIALIST
0829240841
Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on April 17, 2018, 08:17:34 pm
I manage and solve your daily Medical Aid Frustrations.
Title: Re: Medical Aid Advice
Post by: Worth-It on May 23, 2018, 01:20:44 pm
TRAUMA AND EMERGENCY COVER FOR ONLY R99PM
INCLUDES:
•   Panic button and GPS tracking
•   Immediate Emergency Transport (includes Helicopter or Fixed Wing Plane)
•   R100K Guaranteed acceptance into closest facility suited for your type of injury per event
•   R1000 pd cash pay out for in Hospital Stay (after first 24hours)
•   R100K Permanent accidental disability
•   R100K Accidental death cover
•   R50K Repatriation – transportation of remains to location verified by next of kin.
•   Available in SADEC countries
SUITABLE FOR ANY ONE WHO DOES NOT HAVE CURRENT MEDICAL AID COVER
NO WAITING PERIODS
NO  MEDICAL TESTS


Title: Re: Medical Aid Advice
Post by: Worth-It on July 09, 2018, 06:06:53 am
COMMENTS ON NATIONAL HEALTH INSURANCE - BY BONITAS MEDICAL SCHEME
 
While in principle we support the actions of the Government and applaud them for taking proactive measures to improve the quality of national healthcare in South Africa, we have reservations and concerns around some of the proposed amendments. And this not only in respect of representing private medical schemes. The universal National Health Insurance Bill proposed by The Minister of Health, Dr Aaron Motsoaledi, is defined by the World Health Organisation (WHO) as ‘universal health coverage means people will receive the health services they need without ‘suffering financial hardship’.

CONCERNS

No one is disputing that a comprehensive and viable healthcare system is needed in South Africa and is long overdue. However there are a number of questions which still need to be addressed and answered. Such as: How the system will ensure quality healthcare is provided; how it will be administered and how it will be funded? Another major concern is around the proposal that there be a single public purchaser and financier of health services for the country. Previous pronouncements on NHI intimated that medical schemes would essentially be reduced to playing a complementary role within the NHI dispensation. In the draft Bill, there are no explicit provisions that there will be any significant changes in the role, structure and functioning of the medical scheme industry, other than to mention that they will cover what the NHI does not cover. However, it is important to note that the NHI Bill was published in tandem with the Medical Schemes Amendment Bill which contains some fundamental changes for schemes which have potentially far reaching implications on the benefits options structuring, membership coverage and funding obligations.
 
FUNDING
Our knowledge and experience enable us to assist the government with the funding aspect, ensuring there is value for money, for instance, by avoiding duplication. We have a great deal of experience in keeping healthcare systems cost-efficient. We feel that perhaps the Bills were presented prematurely, are more of a strategy with the implementation being at best, vague.
 
MEDICAL AID COMPLIMENTARY ROLE
That said, we remain positive that we can play a role in plugging the gap left by the NHI, a gap conceded by the Government. The Bonitas mandate is to provide affordable and quality healthcare for all South Africans and we see our role as a complementary health product provider to the NHI.
 
FRAUD, WASTE AND ABUSE (FWA)
One of the major drivers of healthcare inflation and increased costs is fraud, waste and abuse (FWA) which adds an estimated R22 billion to the annual cost of private healthcare. A conservative estimate is that between 10 and 15% of claims contain elements of fraud. Private medical schemes have invested heavily to introduce robust analytical software programme to help identify anomalies and irregularities to put a stop to FWA. We’re not sure that one central fund for all healthcare funding and purchasing power is the most prudent option. A system of this kind is open to corruption and abuse on an even larger scale.
 
OPTICAL CARE
While comprehensive in terms of healthcare coverage, the NHI won’t cover everything. Dentistry, optical care and other lifestyle conditions aren’t necessarily high priorities because there are bigger burdens in other areas. According to WHO, 246-million people worldwide have low vision, and 39-million are blind – most of them in developing countries. As much as "80% of all visual impairment can be prevented or cured", says the WHO, but many do not get the treatment needed.
 
So of the world’s 39 million blind people – most of whom are in the developing world – 30 million lost their sight unnecessarily; their blindness could have been prevented through basic health care and simple procedures like cataract operations. In addition to this, 2.5 billion people don’t have access to glasses 700 years after they were invented. We believe this is one of the areas in which we could provide a complementary service.
 
