Bonitas - Parenting Hub

Digital Covid Hub drives education and vaccinations

The 3rd wave of Covid-19, which is predominantly the Delta variant, is having a major impact on our healthcare system with reports of hospital admissions being significantly higher than during waves 1 and 2. ‘We can attest to this by the ongoing monitoring and analysis provided by our actuarial teams’, says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘In 2020 we had a total of 8 111 members hospitalised due to Covid-19 as opposed to 7 815 over the past six months.’ Covid Hub – education for everyone ‘At the outset of the pandemic, 18 months ago, we created an informative and educational Covid-19 hub to create a reliable source of information and to educate and empower our members,’ explains Callakoppen. ‘The information includes helping identify symptoms, providing guidelines on how and where to be tested and receive treatment.’ Recently, the Fund enhanced and bolstered this centralised, digital Covid-19 information hub and made it accessible to all South Africans – www.bonitas.co.za/covid. ‘As new scientific data became available, we continued to update the hub, highlighting key topics such as safety protocols, the different types of Covid-19 tests, dispelling myths around the vaccine and explaining the difference between Covid-19, the common cold and flu. One of the key elements is the comprehensive guide to recovering from Covid-19 which includes tips for caregivers, the do’s and don’ts of Covid-19 recovery, as well as post-Covid care tips.’ ‘Now, given the increased vaccination drive and it being opened to a wider group, we have further enhanced the site to assist our members with registration and help speed up the process at Bonitas vaccination sites.’ Private vaccination sites for all To support the Department of Health’s ongoing efforts to vaccinate as many South Africans as possible, Bonitas has vaccinated over 100 000 South Africans at its private vaccination sites across the country. A quarter of whom (25 245) were Bonitas members. At present, the 50+ age groups are being vaccinated, with registration and vaccinations for 35+ now open. The 10 sites adhere to all the required safety regulations and are staffed by qualified nurses, additional sites are due to come on-line in the new few weeks. ‘As of 13 July 2021, there were 2 031 Bonitas members in hospital, compared to 1 893 the week before and 1 598 at the end of June,’ says Callakoppen. ‘We have conducted a total of 338 981 PCR tests, 150 430 of these were between January and July 12th – with 28 097 members testing positive. This is a 44% increase over 6 months. ‘However, studies have shown that once people are vaccinated, they’re far less likely to fall seriously ill and that the vaccine provides protection against hospitalisation for the Delta variant, which is why the vaccine roll out is critical.’ This aligns with the recent statement from Dr Marian van Kerkhove of the World Health Organisation (WHO): ‘The Covid-19 situation globally is dangerous with high levels of transmission driven by four major factors. The first are these variants of concern, including the Delta variant. The second factor is that we have increased social mixing and social mobility, which increases the number of contacts that individuals have. The third factor is the relaxation or the inappropriate use of public health and social measures. Proven public health and social measures that we know prevent infections, reduce the spread of somebody who is infected with the virus to others and save lives. And the fourth factor is the uneven and inequitable distribution of vaccines.’ Herd immunity Vaccinating as many people as soon as possible remains a priority if we are to minimise the impact of Covid-19. To achieve herdimmunity, the South Africa’s Department of Health is aiming to vaccinate 67% of the country’s population – this equates to around 41 million people. ‘It’s heartening to learn that vaccine acceptance is growing in South Africa, with the latest Covid-19 study revealing that 76% of the population are willing to be vaccinated. The daily average number of doses administered over the past week – counting only weekdays between Monday and Friday – amounts to 150 000 – reaching a total of just over 5 million with 1,67 million South Africans having received both doses. This means 2.9% of the population is fully vaccinated. Plans are in place to ramp this up over the next few weeks, which will include sites being open over weekends and to widen the groups being vaccinated. Educate and vaccinate In collaboration with service providers and employer groups, the Fund’s private vaccination sites also promote key Covid-19 messages, with take home educational leaflets that can be shared. ‘In addition, we have begun the process of opening vaccination facilities at major scheme employer sites, such as Eskom,’ says Callakoppen. ‘We are continually engaging with corporates to improve the support we provide.’ Identified high-risk beneficiaries are also being supported through various initiatives, including disease management interventions, home-based care and medicine supplies where required. QR Code replaces forms ‘Complaints about queues and waiting times at some sites have been taken into consideration,’ says Callakoppen. ‘We have streamlined the process for members by providing access to a QR code, upon registration on the EVDS and our portal. This means that they are scanned upon arrival, eliminating any delay by having to fill in forms – allowing for a smooth and efficient process.’ Registration should still be done via the Government website on https://vaccine.enroll.health.gov.za and everyone must remember to take along their unique token, ID document or passport to the vaccinations site. If you’re on a medical aid, make sure you have your medical aid card with you. ‘We need to remain on high alert about the pandemic,’ warns Callakoppen. ‘It may be day 477 but we cannot afford to be complacent. We must all play our part to stay safe, which means following the protocols and getting vaccinated. ‘The vaccination process is a key focus area for us, along with education. We will continue to use our Hub (available at www.bonitas.co.za/covid) as a central resource for factual information. A

