lang="en-US"lang="en-US"lang="en-US"UTF-8Jackson | Medical-Aid.co.za | Page 19https://medical-aid.co.za/xmlrpc.phphttps://medical-aid.co.za/wp-content/themes/twentytwelve
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LA Health medical aid is part of the more well known Discovery Health Ltd. The scheme currently provides cover to nearly 65,000 members primarily from the local government industry. Although the LA Health brand is often overshadowed by the Discovery name, the scheme has actually been in operation for around 40 years.
The program focuses on enhancing the lifestyle that their members currently enjoy based on extensive research which indicates that making small, sustainable adjustments to your day to day life can make a positive impact on your overall health and can even help to prevent certain diseases. Some of the changes advocated by LA Health medial aid include:
Being more physically active.
Following a healthy eating plan.
Taking preventative measures.
Making good lifestyle choices.
These seemingly insignificant changes to your every day habits can make a substantial difference in both improving and maintaining your overall well-being, not just physically but also mentally and spiritually.
LA Health medical aid members can choose from five different plans all of which offer integrated health and lifestyle benefits which will help members with their quest for a healthier lifestyle. Across these various options the scheme strives to be able to cater for any member’s individual needs. The plans offered include:
LA KeyPlus
LA Focus
LA Active
LA Core
LA Comprehensive
Chronic Illness Cover
One of the things that really sets LA Health medical aid apart from similar schemes is the long list of illnesses which are covered in full under all five plans. These include Bipolar Disorder, COPD (Chronic Obstructive Pulmonary Disease), Haemophilia, HIV & AIDS, Multiple Sclerosis and Parkinson’s Disease among many others. Partial cover is also offered on a range of other conditions including organ transplant, stroke and major psychiatric disorders. The scheme also operates a dedicated oncology program which is also accessible to members on all plans.
Day To Day Medical Expenses
Depending on the plan level selected, members are also covered for many of those day to day medical expenses including eye care, dentistry, doctor’s appointments, over the counter medication and prescription treatments. With the higher level plans there is also additional access to a medical savings account
Preventative Measures
As noted, LA Health medical aid id passionate about improving health and they advocate preventative measures to help members avoid illness. Some of the preventative care benefits offered at some plan levels includes :
flu vaccination
mammograms
pap smears
prostate antigen screenings
annual vitality checks
cholesterol and blood pressure monitoring
LA Health medical aid certainly has a somewhat unique take on how to approach health care schemes. Their focus on making positive lifestyle changes is something that other providers should be looking at since healthier members will surely mean more affordable premiums!
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 a recent interview discussing the interim results for the first half of 2013, Netcare medical aid revealed that they are expecting hospital inflation to stay below consumer price inflation (CPI) even although inflation is over 7%. CEO of Netcare, Dr. Richard Friedland revealed that the medical scheme had managed to contain costs both in terms of CPI and other products. Consumers everywhere have been feeling the pressure financially in recent months, but Netcare medical aid patients have weathered the storm and the groups private health care and dental clinics have also been performing well. In fact, Netcare have opened new facilities in Carlswald, Midrand, Rangeview and Khayelitsha. Netcare medical aid patients have access to 9266 beds across South Africa and there are plans to open up a further 89 beds later in the year with construction of two new hospitals slated to begin later this year in Polokwane and Pinehaven.
Friedland said, ‘I think only about 3.4% of our patients, certainly in the hospital division are out-of-pocket private paying patient.’ However, despite this, Netcare’s primary care division has actually experienced a 7.3% decrease in revenue. Although Freidland does put this down to the recent transition to a managed healthcare risk model designed to provide a low-cost options for health care. The introduction of National Health Insurance (NHI) has been a sticking point for many medical aid providers, but Netcare say that they welcome universal coverage as a way to provide extended services that will be available for all although Friedland admits that he is disappointed that a planned enquiry into the private healthcare sector by the Competition Commission is to exclude the pharmaceutical.
The enquiry which is set to get underway this coming September released a draft of the terms to be discussed late last month. Private hospitals and medical schemes will be placed under close scrutiny but because the pharmaceutical industry is already subject to price controls they will escape direct examination. Friedland states, ‘we all know we are paying 40% more for drugs in this country and cross-subsidising the state sector. If the real aim of this enquiry is to reduce costs, one of the easiest ways would be to help procure drugs at the same prices as you can internationally, which is at least 40% less. To allow parallel importation would be helpful.’