MANAGED CARE
We are also keen to play an active role in preventative and managed healthcare something which has been neglected. Dr Motsoaledi has said numerous times that ‘Lifestyles diseases have become an epidemic in South Africa and this too needs to be addressed’. There are risks involved when people are only diagnosed once they suffer from a certain preventable condition. Diabetes is a good example. Many people are pre-diabetic. Through our managed care programme we encourage people to change their lifestyle and make sure they go to the doctor regularly to prevent them from becoming full-fledged diabetics. The government has made a pledge to tackle the epidemic of lifestyle conditions but we feel that the burden of disease is so vast that the NHI system will not be able to manage this for over 55 million people.
 
ABOLISHING BROKERS
We feel the role of brokers is not completely understood. Their role is not to simply to sign up members. Brokers help alleviate some of this confusion by providing an independent evaluation of a person's specific circumstances, both from a financial and healthcare perspective. From a servicing perspective, brokers are ‘invaluable’, as they aid consumers in resolving their queries quickly and efficiently, and help educate them. We feel South Africans should have a choice whether they would like to use a broker when it comes to making their healthcare choices.
 
CO-PAYMENTS
The reason why rates are higher than those prescribed by the National Health Reference Price List (NHRPL) is that the last time the rates for healthcare services were set was in 2006 – 12 years ago. With an increase of around 3-6% the prices have not kept up with healthcare inflation, the rates are not viable for a healthcare provider to run a viable practice. In fact, the rates set by the NHRPL haven’t broken the R300 mark for a consultation yet. This is why most rates are higher why there are co-payments. The reality is that many medical scheme plans offer payment way over the medical aid rate. 
 
The abolishment of co-payments is quite idealistic. This amendment would mean the full cost of healthcare would be covered by schemes. Co-payments were initially introduced to contain and manage rising healthcare costs by encouraging members to use Designated Services Providers (DSPs) and network hospitals and to manage expensive elective surgical procedures. In all instances in which co-payments arise, consumers have alternative options to take. The reality is that healthcare inflation is rising at an alarming rate and comfortably outpacing general inflation. In order to mitigate the effect of this, medical schemes negotiate rates with DSPs to ensure members access care of high quality and get maximum value for money. However, a member is still free to utilise another provider but this may attract a co-payment as this is a means we use to not only encourage a member to make better healthcare decisions. By way of example, co-payments often apply to elective procedures, or out-of-pocket payments for medicine if generics are available, and if a consumer receives healthcare from a service provider which has not been designated in terms of the rules of the scheme.
 
SOLVENCY RATIOS AND RESERVES
It has been indicated that the Council for Medical Schemes is currently reviewing the legislated 25% reserves requirement with a view to introducing a more risk-based capital approach that could allow a portion of the existing reserves to be released to help alleviate members’ needs in terms of funding for health care services and/or reduce annual premium increases. This review is welcome by the industry, should it be implemented responsibly.
 
REGULATIONS OF PRICES
There are large-scale changes that would affect private providers of care (both healthcare professionals and hospitals), including the data requirements, contracting and tariff regulations. It is envisaged that this will be the cause of much engagement and/or legal proceedings. There are some potential positives in the proposals for the introduction of some uniform prices for health services. This provision could be beneficial for the medical scheme industry as it will create a uniform set of prices/tariffs by which schemes can purchase services from providers and suppliers of health products – nonetheless, it is unclear in the Bill whether the prices that will be determined by the NHIF will be uniformly applicable to all purchasers of health care services.
 
We wish to re-iterate that the process is that comments will be received from various stakeholders within the industry over 3 months and that these will be considered before a final Bill is tabled.

Kind regards
Bonitas Medical Fund

Title: Re: Medical Aid Advice
Post by: Worth-It on July 09, 2018, 06:16:13 am
20 BESTE HOSPITALE IN SA - VOLGENS DICOVERY HEALTH

Hier is die 20 beste hospitale in SA

Die resultate van die nuutste peiling onder pasiënte wat Discovery Health uitgevoer het om die beste hospitale in die land aan te wys, toon sewe hospitale wat al vier jaar agtereenvolgens op die lysie is.

