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There are a number of complex issues that affect medical aid programs and it can be difficult to understand all of the ins and outs. One of the common areas that causes confusion for medical aid members is late joiner penalties. Let’s take a look at Transmed medical aid as an example in order to explain the basics of something that is a feature of the majority of medical aid programs.
What Is A Late Joiner Penalty?
A late joiner penalty is not a one off fee like many people assume, it is a penalty that will be applied to your medical aid payments for the rest of your life. A late joiner penalty is applied when you apply to join a medical aid plan at a certain age. It means that the premiums you pay will be higher than those paid by regular members. The late joiner penalty usually applies to those aged 35 years and over. The penalty is generally between 5% and 7% and is determined by a formula which is outlined in Regulation 13 of the Medical Schemes Act (131 of 1998). The ins and out of the late joiner fee may differ from scheme to scheme, for example with Transmed medical aid the penalty is imposed on applicants over the age of 35 years who have not been a member of a medical scheme since 1 April 2001 without a coverage break exceeding three consecutive months.
Why Do Late Joiner Fees Apply?
If you look at the Transmed medical aid scheme, the members cover a diverse age range from 21 years to 75 years and older. It is pretty logical to consider that the younger members are healthier than the older ones in most cases. The younger members are more likely to be participating in sports and generally leading a healthier life style, which may mean they claim often for sports injuries and preventative benefits. However, older members are more likely to have ongoing health conditions that require regular claims. In short, older members are more demanding than younger members. If a member joins young then by the time they reach an age where they have a greater need for medical care then they will have paid in enough money to cover that additional need. However, if they join at a later stage then they are depending on funds paid in by younger members. If you consider it this way then it is not unreasonable to expect those joining at a later stage to pay a little extra to compensate for the years they have missed!
Often when people think about their medical aid they are often thinking about treatment that they might need in future when they fall ill or sustain an injury, but often medical aid programs also offer preventative benefits to help members to keep healthy. Pharos medical aid provides a wide range of preventative benefits which are designed to help keep members healthy and prevent any serious illness. Let’s take a closer look at the benefits on offer.
Access To Vaccines And Immunisations
One of the main preventative benefits offered by Pharos medical aid is immunisations. Children up to the age of 6 years old who are registered on the ‘our-baby’ program are eligible for all baby and childhood immunisations as per the schedule set out by the Department of Health. In addition to this, any member who is over the age of 60 year old or who is at a higher level of risk because of a chronic condition is eligible for flu and pneumococcal vaccines on an annual basis.
Well Woman Preventative Care
The preventative benefits offered by Pharos medical aid also include some preventative measures that every woman needs to take into consideration. The first of these is cervical cancer screening which is available to all female members of child-bearing age every 3 years, or every 2 years for those at a higher risk. Pap smears are carried out by either a GP or a registered nurse and includes consultation and pathology. All women over the age of 35 years, and those at a particular level of risk, are also eligible for mammograms or breast ultrasounds. Basic screening is offered to those aged 35-39 years and those aged 40-49 years are eligible for screening every 2 years. Those over 50 years and those at risk because of a strong family history of breast cancer can take advantage of yearly screening.
Early Identification Of Serious Conditions
One of the best ways to ensure that you stay healthy is to catch serious conditions as early as possible. Some of the preventative benefits offered by the Pharos medical aid program include:
Prostate Cancer Screening
Colon Cancer Screening
Blood Pressure Monitoring
Cholesterol Testing
Blood Glucose Testing
HIV Antibody Testing
Annual Health Risk Assessment
Maternity & Baby Program
Pharos medical aid also offer the ‘our-baby’ program which offers a range of pregnancy and baby related benefits to members. The our-baby program offers cover for services including antenatal visits, urine tests and ultrasound scans. Members can also take advantage of baby massage classes, nanny training and other benefits.
These are just a fraction of the preventative benefits that are offered to Pharos medical aid members. It is important to take a proactive approach to your health and benefits like these can help you to achieve this. We have used Pharos medical aid as a case study, but many medical aid programs also offer preventative benefits so be sure to use our comparison tool to find the right program to meet your needs.