August 3, 2021

Generics and biosimilars – champion cost savers in the healthcare industry

It is common knowledge that healthcare costs rise exponentially and medical schemes have to find ways to reduce costs both for the medical scheme and its members. Kathy Malherbe spoke to Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, about generics and biosimilars and how they contribute towards reducing healthcare costs. One of the cost drivers is medication which is why The Pharmacy Act of 1997 and the Medicines Control Amendment Act, among other things, have made it mandatory for dispensers of medicine, be they doctors or pharmacists, to offer a patient a generic substitute if one is available. However, generics are not the only cost savers. The patent expiry on many biological medicines is opening the door to more affordable, life-saving ‘biosimilars’ to be produced – another ‘champion’ in the pharmaceutical industry. Increased consolidation in the healthcare industry is also having a positive impact on medicine prices and availability. Medical aids are trying to create more competition, even among medicines that are still under patent. They are also tightening up their formularies, in part to encourage pharmaceutical manufacturers to provide better pricing. What is a generic drug? A generic is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. It is an exact copy of brand-name drugs that has the same dosage, intended use, effects, risks, safety and strength as the original. In other words, their pharmacological effects are identical to those of their brand-name counterparts. But at a much more affordable price… Generic medicines cost, on average, between 30 and 80% less than the original. What guarantee is there that generics are true replicas? In South Africa, the Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective. Generic drug manufacturers have to prove their medicine is bioequivalent to the original brand before a product is approved into the local market. What is a biosimilar? Biological drugs are large, complex proteins made from living cells through highly complex manufacturing processes. Biosimilars are a close equivalent but not exact copies of biologicals. and are manufactured after the patent for the biological/reference drug ends. To be called a biosimilar drug, it must be shown to be safe, work as well as, and work in the same way as its reference drug – the biological. It must also be used in the same way, at the same dose, and for the same condition as the reference drug. The cost of manufacturing biological medicines is more expensive than conventional chemically produced medicines and, because biosimilars are close copies, they remain expensive but are still more cost effective that the original. What are they used to treat? The most important biological medicines are used to treat conditions such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis, diabetes and cancers. How are they different from generics? The reason biological copies are called biosimilars is that, unlike generic medicines, the active ingredients are not exactly the same as the original but ‘similar.’ It is impossible to make identical copies when ‘translating’ biological molecules from living cells in the laboratory. Very importantly to note though, is that even though biosimilars are not a direct copy, the therapeutic effect is the same as the original biological product. Why are generics and biosimilars less expensive? Generics Pharmaceutical companies are researching and testing new active ingredients and medicines all the time. The patent is valid for about 20 years which means that only the approved company may research, create a new formulation (the ‘recipe’ and process for creating the actual medicine) and register the medicine. This takes years and carries a huge financial burden. After about 8 to 10 years on the market the patent usually expires and other drug companies can make an exact copy of the drug without the initial clinical research costs. Biosimilars While these medicines have revolutionised treatments for many diseases, the research and development expenses, including the costs of highly skilled scientists, clinical trials and the specialised equipment needed, are the main cost drivers. Companies are required to fund these costs, often in excess of 10 years, before registration for use by patients. Biosimilars save costs because: The molecule and effects have already been discovered and identified by the originator The number of patients required in the clinical trials is reduced The original biological medicine would have been ‘manufactured’ at least 20 years ago. New manufacturing methods are more efficient. The cost-efficiencies, which generic and biosimilar medicines provide, are assuming greater importance for state and private health funders as populations age and the prevalence of cancers and other non-communicable diseases increase. SA’s already stretched healthcare budget is coming under increasing pressure to fund the high cost of pharmaceuticals, especially biological medicines. While generics and biosimilars may not be a panacea for high healthcare costs, they will go a long way towards offering a cost-effective, quality treatment for a large range of diseases. In addition, these breakthrough treatments can halt progression and sometimes even prevent recurrence by acting on proteins that affect the genome/immune system.

July 5, 2021

Toddler Milestones

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Growing children Children grow and learn at their own pace. It is normal for your child to be ahead in one area, but behind in another. Learning what is normal for each age group can help you feel comfortable with where your child is at and spot any problems early on. Milestones: age 2 Milestones for age 2 include: Walking by themselves; this usually takes place between 9-17 months with the average being 14 months Running: about 6 months after learning to walk Climbing stairs and onto furniture Kicking a ball Ability to scribble with crayons, pencils or markers Imaginative or make-believe play Communication includes using real words by 15-18 months and simple phrases by 18-24 months Milestones: age 3 Milestones for age 3 include: Improved balance: can stand on one foot for a short time, can petal a tricycle and can walk upstairs without holding the railing All baby teeth have come through Potty trained during the day 20/30 vision Communication includes increased vocabulary (hundreds of words), uses short sentences, uses plurals and pronouns and asks many questions Can dress self with exception of laces, buttons, etc. Knows their name, age and gender Learns to share Milestones: age 4 Milestones for age 4 include: Hops on one foot well Throws a ball overhand well Uses scissors to cut out a picture Communication includes increased vocabulary (thousands of words), uses longer sentences, uses past tense and asks even more questions than ever Learns simple songs Starting to understand time better Milestones: age 5 Milestones for age 5 include: 20/20 vision Increased coordination: skipping, jumping and hopping well Learning to use writing utensils well Communications includes increased vocabulary (over 2000 words), uses sentences with 5 or more words and uses all parts of speech Knows the primary colours Learning to understand math Learning to behave with more responsibility and less aggression

June 14, 2021

Infant Milestones: the first year

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Milestones: 1-3 months Milestones for months 1 to 3 include: Ability to raise head and chest when laying on stomach Stretches arms out and kicks when laying on back Smiles purposefully Enjoys playing with other people Can follow a moving object with eyes Ability to open and shut hands and bring hands to mouth Ability to grasp and shake a toy Communication includes facial expressions and body movement, coo’s and babbles Begins to imitate some sounds and expressions Begins to recognize toys and people from a distance Hand-eye coordination improving Milestones: 4-7 months Milestones for months 4 to 7 include: Uses hands and mouth to explore Can find a partially hidden object Attempts to get objects that are out of their reach Can roll from back to tummy and tummy to back Can sit by self for a short time, with or without hands and sit in a highchair Ability to transfer toys between hands, point and reach for objects Communication includes using more variety of sounds and pitches; uses sound to reflect moods, babbles to get attention and can imitate sounds better Play becomes more intentional Milestones: 8-12 months Milestones for months 8 to 12 include: Can move to a sitting position and crawling position on his/her own Crawling Sitting independently Pull up, stand and walk while holding onto furniture; may even take a few steps independently Grasp objects with thumb and first finger; can finger feed themselves Place toys into containers and take them out; find toys that are hidden Communication includes saying mama and dada, oh-oh, shaking head yes or no and imitating other sounds; may even say their first word Uncomfortable around strangers and cries when mom or dad leaves