Lede van mediese skemas wat deur Discovery Health geadministreer word, het aan die peiling deelgeneem oor die hospitale waar hulle in 2017 opgeneem is. Die lys is uit 140 hospitale saamgestel.

Life Healthcare, en die onafhanklike netwerk van hospitale wat lede van die National Hospital Network (NHN) is, het die meeste hospitale op die lys.

Netcare het net een hospitaal op die lys.

NHN het die meeste hospitale wat reeds vier jaar agtereenvolgens op die lys is.

Hier is die lys van die 20 beste hospitale in alfabetiese volgorde:

1. Ahmed Al-Kadi- private hospitaal (Durban, KwaZulu-Natal)
2. eThekwini-hospitaal en -hartsentrum (Durban, KwaZulu-Natal)
3. Gateway- private hospitaal (Umhlanga Rocks, KwaZulu-Natal)
4. Hillcrest- private hospitaal (Durban, KwaZulu-Natal)
5. Life Bay View- private hospitaal (Mosselbaai, Wes-Kaap)
6. Life Carstenhof-hospitaal (Johannesburg, Gauteng)
7. Life Chatsmed Garden-hospitaal (Durban, KwaZulu-Natal)
8. Life Mount Edgecombe-hospitaal (Durban, KwaZulu-Natal)
9. Life Roseacres-hospitaal (Johannesburg, Gauteng)
10. Life St. Dominics-hospitaal (Oos Londen, Oos-Kaap)
11. Life Suikerbosrand-hospitaal (Heidelberg, Gauteng)
12. Life West Coast-hospitaal (Vredenburg, Wes-Kaap)
13. Lowveld-hospitaal (Nelspruit, Mpumalanga)
14. Mediclinic Milnerton (Kaapstad, Wes-Kaap)
15. Mediclinic Panorama (Kaapstad, Wes-Kaap)
16. Mediclinic Victoria (Tongaat, KwaZulu-Natal)
17. Netcare N1 City-hospitaal (Kaapstad, Wes-Kaap)
18. Nu-Shifa-hospitaal (Durban, KwaZulu-Natal)
19. Wilmed Park- private hospitaal (Klerksdorp, Noordwes)
20. Zuid-Afrikaans-hospitaal (Pretoria, Gauteng).

Vier jaar op die lys

Hier is die lys wat Netwerk24 opgestel het van die hospitale wat al vier jaar op die lys is sedert die peiling deur Discovery Health begin is:
1. eThekwini-hospitaal en -hartsentrum (Durban)
2. Hillcrest- private hospitaal (Durban)
3. Lowveld-hospitaal (Nelspruit)
4. Mediclinic Milnerton (Kaapstad)
5. Mediclinic Panorama (Kaapstad)
6. Wilmed Park- private hospitaal (Klerksdorp)
7. Zuid-Afrikaans-hospitaal (Pretoria)

Die twee hospitale wat verlede jaar drie jaar agtereenvolgens op die lys was en nou uitgeval het, is die Mediclinic Stellenbosch en die Midvaal- private hospitaal (Vereeniging, Gauteng).

Dié wat nou die derde jaar agtereenvolgens op die lys is, is die Gateway- private hospitaal en Life Bay View- private hospitaal. Die Netcare N1 City-hospitaal is die tweede jaar agtereenvolgens op die lys.

Discovery sę die inligting van die peiling word openbaar gemaak om die bestuur van hospitale aan te moedig om hul pasiënte se sienings ernstig op te neem.

Discovery

Volgens dr. Roshini Moodley Naidoo, hoof van die gehalte van sorg by Discovery Health, help dit om die pasiënte se ervaring van die sorg wat hulle in hospitale ontvang, openbaar te maak. Dit is nie net om erkenning aan uitnemendheid te gee nie, maar ook geleenthede te skep om gapings aan te pak.

Die peiling word aan volwasse lede van die mediese skemas gestuur wat deur Discovery Health geadministreer word, sewe dae nadat hulle uit die hospitaal ontslaan is. Lede wat meer as een keer in dieselfde hospitaal opgeneem is, kan net een keer elke vier maande aan die peiling deelneem. As dieselfde lid na ’n ander hospitaal gaan, word ’n peiling ook gedoen.