We live our lives striving to obtain different needs and desires. These typically include a good job, a nice home, and plenty of money, but there is one thing that is far more important than any other is – that is our health. It is of the utmost importance that everyone that resides in South Africa has some type of medical aid scheme not only for themselves but also for every member of their family. Having a medical aid scheme can mean the difference between getting the treatment and medications that you need, and going without them. Medical aid schemes, like Bonitas hospital plan, are critical to have in place when the unexpected emergency occurs and you need to spend time in the hospital.
As you can quite imagine when the time comes that something happens to your health, or the health of a family member, you want to know that they will get the treatment that they require. In many cases if you do not have any type of pre-existing medical aid scheme then you could be left having to pay a large amount of money out of your pocket. If you do not have the money to get the treatment you need, it is quite possible that you can end up going without it. If you take the time and effort to choose a medical aid scheme, such as Bonitas hospital plan, then you can live with the knowledge that you or your loved ones that are covered, will be able to get the treatment that is required.
This plan, offered to you by Bonitas comes in two variations. Although some of the features and benefits are the same within the two plans, there are some differences. The two plans are the BonCap and the BonEssential.
Of the two plans, BonCap is the ideal option for the individual that is on a tight budget but still wants to insure that they are covered. This plan covers a number of basic medical needs, which include hospital stays, pharmaceutical needs, optometrists and dental services. With the basic services included in your medical aid scheme, you will get the preventative treatments that you need that can stave off potential serious conditions to your health or those family members covered under your plan.
The BonEssential plan is designed to cover all of the unexpected incidents that may occur to the young, fit, and healthy individual. It does not have all of the benefits that the BonCap plan offers, as it is set up to cover issues that may arise unexpectedly. If you are not concerned with having coverage for an optometrist or dentist, but want to be covered if you fall ill unexpectedly, this is the ideal coverage as it is affordable and will cover you when problems arise.
If you do not have a medical aid scheme of any kind, consider what your needs are and look into one of the Bonitas Hospital plans.
The health, happiness, and well-being of your loved ones and yourself are generally at the top of most individuals list of priorities. Despite this thought and belief, there are many individuals that forget the importance of getting the correct medical aid scheme. A proper medical aid scheme is critical when it comes to the health of your family. Without a good plan in place, if something is to happen to yourself, or one of your dependents, there is a possibility that proper medical treatment and/or required hospitalisation may not occur. By taking the time to select a medical aid scheme that is right for yourself and your family you will be able to rest easy in the knowledge that you are covered. In the unfortunate event that one of you come down with an unexpected illness, or have an unforeseen accident, you will not have to wonder how you can afford the treatments and medications that you will need.
If you are uninsured and are looking to find a medical aid scheme that will work best for you and your family then consider the different plans available with Sab Medical Aid. They offer different plans that suit a variety of needs and budgets. The plans they offer are Essential Options Benefits, Comprehensive Options Benefits, Premium Table Essential Option and Premium Table Comprehensive Option. Each of these plans were designed to meet the different needs that individuals and their families have when it comes to preventative medical care, diagnosis, treatment, hospitalisation and so much more.
Each of these medical aid schemes offered by Sab Medical Aid offer a wide array of medical benefits at various levels. Just a few of the benefits that will be covered regardless of the scheme that you select include dental services, mental health assistance, ambulance services, optical services, alcoholism and drug dependency treatment. There are a host of other benefits that each of the different plans offer that will guarantee that you and your family will be taken care of regardless of your medical condition.
Do not risk the health and well-being of your family by not taking the time out of your busy schedule to find the perfect medical aid scheme for your family. By determining exactly, what you need by way of treatments in case of emergencies, as well as preventative medical treatments and diagnosis, you will not have to worry about how you will pay for the medical assistance that you may need or require at some point in your life. Do not leave your health and medical treatment to chance. Choose the one of the plans offered by Sab medical Aid and never worry about what you will do in the event of a medical emergency or illness.