June 7, 2021

Boosting your immune system

The global pandemic has highlighted more than ever the need to stay healthy and keep our immune systems as strong as possible. It is well documented that people with co-morbidities and poorly functioning immune systems are at the highest risk of getting really ill from Covid-19. Although you cannot suddenly reverse a co-morbidity or instantly boost your immune system, now is a good time to make your health and natural defences a priority. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund offers some input as to how to boost our immune system and keep it that way. What is the immune system? The immune system is a complex network of cells and proteins that defend the body against infection. It also keeps a record of every germ (microbe) it has ever defeated, so it can recognise and destroy the microbe quickly if it enters the body again. Dr Mkhatshwa stresses the fact that Covid-19 is a novel (new) pathogen which means our bodies don’t have any existing antibodies to mount a defence. For that reason, it remains imperative to continue wearing masks and practising social distancing, hand hygiene and cough etiquette. Can over-the-counter vitamins and supplements help? There is no magic pill that will instantly boost your immune system. However, together with a healthy lifestyle habits, various supplements can boost your immune system and give you a fighting chance. What are considered useful vitamins and supplements to take? The recommendation for general health is a combination of 5 essential vitamins and minerals to keep your body healthy. These include: Vitamin C: Supplementing with Vitamin C has been shown to reduce the duration and severity of upper respiratory tract infections, including the common cold. This vitamin can also be found in oranges, grapefruit, broccoli, strawberries, red bell peppers and tomato juice. Vitamin D: Also fights off infections and maintains strong bones. Vitamin D has been highly researched in connection with Covid-19 because of its effect on the immune system. – it is found in salmon, mushrooms, milk, cereals and breads. Studies have shown that Vitamin D can expedite healing and stall inflammation in the respiratory system but there has not been robust clinical evidence to prove its use against Covid-19. Vitamin A:Helps regulate the immune system and protects against infections by keeping your tissues and skin healthy – it can be found in sweet potatoes, carrots, apricots and spinach. Vitamin E: Is an essential antioxidant that helps fight cell damage. Nuts and peanut butter are filled with Vitamin E. Zinc: Works as an antioxidant and boost the metabolism along with healing wounds. Meat, shellfish, beans/legumes and nuts/seeds are high zinc foods. Zinc is needed for immune cell development and communication and plays an important role in inflammatory response. A deficiency in this nutrient significantly affects your immune system’s ability to function properly, resulting in an increased risk of infection and disease. It has also been highly researched in the fight against Covid-19 but sadly has not shown any proven clinical results. Taking a deep breath – the science behind breathing and the immune function Your mental state influences your physical health. Our immune and lymphatic systems are chemical based so we are essentially a collection of chemicals, from our brains to our bones. The air we breathe converts into chemicals that we need to fuel our cells. The way we breathe matters and even impacts our body chemistry. The physiological responses to deep, controlled, mindful breathing is so profound that if we could bottle them and sell them as drugs, they’d be worth a fortune. Learn to exhale, activate your diaphragm, breathe deeply and work on fixing your posture. Simply thinking about better breathing will trigger positive immune responses. Breathing slowly and deeply is one of the most effective things you can do right now for your wellbeing. The immune function and auto-immune disease are complex topics. The state of our health is not black and white, nor can it be affected by one-stop solutions. A holistic approach to health will always win against quick fixes. Once we understand that, improvements in these essential body systems can happen naturally. Will the flu vaccine help your immunity? Flu vaccines have been shown to reduce the risk of influenza illness, hospitalisation and death. Not only will flu vaccinations reduce the risk of getting flu but are an important conservation measure for scarce health care resources. This remains a concern with the ongoing the Covid-19 pandemic. A protective antibody response takes about 2 weeks to develop so should be taken early. The third wave of Covid-19 in South Africa, as predicted by The National Institute for Communicable Diseases (NICD), has begun and Dr Mkhatshwa recommends doing everything you can to boost your immune system, according to your personal preference. In terms of Covid-19, it’s especially important to understand that no supplement, diet or other lifestyle modification, other than social distancing and proper hygiene practices can protect you.

May 28, 2021

Free Flu Vaccines

Annually, seasonal influenza (flu) kills around 11 500 people in South Africa. Which is why Bonitas Medical Fund offers flu vaccines annually at no cost – to every member and beneficiary. The Fund has announced that the cost of administering the flu vaccine – as well as other vaccines covered from the risk benefit – will also be covered or subsidised for its members. Flu vaccines have been shown to reduce the risk of contracting flu, becoming seriously ill if you do, being hospitalised and even death. Flu vaccinations are also an important conservation measure for scarce health care resources, which remain a concern during the ongoing the Covid-19 pandemic. According to Principal Officer of Bonitas, Lee Callakoppen, the World Health Organization (WHO) has also recommended that high risk groups consider having the flu vaccination in 2021, particularly because of Covid-19. ‘As part of our preventative care benefit, we offer free flu vaccinations annually to our members to help maintain their health and immunity. ‘Due to the unique circumstances created by the pandemic and our members being financially constrained, we have negotiated with our network of over 60 pharmacy groups – which include Dischem, Clicks and PnP – to cover cost of the flu administration fee, capped at R50. However, should a provider charge more than R50, the shortfall will be for the member’s account.’ He says the Scheme is financially stable and sound and has set aside funds to cover the flu vaccine – estimating around 40 000 doses will be utilised during the 2021 season – along with the administration costs. Although the flu vaccination is free to all members, the Scheme (guided by WHO and the Department of Health) highly recommends that the following groups consider being vaccinated: Healthcare workers Individuals over the age of 65 years People with comorbidities like heart disease, diabetes or lung disease Pregnant women People living with HIV and AIDS ‘We believe the best and first form of defence against flu is the vaccine,’ says Callakoppen. ‘And we suggest people get vaccinated soon, ahead of the flu season – which traditionally runs from May to August because the protective antibodies take about two weeks to develop. However, we know that protocols in place for Covid-19 such as social distancing, wearing a mask, handwashing and sanitisation will also go a long way in protecting against us against getting flu.’ In addition to the free flu vaccination and as part of the preventative care benefit, Bonitas also covers the costs of a pneumococcal vaccine for beneficiaries over the age of 65 years once every 5 years and childhood immunisation, this includes the vaccine admin fee.