Van die vrae hou verband met die gehalte van die sorg wat die verpleegpersoneel bied; die reaksietyd van personeel; die gehalte van dokters se sorg; die hospitaalomgewing; pynbestuur; inligting wat aan die pasiënte gegee word oor hul medikasie; inligting wat aan die pasiënte gegee word oor hul ontslag uit die hospitaal, en ’n algehele telling.

Moodley Naidoo sę daar is in sekere kategorieë die afgelope jare voortdurende vordering gesien. Dit kategorieë wat deurlopend die hoogste punte kry, is kommunikasie deur dokters en pynbestuur. Volgens haar is ’n goeie verbetering gesien in die inligting wat oor medikasie gegee word, en in die kommunikasie deur verpleegpersoneel.

Waar daar ’n verbetering nodig is, is met die ontslag van pasiënte. “Pasiënte wat goed voorbereid is op hul ontslag uit die hospitaal, het ’n beter kans om gesond te bly en sal minder waarskynlik weer opgeneem word.

“Herhaaldelike opnames word węreldwyd beskou as ’n tekortkoming in gesondheidsorg.”
Title: Re: Medical Aid Advice
Post by: Worth-It on July 09, 2018, 06:27:26 am
COMMENTS ON NATIONAL HEALTH BILL - BY ZEST LIFE GAP COVER

As a Gap Cover provider we would like to comment on Health Minister Aaron Motsoaledi's public address on the NHI Bill and the Medical Scheme Amendment Bill.

We are fully supportive of the NHI Bill and the goal of providing universal healthcare for all South Africans. This we believe to be consistent with our constitution and supports the enshrined rights contained therein. Despite the mammoth task of realising this vision and considerable resource and implementation challenges that will need to be overcome, we see this as a massive step in the right direction.

The Medical Schemes Amendment Bill which seeks to eradicate medical scheme co-payments, does not serve the interests of all South Africans and does raise some serious considerations around the practicality of implementation.

Before addressing the shortcomings of the Medical Schemes Amendment Bill, it's important to understand that a bill is a proposed law which is yet to be made law and as such it is merely a proposal by Government. A bill remains subject to public and industry comment and only when these issues have been adequately addressed through further probable amendments can a bill be finalised as an Act of Parliament. With a contentious subject such as this and the millions of South Africans that are affected by it in its current form, the process may take years to finalise.

The burning question is how the bill in its current form could obligate medical schemes to pay for the total cost of healthcare treatment for its members without resulting in a significant increase in member contributions. The concern is that medical schemes will be forced to increase member contributions to enable full cover for members. This will result in a further decline of membership.

The suggestion by the Health Minister that the abolishment of co-payments can be funded by reserves is not workable especially in the medium to long term because reserves are needed for the security of solvency and the reserves will run out. The suggestion to abolish broker commission is also not workable. This will impact on the livelihood and employment of brokers and in the complex world of medical schemes, brokers provide a vital role for the public.

The main problem the Health Minister is trying to address is the uncapped fees that specialists charge. The limited pool of South African medical specialists are in high demand and they operate using free market principles where high demand and short supply of this expertise has an inflationary effect on their service fees. Should the Health Ministry attempt to control the fees that specialists may charge, it will likely drive a mass exodus of doctors from the county which will place us in an even worse position. This will not only be totally detrimental to medical scheme members but also the recipients of NHI as the successful implementation of universal healthcare requires us to retain our existing health specialists and draw foreign trained doctors to make up the resource shortfall.

Our conclusion is that the bill is likely to take a long time before it is finalised and will probably change significantly. In the meantime Gap Cover will continue to plug the essential shortfalls not covered by medical scheme payments. We do not forsee that we will achieve a system where medical schemes cover absolutely everything and there will therefore always be a need for Gap Cover. It may transpire that medical schemes will have to pay more than they currently do. This will correct the imbalance where Gap Cover currently pays more than the medical schemes for specialist charges, but this remains to be seen. A further possible outcome is that the bill will result in the re-introduction of a universal tariff for all medical schemes, but in our opinion it is not possible to make this tariff high enough to cover the total cost of healthcare for all the members.

Title: Re: Medical Aid Advice
Post by: Worth-It on October 01, 2018, 08:41:17 pm
Dear Member,

It is my pleasure to introduce to you the announced changes for 2019 for Discovery Health.

 Herewith a short overview of the changes as received on their Launch on 13th September 2018.