Ensuring that your family and yourself are protected and receive the medical care that they may require from time to time can only be achieved if you have signed up for the correct medical aid scheme. The health of yourself and your family is not something that you should ever take for granted. Things happen, whether they be accidents or becoming suddenly ill, and when they do you need to be protected otherwise you may be in a position where you cannot receive the medical treatment that you need. As daunting, a task as finding a medical aid scheme may be there are a number of options available for you and your family. Afrox Medical Aid is a provider of medical aid that will help you ensure that when they need it, your family as the medical coverage that they need.
When it comes to selecting, the proper medical aid scheme for you and your family you need to take into consider your current age, physical condition, and medical condition. Although you may be on a tight budget, it is still extremely important that when selecting your scheme that you get the absolute best plan for your money to truly benefit from it. It is also important then you consider any of the plans offered by Afrox Medical Aid that you get a plan that covers your current condition and any plans you may have that will require medical attention, such as chronic illnesses or a future pregnancy. By getting the appropriate medical aid scheme you can rest easy in the knowledge that when you or one of your dependents become ill, that you will have the medical help ready to help with the treatment and recovery.
Some of the key benefits that are offered by Afrox Medical Aid are as follows. Most importantly, your medical aid scheme is good for the period of a year, from January 1 to December 31. This means that regardless of the day of the week, or the month you will have the help that you or your family needs. Other basic benefits are the 100% coverage of any hospitalisation that takes place throughout the year when you are required to be admitted. It is important to note that this coverage is only in effect when you are admitted into an approved hospital a co-payment is required. You and your dependents will also receive chronic medication benefits, and care for a list of 26 specified chronic conditions.
Do not leave your health or the health of your dependents at risk; look into getting the correct medical aid scheme that you require in the case of illness or accidents. Having coverage in place can make the difference between quality treatment that is covered or costly treatments.
With Nampack medical aid, members and their beneficiaries are able to access a number of benefits designed to assist in the treatment and management of HIV and AIDS. These benefits can be accessed by registering on the Your Life HIV Management Program, which is administered by Momentum Medical Scheme.
Nampack medical aid are dedicated to the ethos that HIV sufferers should be able to live a normal and productive life wherever possible. They believe that discrimination and misunderstanding through ignorance is not acceptable. In today’s modern society we have access to advanced medical care which means that both HIV and AIDS are now considered to be a manageable chronic disease instead of the death sentence that it once was. With the Your Life management program Nampack medical aid members will have the support they need to remain healthy, something that is especially important for HIV/AIDS sufferers due to their lower immune systems.
The benefits offered by the Your Life program are designed to address total wellness, not just the HIV virus. AIDS and HIV manifest differently in different patients meaning that all patients registered on the program have their own specific needs. When registering on the program each member is allocated a dedicated consultant who will create a management program within your allocated budget.
Post Exposure Treatment Benefits
Members can access advice and recommended antiretroviral treatments which are intended to prevent infection by the HIV virus in the case of accidental exposure. This has to be done within two to six hours of the exposure to the virus for the best treatment results. An HIV diagnosis can be devastating and it brings with it many emotions and social burdens. Staff involved with the program are trained to a very high standard and are fully experienced in these issues. Members will be given support every step of the way in overcoming your fears. The main goal is to help members of the program to learn how they can live a positive and more importantly healthy life even after contracting HIV or AIDS.
Confidentiality Guaranteed
Nampack medical aid reassure their members that confidentiality is of the utmost importance. They state that anyone who has the courage to disclose that they have a condition like HIV or AIDS deserves only respect and all staff will offer this to those members. Your condition will be disclosed only to your medical team so there is no need to be concerned that other people, including your employer, would ever learn of your condition.
It happens to all of us at one point or another. We fall ill, have some type of accident or someone that we know and love does. Whereas we cannot prevent accidents from happening, or illness from striking, there are things that we can do that will help us either prevent them or help us get the medical assistance we need once they do occur. The best way to do this is to look for the best medical aid scheme that will work for yourself and those that we love and are responsible for in our lives. Since medical aid schemes are so varied it is important that you determine exactly what your needs are and what sort of coverage you are going to require. This could be limited to an extremely basic scheme to something that is a bit more elaborate that offers you and your family extensive benefits. The Bonitas Hospital plan comes in two different forms and either one, is a great option for anyone seeking medical coverage.