May 20, 2021

Gestational Diabetes: Reasons, risks and recovery

Kathy Malherbe speaks to the clinical team at Bonitas Medical Fund to get some insights on Gestational Diabetes (GDM) and tells the story of mother-of-two, Theresa’s (36) experience with Gestational Diabetes. Diabetes is a condition whereby your body is unable, in varying degrees, to produce or respond to the hormone insulin. This causes abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Diabetes is commonly divided into four types: Type 1, Type 2 (often lifestyle related,) Gestational Diabetes and Diabetes Mellitus. Normally when you eat, your blood sugar rises. The pancreas, a gland deep in your abdomen, releases a hormone called insulin. It helps move sugar from your blood into your cells for energy and storage. In a non-diabetic person, the blood sugar will go back down to normal after eating. What is Gestational Diabetes? Gestation comes from theLatin gestare, which means ‘to bear’ or ‘give birth to’. Medically speaking it is the period between conception and birth. There are two types of Gestational Diabetes. Women with class A1 can manage it through diet and exercise. Those who have class A2 need to take insulin or other medications. Gestational Diabetes usually goes away after you give birth. But it can affect your baby’s health, and it raises your risk of getting Type 2 diabetes later in life Unlike Type 1 diabetes, Gestational Diabetes is not caused by a lack of insulin but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational Diabetic symptoms disappear following delivery. Why does it develop? During pregnancy, your placenta makes hormones that cause glucose to build up in your blood and produces a hormone called the Human Placental Lactogen (HPL). HPL breaks down fats from the mother to fuel the growth of the baby. Usually, your pancreas can send out enough insulin to handle it. But if your body can’t make enough insulin or stops using insulin as it should, your blood sugar levels rise and you get Gestational Diabetes. It can lead to insulin resistance and carbohydrate intolerance in the mother. Who is at risk? About 10% of pregnancies result in Gestational Diabetes. The causes are not known but the risk factors include: Age-older women High blood pressure, high cholesterol, heart disease Obesity Not exercising Immediate family history of diabetes History of Gestational Diabetes in a previous pregnancy Have had a miscarriage or a stillborn baby Polycystic Ovarian Syndrome It is important to note that there is no definitive way to prevent Gestational Diabetes. Even mothers who have had Gestational Diabetes in a previous pregnancy may not get it with a later pregnancy. Warning Signs of Gestational Diabetes Sugar in the urine Unusual thirst Frequent urination Fatigue Nausea Blurred vision Vaginal, bladder and skin infections. When and how is it detected? In most cases, Gestational Diabetes develops in the second or third trimester (from week 14 to the birth) and disappears after the baby is born. A screening or finger prick blood test can be done at a clinic or pharmacy to give you a snapshot of your blood sugar levels. However, a formal diagnosis requires a blood test and sometimes this will need to be repeated. Gestational Diabetes is detected by using an oral glucose tolerance test (OGTT) or a random blood glucose test. The OGTT test is done by a nurse or doctor taking a blood sample from your vein to test the blood sugar levels. Then you will drink a glass of water mixed with glucose. An hour later you will have another blood test. Your blood glucose level should rise after you finish the sugary drink, then go back to normal, as insulin moves glucose into your cells. If it takes too long to go back to normal you could have diabetes. What the test shows The blood glucose is measured in milligrams per deciliter (mg/dL). Two hours after you finish the glucose drink, this is what your results mean: Below 140 mg/d: Normal blood sugar (7.8mmol) Between 140 and 199: impaired glucose tolerance or prediabetes (11mmol) 200 or higher: diabetes (11.1mmol) The random glucose blood test is carried out a couple of times to see if your glucose varies widely. If initially you are not diagnosed with Gestational Diabetes, the test may be repeated at around 24-28 weeks. What are the dangers? In many cases it can be controlled with a healthy diet and exercise but at least one in ten women will need their blood glucose levels controlled with medication. If your diabetes is not picked up during pregnancy it can cause risks at birth. The most prevalent is shoulder dystocia which is when the baby’s head gets stuck during the birth. This can cause: Fractures to the collarbone and arm Damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm Lack of oxygen to the body (also called asphyxia). In the most severe cases, this can cause brain injury or even death It can also lead to babies being large for their gestational age which can result in birth complications How can you help yourself? By adhering to an eating programme that is healthy for you and for your baby including: Eat protein with every meal Include daily fruits and vegetables in your diet Limit or avoid processed foods Pay attention to portion sizes to avoid overeating Exercise regularly. Aim for at least 30 minutes of exercise 5 days a week. Just remember to speak to your doctor before starting any new exercises Don’t skip meals. To regulate your blood sugar levels, aim to eat a healthy snack or meal every 3 hours or so. Eating nutrient-dense foods regularly can help keep you satiated and stabilise blood sugar levels. Take your prenatal vitamins, including any probiotics, if they’re recommended by your doctor. Being diagnosed with Gestational Diabetes can be extremely stressful and dangerous to both mother and baby. It is imperative to have your blood glucose monitored during pregnancy. However, if you are tested regularly, stick to a healthy eating programme and exercise regularly,