Increase 2019 (Measured against CPI + 4% and compulsory Vat Increase)

•   Saver, Core, Priority and Smart options – 8.9%
•   Comprehensive  and Executive options – 9.9%
•   Executive option – 9.9%
•   Priority options – 8.9%
•   Smart Options – 7.3%
•   KeyCare options – 6.9%.

Enhanced Benefit on All options

•   Oncology Care Enhancements
•   3 New Care Programmes: Cardiocare, Mental Health Care and Diabetes Care
•   Day Surgery Hospitals as Designated Service Providers
•   MedXpress as Designated Service Provider for Chronic Medicine on Priority and Saver Plans
•   Updates to limits, co-payments, deductibles and Thresholds
•   Trauma Benefit added to Primary Care
•   KeyCare Access renamed to KeyCare Start. 
•   KeyCare Start - new option - 17 private Hospitals. Day surgeries becomes designated service provider.  Chronic Cover provided by State Facilities
•   New income bands on KeyCare - current members on lowest income bands will  be moved
•   Vitality - Maintaining R799 Gym activation fee
o   Partnership with Sportsman Wharehouse for Huawei Band 2 Pro with huge discounted offering
o   Introducing Health Dining
o   Introducing Vitality Open (to all South Africans)
o   Increased Points for Health Checks
o   Increase Activity Rewards 
o   Updated Vitality App with more features         
     
*Rules of the Scheme will prevail.  Refer to the attached Brochure for detailed information*
 
The deadline for option changes is 14th December 2018.  However,  the administration department and call centre of the scheme will be challenged with the increased amount of work during November and December.  The Scheme might operate on skeleton staff over the Holiday Season and therefore all the processes will take longer than usual to complete. Therefore, I urge you to allow for this delay and submit your option changes by the 7th of December 2018.  The option change can be requested by the main member per email or telephone call. Email: healthinfo@discovery.co.za Call Centre: 0860 99 88 77.
 

Should you require assistance with your current option, upgrade, downgrade, or even consider a different Scheme or Gap Cover in totality, please do not hesitate to contact me to assist.

LIESL DU PLESSIS
0829240841
Liesl.cmac@telkomsa.net

Title: Re: Medical Aid Advice
Post by: Worth-It on October 01, 2018, 09:24:48 pm
Dear FEDHEALTH  Member,

It is my pleasure to introduce to you the announced changes for 2019 for FEDHEALTH.

Herewith a short overview of the changes as received on their Launch on 12th September 2018.

AVERAGE INCREASE: 8.5%

OPTION CHANGES

MyFed – (replaces the Blue Door Plus option) Affordable, entry level benefits through network providers.
FlexiFed 1 – Core Benefit Bundle for Young Healthy People
FlexiFed 2 -Core Benefit Bundle for Young Families
FlexiFed 3[/color] – Core Benefit Bundle for Growing Families
FlexiFed 4 – Core Benefit Bundle for Mature Families       
 
Current Maxima members will automatically be defaulted to closest option on FlexiFed e.g Maxima Standard members move to FlexiFed 4.

MaxiFed – Includes the Maxima Exec and Plus benefit. Offer ample in-hospital, chronic, screening and day-to-day benefits.
 
All FlexiFed options come with added benefits paid from Risk:
*Unlimited Network GP visits
*Preventative Dentistry through the Benefit Maximiser
*Maternity Benefits (Flexifed 2-4)
*Trauma treatment in casualty ward
*Female contraceptives
*General Health Screenings

Pay lower contributions by choosing between the following:
FlexiFed 1: Save 25% by choosing restricted hospital network and pay co-payment for planned procedures at hospital of your choice
FlexiFed 2-4: Save 11% by choosing network hospitals or Save 25% by choosing restricted hospital network and pay co-payment for planned procedures at hospital of your choice

Introducing Medivault and Wallet on FlexiFed 1-4
You don’t pay for savings upfront. You are now allocated money for day-to-day expenses in your Personal Medivault. The amount in your Medivault is based on your selected option and family composition. To access these funds, when needed, you transfer funds from the Medivault to your Wallet. You pay back the money interest-free over a period of 12 months.