One of the first things that you need to consider when you are looking for medical coverage is what state of health you and your family members are in at that time. If you are young, fit, and healthy, the kind of coverage you will need is a bit different from older individuals. If you are on a tight budget but are still seeking some type of medical cover there are options available for you there as well. The most important thing to remember is that basic coverage if much better to have than no cover at all in the case of a medical emergency brought on by a sudden illness or accident.
The two options that you can get from Bonitas include the BonEssential and the BonCap. Both of these medical aid plans offer a variety of medical benefits that include hospital stays and cover 26 chronic conditions. The BonCap is ideal for those that want coverage that is more comprehensive while the BonEssential is great for those young and fit individuals on a tight budget.
Protect yourself and your family by seeking out some type of medical aid scheme today. You will be able to find a plan that will not only fit into your budget but will give you the benefits that you need and require. Bonitas Hospital plan has two options that will work for you and your family regardless of your age or medical state. Simply take the time to look through all of the various benefits that they offer and get the peace of mind that comes with knowing when the unexpected happens that you and your family will be taken care of, allowing for you to focus on your recovery.
When it comes to securing access to health care, most South Africans just want a medical aid scheme which is straightforward and easy for them to understand. That is exactly what Hosmed medical aid strive to offer to their members. This particular medical aid scheme is available to both the private and public sectors in South Africa. The Hosmed medical aid scheme was first established in the late eighties with the goal of securing health care for civil employees, but it has now grown at a steady rate and now boasts around 34,000 members.
The key thing that most people look for in a medical aid program is a good selection of benefits at an affordable rate. There are three main plans offered by Hosmed medical aid all of which certainly offer a great combination of benefits that do not carry exorbitant premiums.
The Hosmed Step Option
The basic level of medical aid offered to the public is the Step Option which offers admission to any state run medical facility including hospitals, clinics and treatment centres. These admissions do need to be backed with a pre-authorisation slip. The plan also offers a number of high risk benefits including coverage for chronic illness that does not exclude HIV and AIDS. This is something that many other schemes charge a surcharge for, although the Hosmed medical aid do pace several protocols on this cover. However, HIV management cases will only be approved if the patient is a member of the scheme prior to treatment beginning.
The Hosmed Value Option
If the step plan does not seem the right fit, then the mid level plan may be a better option. The Hosmed Value Option offers most of the same benefits that the Step Option does, but one of the main additions is that this particular scheme option offers a very attractive day to day option which covers over the counter medication with a limit of R500 per family or R120 per prescription. Additional cover offered also includes treatment for mental health issues, physiotherapy and alternative therapies.
The Hosmed Plus Option
At the top level of the scale, Hosmed medical aid offer the Plus Option plan. This is the most fully comprehensive plan offered by the scheme. The over the counter medication usage limits are higher with an annual family limit of R850 and a per prescription maximum of R180. The plan also includes cover for prescription medication. There are also some increases in the day to day benefits.
The important thing to keep in mind if you feel that Hosmed medical aid is an appropriate choice for you is that you need to decide what your needs are prior to choosing a plan. This means taking a closer look at the benefits offered and also at the general health of you and your family members.
One of the up and coming medical aid schemes at the moment is Gems Medical Aid which can offer plans that are a little different to those offered by the more well known plans such as Discovery and Bonitas. Gem medical aid is primarily aimed at providing healthcare to suit government employees. The scheme has five affordable plans which have been created with members’ needs in mind.
Gems medical aid aims to provide members with access to an extensive range of benefits while still maintaining affordable monthly premiums. Gems provides access to quality healthcare to public service employees and low income families. Gems medical aid members can also receive medical care at private clinics, access disease management programs and get emergency care as required. Let’s take a closer look at the plans on offer to Gems medical aid members.
The Sapphire Plan
The Sapphire Plan from Gems medical aid offers members access to a large network of health care providers including pharmacists, dentists and GPs among other services. Plan members do not need to pay any additional fees for treatment and consultations received within this network.