May 6, 2021

Vaccines and the way forward

Bonitas Medical Fund, gives an update on Covid vaccines and how the Fund is positioned for the rollout to its members. Various scenarios have been presented regarding the speed of propagation of the third wave – the worst assumption is that it will be twice as fast as the second wave. The best case scenario is that the virus is 50% more transmissible than the second wave. Regardless, the urgency for the roll out of the various phases of the vaccination programme is undeniable. Unfortunately private procurement of the vaccine is currently prohibited but as procurement is opened to other entities, we will take every step to ensure we have access to vaccines for our members. We want to mitigate the risks of them contracting Covid-19 as well as getting seriously ill or dying, which is why we are working behind the scenes to ensure we are ready to roll out the vaccine to our eligible members. Medscheme (Bonitas’ administrator) is engaged and collaborating with the Department of Health (DoH), Business for SA, Board of Healthcare Funders (BHF) and various industry stakeholders in order to assist with the rollout from Phase 2. We are also in the process of requesting accreditation to set up private vaccination centres. This will ease access for our ‘at risk’ members and provide a broader footprint, including remote areas of the country. Our over 10 000 members, who are healthcare workers, have already started the vaccination programme in Phase 1. There are around 72 000 members who are classified as ‘Essential/Congregate workers’ and 185 000 high risk members who are either over 60 or have comorbidities. We intend beginning the Phase 2 rollout as soon as the vaccine is secured. The latest information on South Africa’s procurement of vaccines is that there are: 11 million doses of Johnson & Johnson (J&J) 20 million doses of Pfizer BioNTech A further 20 million doses of the J&J is being negotiated. This would be sufficient to cover the targeted 37 million adults in SA Through collaboration with one of our partners, Afrocentric Health, we will be able to administer up to 150 000 vaccinations per day. We are all familiar with the 3 Phase roll out plan as outlined by the DoH but there remains uncertainty about some definitions such as an essential worker – outlined in Phase Two: Essential workers, persons in congregate settings, persons over 60-years and persons over 18-years with comorbidities. The DoH announced from the onset that healthcare workers would be vaccinated in Phase 1. Phase 2’s priority group would include essential workers, persons in congregated settings, persons 60 years and older and persons over 18 with comorbidities. However, it has since been announced that, as a result of a shortage of the acquisition of vaccinations, these groups will be adapted in order of priority. As it stands on 8 April 2021 (subject to change), these groups include the following: Phase 2 Priority Group Definition Essential workers Teachers, police officers, miners, workers in security, retail food, funeral, banking and essential municipal and home affairs, border control and port health services Persons in congregate settings People in prisons, detention centres, shelters and care homes. In addition people working in the hospitality and tourism industry and education insititutions are also at risk Persons 60 years and older Persons older than 18 years with comorbidities Persons living with HIV, TB diabetics, chronic lung disease, cardiovascular disease, renal disease, obesity, etc What we have done is to ensure we know, upfront, who our high risk member population is and, once Phase 2 commences, we are able to ensure that all those who want to be vaccinated, will be. Together with our administrator, we have set up various processes to ensure we are able to achieve this goal to ensure peace of mind for our members.

April 14, 2021

Woman’s Health

Birth Control Side effects of birth control pills The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you have just started taking birth control pills you may experience a headache, dizziness, breast tenderness, nausea, breakthrough bleeding, mood changes or other side effects. Be patient, these side effects often go away after a few months. If they don’t you may want to talk to your doctor about your options. Some positive effects of taking birth control are lighter (and sometimes fewer) periods, milder menstrual cramps, and improved acne. Consult your doctor if you have questions about what type of birth control is right for you. Women’s Nutrition Unsaturated fats: the good, the bad and the uglyThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. There are two types of unsaturated fats, polyunsaturated fatty acids and monounsaturated fats. Polyunsaturated fats are found in most vegetable oils, flaxseeds and walnuts as well as in fatty fish such as salmon, and mackerel. Monounsaturated fats can be found in olives, avocados, hazelnuts, almonds, Brazil nuts, cashews, sesame seeds, pumpkin seeds, and olive, canola, and peanut oils. Both kinds of unsaturated fats may help lower your cholesterol and reduce your risk of heart disease. The bad fats, saturated and fatty acid fats should only be eaten on occasion. Lactose intolerant: the solution for getting your daily calcium intakeThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Lactose Intolerant? Scared of not getting enough calcium? Don’t worry; you can get calcium from eating foods that don’t contain lactose. These foods contain calcium, but are dairy free: Broccoli Leafy greens Canned salmon &sardines with edible bones Almonds Oranges Pinto Beans Tofu and soymilk Calcium-fortified breads Calcium fortified juices. Risks in Women Urinary tract infectionsThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you are experiencing a burning sensation when you urinate, or feeling the need for frequent urination, leaking a little urine or cloudy, dark, smelly or bloody urine you may have a urinary tract infection. To avoid getting a urinary tract infection: Drink plenty of water to flush out bacteria Don’t hold your urine when you need to go Wipe from front to back after a bowel movement Try to urinate after having sex to wash away bacteria Do not use feminine hygiene sprays and douches, which may irritate the urethra and possibly begin a case of urinary tract infection Try vitamin C supplements which increase the acidity level of your urine which helps decrease bacteria Wear cotton panties or underwear Breast cancer prevention The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Although you should have a mammogram and clinical breast exam every 1 to 2 years if you are 40 and older, there are ways to examine your breasts in between visits. This helps you become familiar with your breasts and breast tissue, so you are more likely to notice any changes over time. Women may start doing self-breast exams any time after the age of 20. Here are the steps: Look at your breasts in the mirror for any abnormal changes in colour, size or shape. While lying down or taking a shower use the pads of your fingers to press firmly into your breast and move your fingers in a circle around the whole breast. Check for any abnormal lumps or changes. By limiting the amount of alcohol, you drink, maintaining a healthy weight, staying physically active, and limiting the bad, saturated fats in your diet you may lower your risk of breast cancer. Heart attack warning signs and prevention The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you feel pressure or tightness in your chest, pain that goes from your chest into your jaw and/or left arm, or shortness of breath, you may be experiencing a heart attack. The most common symptom for both men and women is in fact tightness or pain in your chest; however, women are somewhat more likely to experience other common symptoms, specifically shortness of breath, nausea or vomiting, and back or jaw pain. Smoking, high cholesterol, high blood pressure, lack of exercise, stress and obesity are all risk factors for a heart attack. Quit smoking; exercise and maintain a healthy diet and weight to help decrease the risk. Also, talk to your doctor about whether aspirin could help reduce your personal risk of a heart attack. Aspirin may help keep your blood from forming clots that could eventually block arteries in the heart, causing a heart attack. Stroke warning signs The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. A stroke is a blood clot or a break in an artery that interrupts blood flow to part of the brain. Some symptoms of a stroke could be sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; and sudden trouble walking, dizziness or loss of balance. If these symptoms occur, get emergency medical help immediately. Act F.A.S.T if someone you know is experiencing signs and symptoms of a stroke. F. (Face) Ask the person to smile to see if one side droops.A. (Arms) Ask the person to raise both arms to see if one drifts downward.S. (Speech) Ask the person to say a sentence to see if their words are slurred and to see if they