NEW BENEFITS / ENHANCEMENTS
*New Paed-IQ Baby Help Line – access to a 24 hour children’s health advice line.
*New Childhood Illness Benefit (specialised medication) – now available on the more affordable option – FlexiFed 2, FlexiFed 3 and FlexiFed 4.  The medications are *Palivizumab for prevention of serious lower respiratory tract diseases; growth hormone products and Genotropin for treatment of short stature in the presence of open epiphyses to stimulate normal growth development and Botulinum toxin for treatment of a variety of conditions.
*Enhancements to the Weight Management Programme – now include 2 dietician consultations and 12 one-on-one or group bio kineticist sessions
*ncreased reimbursement of obstetricians – On FlexiFed 1 core benefit bundle the reimbursement rate increased from 100% to 165%.
*Removal of co-payment on elective C-sections – all co-payments removed on all options
*Preventative Care Benefit – Include Breast Cancer Screening (Mammogram) *MyFedOption excluded, Colorectal Cancer Screening (Faecal Occult Screening) *MyFedOption excluded, Osteoporosis Screening (Bone Mineral Density), Pneumococcal Vaccine, Prostate Specific Antigen and Review of hysterectomy co-payments.   
*Reducing co-payments on open hysterectomies to R3,600 on FlexiFed1, FlexiFed2 and FlexiFed3 Core benefit bundles.
*Review of laparoscopic varicocelectomy co-payments – Introducing a R6,200 co-payment on laparoscopic varicocelectomies on FlexiFed1, FlexiFed2 and FlexiFed3 core benefit bundles.  On MyFed – only open varicocelectomies will be allowed (PMB level of care).
*Changing the Maxima Exec formulary from restrictive to comprehensive (chronic medicine formulary).
*Removal of OHEB benefit on Maxima Exec.

The deadline for option changes is 30th November 2018.  However, the administration department and call centre of the scheme will be challenged with the increased amount of work during November and December.  The Scheme might operate on skeleton staff over the Holiday Season and therefore all the processes will take longer than usual to complete. Therefore, I urge you to allow for this delay and submit your option changes by the 15th November 2018.  The main member can request an option change by submitting an option change form to queries@fedhealth.co.za. Or call 0860 002 153


Should you require assistance with your current option, upgrade, downgrade, or even consider a different Scheme or Gap Cover in totality, please do not hesitate to contact me to assist.

LIESL DU PLESSIS
CMAC
0829240841
Liesl.cmac@telkomsa.net


Title: Re: Medical Aid Advice
Post by: Worth-It on October 01, 2018, 10:12:39 pm
Dear Bonitas Member,

It is my pleasure to announce the 2019 Bonitas changes and increases anounced on their launch recently


Average increase of 8.9%

•   5% for BonFit
•   7.9% for BonSave, Primary, BonEssential
•   8.9% for Standard and Standard Select
•   9.9% for BonCap
•   11.5% for BonComprehensive, BonClassic, BonComplete and Hospital Standard

Unfortunately, Hospital Plus will cease to exist for 2019. Members will be moved to most suitable option.

Two new plans introduced

Primary Select and BonEssential Select, will use a network of providers and are priced around 15% cheaper than Primary and BonEssential, while offering the same level of cover.
Members will have to nominate a GP for Primary Select and use a hospital network for planned procedures on both options. The contributions for these options are from R1 904 for Primary Select and R1 477 for Bon Essential Select.

Changes for the year

Improved preventative care benefits
We have enhanced our preventative care benefits to include mammograms for women over 40 once every two years on all our plans. In addition, prostate screening antigen tests will be covered for males between 45 and 69 years on all options.

Childhood immunisations covered from risk
We are pleased to announce that in 2019, children’s vaccines according to the Expanded Programme for Immunisations will be covered on BonClassic, BonComplete, Standard, Standard Select, BonSave, Primary, Primary Select and BonFit. This benefit will be in addition to savings and day-to-day benefits so that our younger members get the care and support they need.

PPN has been appointed as the optical provider in 2019 on all options
Our optical provider for 2019 will be PPN. PPN is the largest optometry network in South Africa with over 2 600 providers located countrywide. We have also appointed Ampath, Lancet, Pathcare and Vermaak as designated service providers for all blood and lab tests in and out of hospital.

Internal prosthesis benefit added to BonEssential
An internal prosthesis benefit of R31 500 per family (excluding joint replacements) will be added to the BonEssential option in 2019. The benefit will also be included on BonEssential Select.