The Beryl Plan
Beryl offers all of the same benefits of the Sapphire plan, but members also have access to some additional benefits including out-of-hospital over, chronic mediation cover, maternity programs, dental cover, HIV/AIDS management, Oncology cover and optometry care.
The Ruby Plan
The Ruby Plan allows Gems medical aid members with an additional level of care. Not only do they get access to care programs for chronic diseases which will provide both them and their families with the necessary support and medical care they need, but the plan also includes a savings account.
The Emerald Plan
With the Emerald option plan members still have to make use of the approved GEM network of health care providers if they are to avoid out of pocket expenses, but using them is not required. It is necessary to seek re-authorisation for hospital visits including out patient visits, physiotherapy and ambulance transport.
The Onyx Plan
The upper level plan offered by Gems medical aid is the Onyx plan which offers members very specialist care programmes to help manage a range of chronic diseases. This includes education about a number of conditions including asthma, diabetes and mental health. There is no requirement for Onyx members to use the GEM network of providers, but doing so will remove the potential for out of pocket expenses.
Pre-Authorisation For Gems Medical Aid Plans
The various plans do require pre-authorisation when it comes to specialist dentistry, physiotherapy, out-patient hospital treatments, MRI scans and CT scans. Ambulance transportation is also a requirement for re-authorisation.
In conclusion, Gem medical aid presents the ideal solution for government employees and low income employees who are looking for quality healthcare at affordable rates while also gaining access to great benefits.
In recent years, medial aid members have experienced steady increases in their monthly contributions as the industry battles against the increasing cost of claims. A huge percentages of these costs can be attributed to fraud. That is one of the reasons why medical aid provider Polmed have recently launched a renewed crack down on fraud.
Fraud can deplete the funds that are available to payout on legitimate claims made by Polmed medical aid members, and that is something that Polmed are seeking to avoid so that members are not faced with higher contributions and fewer benefits. One of the steps that Polmed are taking is to try and educate their members on how they can personally help prevent fraudulent claims. In a recent newsletter sent to all Polmed medical aid members they offered the following tips for prevention and detection of fraud:
Be sure to carefully compare the actual medical care you have used to the services which have been charged and report any discrepancies.
Never allow service providers to use your medical aid card to claim any services that are not healthcare related.
Be sure to be 100% truthful on all claims, falsifying any information is classed as fraud.
There are a number of different things which can be considered as fraud including pretending to be someone else in order to receive healthcare, lending someone your identity documentation including a medical aid card, using someone else’s medical aid card and making any kind of untruthful statement with the goal of getting medical care or pharmaceuticals.
Fraud is a very serious criminal offense and it is something that Polmed are taking very seriously. Any Polmed medical aid members who are discovered to have done anything which defrauds the scheme will face some very stiff penalties as well as a potential custodial sentence. Polmed have reiterated the fact that they operate a zero tolerance policy in regards to fraud and the company have now implemented a very solid task force which has the sole purpose of combating health care fraud. The task force can be contacted on 0800 200 564.
Prevention & Protection Tips
If you are a Polmed medical aid member, or a member of any medical aid scheme for that matter, you can follow these tips to both prevent and protect yourself against health care fraud.
Never give out your membership number to anyone except your doctor or health care provider.
Never give out your membership number over the telephone.
Treat your medical aid card as you would your credit card – it is just as valuable.
Use your personal health care journal or any other diary to record all of your health care including appointments, therapies and pharmaceuticals used.
Review all claim statements for discrepancies, asking yourself these 4 basic questions each time :
Did you receive all of the treatment listed?
Did your doctor order any tests or products listed?
Have you been billed for treatments multiple times?
Is the service listed relevant to your condition?
With a little care and vigilance it is possible for you to help prevent health care fraud, which costs up to R13 billion every single year. With every rand which is claimed fraudulently the risk of legitimate claimants not getting the treatment they desperately need increases, so it is something that needs to be stamped out.
There are a number of complex issues that affect medical aid programs and it can be difficult to understand all of the ins and outs. One of the common areas that causes confusion for medical aid members is late joiner penalties. Let’s take a look at Transmed medical aid as an example in order to explain the basics of something that is a feature of the majority of medical aid programs.