April 9, 2021

Making your medical aid benefits last

Around 9 million South Africans are members of medical aid schemes to ensure they have access to private healthcare. As each new year begins, members start with a clean slate, with new benefits and replenished savings. However, across the industry, members often complain that their benefits seem to ‘run out’ early on in the year. If you manage your medical expenses correctly you can avoid out-of-pocket expenses and limit the possibility of running out of benefits. Here are 8 tips from Lee Callakoppen, Principal Officer of Bonitas Medical Fund, on how to stretch your medical benefits to maximise your value. 1. Use DSPs or networks Medical schemes negotiate preferential rates with providers – known as Dedicated Service Providers (DSPs) – who have partnered with them. This allows schemes to ensure that members get the best quality services at the most cost-effective rate so that benefits are optimised and the scheme at large is sustainable. Using network doctors is an invaluable tool to helping make your medical aid last longer because it means you won’t be charged more than the negotiated amount. With over 6 000 GPs, Bonitas has the largest network in South Africa 2. Ask your pharmacist Buy over-the-counter medicine to treat less serious ailments and always, where possible, use generic medicine which has the same active ingredient, strength and dosage as the original brands and are just as effective. Pharmacists are able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask! 3. Managed Care benefits Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes, HIV/AIDS and back and neck problems These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers. Other benefits – such as maternity consultations, wellness benefits, preventative care and dentistry – are also paid from risk by some schemes. Again giving you more value for money and are in addition to your savings and day-to-day benefits. Carefully read through what your plan offers and choose wisely to make sure you find the right plan to suit your specific healthcare needs. 4. Go virtual Look out for telemedicine or virtual consultation options – which are cheaper. A doctor will engage with you in a virtual video consultation on any medical issue and advise you on the most clinically appropriate steps for further care. 5. Be aware of consulting after hours In an emergency one has no choice but be aware that after hours consultations are expensive. 6. Know the facts If you do need to be hospitalised and it’s not an emergency, ensure that the healthcare practitioner is on your medical aid’s DSP list. Talk to your doctor or specialist to find out all the facts in terms of what they will be charging and compare this to what your scheme will cover. If the difference is substantial, negotiate. Approach your doctor and ask if he/she is prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers on your scheme’s network that will charge you a better rate. You can also avoid the unwelcome surprise of a co-payment or sub-limits by: Making sure you obtain pre-authorisation Making sure the medical practitioner uses the correct ICD-10 codes Getting a quote from the doctor, hospital and anaethetist and submit it to your medical aid to see which additional costs will apply (if any), what costs will be covered and how you can avoid these. 7. PMBs If you suffer from a Prescribed Minimum Benefit (PMB) condition, understand what benefits are provided as part of PMB conditions and use the service of a DSP to ensure your claims are paid from risk rather than from your medical savings account. 8. Keep moving One of the best ways to manage your health and the associated costs, is to live a healthy lifestyle and this includes getting enough exercise. Try different exercise routines and find one that works for you. Whether it is a regular short power walk, playing tennis or soccer, riding a bike or attending a yoga or pilates class, it will be beneficial to your mental and physical wellbeing. ‘Be informed’ says Callakoppen. ‘Your health is important, as are your finances, so take the time to research and understand the medical aid plan you’ve chosen. Even if you have not changed plans your benefits and savings differ year-on-year. Make sure you read the information sent to you, including the fine print to understand the Scheme Rules fully. If in doubt, phone the call centre, your broker or financial advisor. This will go a long way in helping you know your rights and making the most of your benefits.’

April 1, 2021

15 Facts about the Covid vaccine

Although the vaccine rollout for healthcare workers has begun, myths and misinformation continue to circulate around its development, efficacy and just how the vaccine will help manage or mitigate the spread of the virus. We asked Lee Callakoppen, Principal Officer of Bonitas Medical Fund for 15 facts about the vaccine. #1. How does the Covid-19 vaccine work? The Covid-19 vaccines produce protection against the disease by developing an immune response to the SARS-Cov-2 virus. The vaccine stimulates an immune response to an antigen, a molecule found on the virus and provides a supply of ‘memory’ T- and B-lymphocytes that help fight that virus in the future. There are four types of Covid vaccines and they are all trying to achieve the same things: Immunity to the virus, reduction of symptoms if you are infected and being able to slow down or stop transmission. South Africa is currently using the Johnson & Johnson (J&J) single dose vaccine but, regardless of which vaccine you receive, you won’t reach full protection until around two weeks after the vaccination. Your immune system needs this time to develop the antibody response. #2. It is safe? Yes. The vaccine that is being used in South Africa is safe and has been given to millions of people around the world. Although it was developed very quickly to save lives, it has gone through the same rigorous processes as other vaccines. All medical products – including the Covid-19 vaccine – have to be approved by South African Health Products Regulatory Authority (SAHPRA) before they can be administered. #3. Are there any side effects? Some individuals vaccinated with the J&J vaccine have experienced temporary, mild side effects. They are similar to those experienced with other vaccines, such as soreness at the injection site, muscle pain, chills and a headache. Some also experienced fatigue and nausea. These are nothing to worry about and will disappear within a couple of days. #4. Can you be allergic to the vaccine? People who are prone to allergies should inform the healthcare personnel administering the vaccine beforehand. This, in order for them to observed and monitored for a longer period after receiving the vaccine. However, if you experience a severe allergic reaction after getting a Covid-19 vaccine, vaccination providers – or your healthcare provider – can provide care rapidly and call for emergency medical #5. Can you get Covid from the vaccine? No. None of the Covid-19 vaccines contain the live virus that causes the coronavirus. The J&J vaccine uses a harmless, modified form of the common cold virus in humans, called adenovirus. The vaccine will help your immune system fight the virus but will not infect you with it. #6. How effective is it? No vaccine is 100% effective but fortunately, the emerging data on Covid-19 vaccines have a high efficacy, at least against some of the variants. If a vaccine has 70% efficacy, it means a person vaccinated in a clinical trial is around two-thirds less likely to develop the disease than someone in the trial who didn’t receive the vaccine. Due to the severity of the virus, a 50% efficacy threshold was set for Covid-19 vaccine. #7. Am I forced to have the vaccine? No. Having the Covid-19 vaccination remains a personal choice as confirmed by President Cyril Ramaphosa. #8. Do I need the vaccine if I have already had Covid-19? Yes, the advice is that you should still be vaccinated even if you have had Covid-19 or if you have a positive antibody test. Research indicates that the natural immunity from having Covid does not last which means the best way of fighting the virus is a combination of being vaccinated and following the protocols. #9. Will I be immune after the vaccine and will this be forever? It is too soon to know how long the vaccine will last as it is still being researched. Of the people who have received the vaccine, we know that they have been protected from Covid-19 for at least 4 months. The risk of Covid-19 infection in vaccinated people cannot be completely eliminated. #10. Can you have the vaccine if you are pregnant or breast feeding? None of the vaccine trials included pregnant individuals, so direct knowledge is limited. However, the Centres for Disease Control and Prevention (CDC) as well as a number of other medical organisations agree that any of the currently authorised Covid-19 vaccines can be offered to people who are pregnant or breastfeeding. #11. Is it safe to be vaccinated if I’m living with HIV/Aids? Yes. There is some evidence that people living with HIV may be more vulnerable to developing severe Covid-19 symptoms and so getting vaccinated is even more critical if you are HIV positive. The Covid-19 vaccinations are the most powerful tools available to help prevent severe disease due to SARS-CoV-2. The vaccines are not live and are safe for people with compromised immune systems. It’s too early to tell how effective the vaccines will be at reducing transmission of Covid-19, but we do know that they are effective at preventing severe disease and death. #12. What does herd immunity mean? Herd immunity occurs when a large part of the population becomes immune to a virus, through vaccination or infection. South Africa’s Department of Health (DoH) is aiming to vaccinate 67% of the country’s population against Covid-19 – this equates to around 41 million people – to achieve herd immunity and slow down the rate of transmission of the virus. #13. How does the vaccination process work? Everyone over the age of 18 will be vaccinated in line with the Government’s Covid-19 vaccine roll out plan. You have to be registered on the national Electronic Vaccination Data System (EVDS) and then a 3-phase approach (starting with healthcare workers) is being adopted to ensure there will be enough vaccines to meet the demand. #14. Can you elaborate on the EVDS? The EVDS is based on a pre-vaccination registration and appointment system. Individuals have to