About NetCare
Netcare operate one of the largest private hospital groups, primary care networks and emergencies medical services in South Africa in addition to being the largest training provider for emergency medical personnel and health care workers. Netcare is also the largest provider of private acute hospital provider in the United Kingdom offering independent services to the National Health Service (NHS).
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.
This entry was posted in Medical Aid and tagged Crime, Fraud, Health, Health care, Health care fraud, Identity theft, Medicaid, Medicare on by Jackson. 614class="post-614 post type-post status-publish format-standard hentry category-medical-aid tag-disease tag-facilities tag-health tag-health-care-provider tag-hospital tag-managed-care tag-medicine tag-south-africa"
Transmed is one of the many private medical aid programs which medical-aid.co.za can provide you a quote from. Transmed medical aid have a huge range of health care related services which is one of the reasons that they are considered to be one of South Africa’s premier medical aid providers. One of the key selling points for Transmed is that their policies offer a large range of benefits which can be extended to the primary member’s immediate family.
A Closer Look at the Transmed Medical Aid Program
The main focus of Transmed medical aid programs lies in taking into consideration the people who require the medical coverage. One example of this is the fact that when members are signed up via their employer, even in the event of them being terminated due to disability, ill-health or retirement the deal agreed with Transmed will still apply. This means that even if updates are made to the plan after the member’s employment is terminated, the new benefits will still apply.
As noted, Transmed offers a range of different medical aid plans to their members. The three most popular Transmed medical aid plans are:
State Plus Network
State Plus Own Choice
Private Network Saver
The State Plus Network plan can offer members a wide range of benefits including the day to day services of clinics and physicians and will allow for hospitalization in either State enhanced or basic medical facilities, while the State Plus Own Choice plan will also allow for state owned medical centers.
If a member prefers to opt for care in a private hospital, then they can do so, but only if the hospital or clinic is one of the Transmed Private Hospital Network. However, acceptance can only occur if admittance to such a facility can be considered involuntary. For instance, if the required treatment is only available at a private facility. This can include both planned treatment and emergency care.
Managed Care Programmes From Transmed
Transmed medical aid also offers managed care programs designed for the over 60’s. One such program is the Eldercare system which offers support not only for the elder,but also for their family members. Eldercare promotes ‘healthy aging’ and will allow members to become further educated in dealing with the illnesses that commonly affect older people. In addition to the Eldercare system, Transmed also offer HIV care programs and Oncology care. These managed care programmes are intended to help members find the most appropriate treatment and care as well as support them in living a normal life as much as is possible.
A lot of people that do not belong to a medical aid scheme often say that they consider them to be too expensive. Cheap medical aid is available, however, if you are on a low income and have other bills to pay, it can seem as though medical aid is beyond your reach.
Taking care of your health should be of the utmost importance, yet many people do not consider some of the ailments or injuries that may befall them at any time. A sudden medical crisis can occur when you least expect it, and all it takes is one careless driver to cause a crash which could leave you in need or serious medical attention. The cost of that medical attention could be very high, depending on how long you are in hospital and the intensity of your treatment. Without a medical aid plan to help you to meet the costs, you could end up having to find the money to pay for your treatment from elsewhere, and therefore you could end up in a lot of debt.
Cheap medical aid does not mean that you have to settle for poor medical treatment or not be covered for certain conditions. Most of the healthcare plans at the bottom end of the scale are there to provide protection against transport to hospital, hospital admissions and treatment, as these are among some of the highest expenses you will have to face.
Cheap medical aid schemes may not be as inexpensive as relying on public healthcare; however, you will find that the treatment you receive will be much better and much more efficient. Paying money every month towards a healthcare plan is one way in which you can soften the financial blow that is caused by having to pay hefty medical bills.
Despite the fact that there is so many medical aid schemes to choose from currently in South Africa, as many as four in five people still do not belong to a medical aid scheme. This means that the public health facilities are under an enormous strain due to the sheer number of people that are using them for treatment. This has the effect of causing long waiting times as well as a less efficient service, and that could mean the difference between overcoming injury and illness quickly, or the situation getting worse.