Changes to BonComprehensive
We introduced ICON as a preferred provider for oncology services and ICPS/JointCare/Major Joints for Life as the preferred provider for hip and knee surgery. The specialised radiology benefit was combined to R31 330 per family, in and out of hospital.

Changes to BonClassic
The out-of-hospital radiology and pathology benefits have been combined into one benefit and the out-of-hospital physiotherapy and paramedical services have been combined into one benefit as well. We have also removed the benefit for specialised drugs on this plan.

Day-to-day benefit on Primary increased by 15%. This will increase from R2 010 for a principal member in 2018, to R2 310 in 2019.

Free rewards with the Multi-insurer Platform
The Multi-insurer Platform will allow Bonitas members to start taking comprehensive and holistic care of their financial health and wellness without paying anything extra. No points, no fees, no levels and no jumping through hoops to earn rewards. It features the following:

•   Free monthly voucher rewards from Electronic Line from January 2019
•   Life insurance, life cover with quick payout, critical illness cover, income protection, disability cover, funeral cover through Indie with an extra 10% added to the Bounty Investment for Bonitas members.

The deadline for option changes is 30th November 2018.  However,  the administration department and call centre of the scheme will be challenged with the increased amount of work during November and December.  The Scheme might operate on skeleton staff over the Holiday Season and therefore all the processes will take longer than usual to complete. Therefore, I urge you to allow for this delay and submit your option changes by the 15th of  November 2018.  The option change can be requested by the main member by completing an option change form. Email: optionchanges@bonitas.co.za or call 0860 002 108
 


Should you require assistance with your current option, upgrade, downgrade, or even consider a different Scheme or Gap Cover in totality, please do not hesitate to contact me to assist.

LIESL DU PLESSIS
CMAC
0829240841
Liesl.cmac@telkomsa.net
Title: Re: Medical Aid Advice
Post by: Worth-It on October 02, 2018, 11:39:06 pm
Dear Member,

The tax season is currently in full pursuit with the closing date of end October 2018 rapidly approaching.

If you still have to submit your tax, your medical scheme tax certificates can be requested from your scheme's call centre or download it from your fund’s website.
Please do not hesitate to contact me should you require any assistance.

Kind regards


LIESL DU PLESSIS
CMAC
0829240841
Liesl.cmac@telkomsa.net

Title: Re: Medical Aid Advice
Post by: Worth-It on October 16, 2018, 08:10:36 pm
Dear Medihelp Member,

It is my pleasure to announce the increases and changes to Medihelp Medical Scheme for 2019.

Average Increase 9.92%

Enhancements and changes for 2019.

Radiography (all options) - Services rendered by radiographers receive a separate benefit across all options to the amount of R1100 per family
Added insured benefits (Prime 1,2,3 Elite and Plus) - An amniocentesis screening per pregnancy has been added to maternity benefits
Prime Hospital Network - 3 Additional Hospitals have been added to the network 
Unify Option - A cornea implant benefit of R27400 per implant per year has been added.
Necesse Option - Income bands have been collapsed to 3 new bands only. 
Increase Oncology for non-PMB Cancer - On Prime 1,2,3 and Elite
Increased Optometry Benefit - On Prime 3, Necesse and Elite
Introducing of a Specialist network - Network of Specialist contracted to curb co-payments and private tariffs


The deadline for option changes is 17th December 2018.  However,  the administration department and call centre of the scheme will be challenged with the increased amount of work during November and December.  The Scheme might operate on skeleton staff over the Holiday Season and therefore all the processes will take longer than usual to complete. Therefore, I urge you to allow for this delay and submit your option changes by the 1st Decemer 2018.  The option change can be requested by the main member by completing an option change form. Email: membership@medihelp.co.za or call 0860 678 100. You should receive a confirmation of your option change, if not, please  investigate.


Should you require assistance with your current option, upgrade, downgrade, or even consider a different Scheme or Gap Cover in totality, please do not hesitate to contact me to assist.

LIESL DU PLESSIS
Liesl@ cmacldp.co.za
0829240841
Title: Re: Medical Aid Advice
Post by: DirtRebell on October 16, 2018, 09:31:32 pm
Sent you an email this evening.