April 1, 2021

Hospital Plans vs Hospital Insurance: Knowing the difference

In times of economic pressure we all relook our monthly expenses to see where we can save on costs but having access to quality healthcare remains a priority – even more so during a global pandemic. Hospital insurance may be cheaper than medical aid hospital plans but is definitely not the same product. We asked the Principal Officer of Bonitas Medical Fund, Lee Callakoppen, to help us understand the two different products offerings. Regulation ‘Firstly, before I take you through the benefits and possible shortfalls of hospital plans as opposed to hospital insurance, it is important to point out that hospital plans are part of the offerings provided by medical aids. This means the product is regulated and overseen by the Council of Medical Schemes and in accordance with the Medical Schemes Act 131 of 1998. Hospital insurance (or medical insurance) is part of the umbrella term, health insurance and includes hospital insurance, hospital cash back plan and gap cover. Hospital insurance is not part of a medical aid but is governed by the Financial Services Board (FSB) and the Long-term and Short-term Insurance Act,’ explains Callakoppen. Medical Aid Hospital Plans A hospital plan provides you with basic, yet important medical cover. The product differs from scheme to scheme but in essence this plan is offered by a not-for profit medical scheme and will cover you in hospital for emergency and planned procedures In the case of Bonitas – you also get access to some additional benefits for wellness and preventative care The hospital plan ensures that when you are admitted into hospital for a procedure or due to an accident or illness, your expenses are covered – within the limits set by your particular plan There are 27 chronic conditions that all medical aid plans must cover, so the hospital plan also covers these which are known as Prescribed Minimum Benefits (PMBs) This type of plan does not cover you for other day-to-day medical costs like visits to the doctor, specialist or medicine It is tax deductible Hospital Insurance Hospital insurance is not a medical aid, it pays you for the time you spent in hospital but not for the treatment you receive It provides cash benefits depending on the number of days you are in hospital due to illness or an accident The insurer pays the money directly to you, you are able to use the money however you please – to pay for daily household costs or the hospital, doctor and specialist bills This often seems more attractive than a hospital plan and has a cheaper monthly premium however, the daily amount you receive is often way below the medical expenses incurred while in hospital It is governed by the Short or Long-term Insurance Acts Does not cover Prescribed Minimum Benefits (PMBs) May include Personal Accident risk cover such as disability and loss of limbs, inability to work, salary protection, death and/or funeral covers Is not tax deductible The limitations of hospital insurance It is a set amount which might not cover your hospital or medical bills, leaving you financially short and, in some cases, has a waiting period New regulations state that pay-outs are limited per insured life, per hospital stay with an annual limit Typically people buy the policy that pays less than R1 000 per day If you have one of the top plans, the daily pay-out during your stay in hospital may sound like a lot of money however, it usually falls short of actual costs charged by hospitals, doctors and specialists For example, a caesarean birth costs around R30 000. This can be much more if complications occur. Remember that hospital insurance companies are ‘for profit’ unlike medical schemes who are ‘not for profit’. The recommendation by most financial advisors is that a hospital insurance product should be used in conjunction with medical aid, or hospital plan, as income replacement rather than medical aid cover. And what is GAP cover, how does it work? Callakoppen provides an update. Minding the gap At times there may be a shortfall between what the medical scheme pays and what the hospital or specialist charges. You are responsible for paying the difference There is an insurance policy called gap cover which you can take out to pay for this shortfall The amount you receive depends on your policy but there is an overall annual limit Some gap cover policies have a waiting period for certain conditions Most people usually take gap cover together with a medical aid hospital plan It is important to know that gap cover, like hospital insurance, is an insurance ‘policy’ and is registered as Short-Term insurance policies Gap cover premiums are not tax deductable ‘There has been a growth in health insurance products over the past few years and they appear to provide medical cover, but actually don’t,’ says Callakoppen. If you choose to take out health insurance, do so as complementary to medical aid, not a substitute. ‘My advice: Shop around to find the best plan that covers your health needs and suits your pocket. A number of Low Cost Benefit Options have been introduced by Medical Schemes – these offer more affordable plans that give you peace of mind in terms of access to quality healthcare. Interrogate the benefits you receive on the plan you are considering versus the monthly contributions but, above all, never compromise on your health.’

