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South Africa is currently enjoying being one of the most productive nations in the world and with our growing economic success has come improvements in health care and medical services. Naspers Medial Aid is just one of many schemes on offer to help South African’s to meet the cost of improved health services. With so many programs on the market it can be difficult to stand out from the crowd, which is why Naspers has opted for a diverse range of features and benefits designed to provide a functional medical aid program to members.
In general, Naspers medical aid is only available to employees and family members of Media24 and their affiliates although in certain cases continuous membership is also available, albeit under certain restrictions.
Conditions Of Continuous Membership
On of the main reasons why continuous membership to the Naspers Medial Aid scheme may be applied is that if the employee loses their job due to illness or disability, they will continue to receive benefits even after termination of employment. Another situation in which continuous membership might apply is where member has been retrenched due to cut backs in the department that they work in. Lastly, continuous membership may be offered to those who have retired.
Basic Health Plan Options
Naspers Medical Aid offers two basic care plans to the general public, the N Option Plus and the N Option Basic. The plans each comes with their own set of benefits. On both products, one of the key features is the Chronic Illness coverage which has proved very popular with many members who are used to medical aid programs charging additional fees for this service. There is a long list of diseases which are covered by Naspers medical aid plans including, but not limited to:
Asthma
Parkinson’s Disease
Rheumatoid Arthritis
Chronic Kidney Disease
Naspers medical aid offers sufficient benefits for members to receive adequate medical care for most issues that they will encounter, although there are some diseases which will have limitations applied to them. Overall, the programs offer a good choice in medical aid with N Option Plus members getting hospitalization benefits of up to R2 million per family and Basic plan members being entitled to up to R1 million. If you are employed by Media24 or one of their subsidiaries then the Naspers medical aid program is well worth looking into.
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.
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.
If you are thinking about obtaining cheap medical aid cover, or you want to make sure that you are still getting value for the money spent on your current cover, then a few simple steps can help. These steps will guide you through what can be a bit of a maze when it comes to medical aid schemes in South Africa.
Firstly, you will need to make a list of the kind of things that you need your medical aid scheme to cover. This will depend on your individual requirements or the needs of your dependents. If you already belong to a medical aid scheme then it is good practice to take a long hard look at the details of that cover in order to make sure it is still going to be beneficial to your needs as well as your family’s needs. The best time to review your medical aid policy is at the start of the year, as this is the time when most medical aid companies increase the cost of their premiums or even reduce the amount of cover included within the policy itself.
Secondly, you will need to think hard about the level of medical aid cover that you and your family are going to require. The most proficient way of doing this, is to work out just how much your medical bills were in the previous 12 months whilst at the same time allowing for unexpected emergencies that can crop up at any time. Most medical aid companies offer policies that can be changed throughout the year in case you need to remove certain cover or add new cover, such as maternity medical aid. If you think that you might be facing a lengthy spell in hospital in the coming year then you need to check the small print of your policy in order to ascertain just how many days in hospital your policy covers. This can also apply to the cost of prescription medication for chronic illnesses as this medication can often last for quite some time, and there may be a limit on your policy that only allows for medication to be funded over a certain length of time.
Some medical aid companies will offer many different policies that cover most medical situations. Finding the right one can be a lengthy and complicated process, as well as a tedious one. However, there are now companies that offer three or four different schemes that cover most of the population and their medical requirements.
You will find that as you get older that you will have to pay more for your medical aid than when you were younger, and this is simply because the older you get, the more likely you are to need medical assistance.
Spending some time in order to work out exactly what kind of medical cover you need in conjunction with your budget means that you will not be left high and dry when you need medical assistance.