March 18, 2021

Trimester two overview

Your second trimester begins in week 13 and ends at week 28. During this time your morning sickness will ease off, and initially your baby will be small enough that your body won’t be in too much discomfort, earning this trimester the nickname of the honeymoon period of pregnancy. During this trimester you’ll probably tell your family, friends and employees you’re expecting and your tummy will begin to show – time to upgrade your wardrobe! Your body during your second trimester During the second trimester the pregnancy you’ll hopefully notice that your morning sickness is easing up and your energy levels should begin to rise. While you will be feeling better don’t put pressure on yourself to exercise or socialise more than you’re comfortable with. This trimester your baby bump will go from barely noticeable to one that you may struggle to hide. Embrace your changing body and adapt your exercise plan to accommodate your baby, prenatal yoga and pilates classes are a great way to stay in shape, meet other moms-to-be and prepare for labour and delivery. A growing belly and breasts, Braxton Hicks contractions and leg cramps are all common pregnancy symptoms you may experience during this trimester. Not only this but you may experience dental issues, sore and swollen feet, and an achy back and/or pelvis. Your baby’s growth during the second trimester Your little one does lots of growing during your second trimester, and during this time you’ll begin to feel them moving around inside your belly (this is also known as quickening). Not only this, but during trimester two your baby’s ears develop to the point that they can hear your voice and other external sounds. During the second trimester your baby’s eyes and ears become more developed and you’ll soon be able to find out their gender on an ultrasound (if you want to!). Your baby’s muscle tone is also improving, they’ll be swallowing amniotic fluid and their sucking reflex will develop – they may even suck their own thumb. Important things to note during the second trimester At week 19 to 20 you’ll have an anatomy scan. In this scan your doctor will be able to see how your baby is developing, and if there is anything unusual that would be cause for concern. During this scan the doctors will also be able to tell you the gender of your baby – if you decide to be told you can start thinking of baby names! This trimester is also a good time to decide how and where you’d like to have your baby. Decide on if you like a hospital or home birth, and start putting together a birth plan.

March 16, 2021

When the stomach turns .. tummy bugs or COVID-19?

As South Africa nears the end of the second wave of Covid-19 and braces for a third, a stomach bug is circulating and spreading in schools and the community. Dr Morgan Mkhatshwa, head of operations at Bonitas Medical Fund, discusses the signs and symptoms of a stomach bug and common gastrointestinal (GI) viral infections versus the GI symptoms from Covid-19. He says, ‘Although the period between November and May usually coincides with an increase in diarrhoea and pneumonia cases, according to the MMC: Community Services and Health, Zahid Badroodien, it is significantly reduced with a 29% decrease in cases and a 15% decrease in hospital admissions. The decline is partially attributed to the increased adherence to health protocols for Covid-19 like hand-washing, sanitisation and wearing masks.’ However, the recent tummy bug that is circulating, is proof that the virus is still around, Dr Mkhatshwa talks about common GI viral infections and GI symptoms associated with Covid-19. What are the symptoms of a tummy bug? Stomach bugs (or stomach flu) are known as viral gastroenteritis and are characterised by the following symptoms: Diarrhoea Abdominal cramps Nausea Vomiting Fever Thirst Joint aches Headache General malaise How long does a stomach bug last? People typically develop stomach bug symptoms within 24 to 72 hours of being exposed to the virus. While most cases resolve in three to four days, it’s not uncommon to feel unwell for up to a week. How do I know if it’s food poisoning or a stomach virus? The symptoms of food poisoning and a stomach virus are very similar. However, food poisoning symptoms develop in as little as a few hours. Most people suspect food poisoning when symptoms develop shortly after eating food which may seem questionable. Covid and gastroenteritis Research consistently shows that approximately 10% of adults with Covid-19 report GI symptoms such as nausea, vomiting or diarrhea. Typically, patients will also have the more common upper respiratory symptoms that accompany Covid-19, such as a dry cough or difficulty breathing. How do you tell the difference between Covid-19 symptoms and ‘stomach flu’? So, how do you know which one you’re dealing with if you’re experiencing, for instance, a fever, vomiting, and diarrhoea? ‘Unfortunately, it is not always easy,’ says Dr Mkhatshwa, ‘if you have respiratory symptoms, (particularly chest pain) and loss of smell or taste, it is pretty clear cut. However, GI symptoms can occur on their own with Covid-19. A stomach bug also typically lasts only 72 hours while GI related symptoms with the coronavirus can last much longer.’ What should you do if you suspect the GI symptoms are in fact, Covid-19 related? Consult your doctor – via phone or virtually – to discuss your symptoms and if he/she feels you are displaying signs of the coronavirus infection, they will refer you for a Covid-19 test. How long are you contagious with a stomach bug? Stomach viruses are highly contagious and can spread quickly. People infected with a stomach virus are contagious from the moment they begin feeling ill and also for the first few days (up to 72 hours) after they recover. A stomach virus can spread in several different ways: Eating food or drinking liquids that have been contaminated with the virus Having direct or indirect mouth contact with an infected person or surface with the virus on it Unhygienic behaviour, such as not washing hands after toilet use, not washing fruits and vegetables before consumption The virus also inhabits the vomit and stools of people who have the infection How do you treat or get rid of a stomach bug? Supportive therapy that includes increased hydration, rest, electrolyte replenishment and medication for fever is usually all that is needed for viral illnesses. This is because viruses do not respond to antibiotics and simply need to run their course. If the infection is caused by bacteria, like Salmonella, an antibiotic may be prescribed. Viral gastroenteritis will typically resolve within a few days or less without medication. However, hydration is vital to a speedy recovery and prevention of complications. Here are a few steps you can take at home to aid recovery from a stomach virus or food poisoning: Try not to eat any solid foods until you feel better Suck on ice chips or take small sips of water to prevent dehydration Avoid juices or other beverages with a lot of sugar or sweeteners that can make diarrhea worse Ease yourself back into eating. Start with bland, easy-to-digest foods, such as toast and rice. Stop eating if a feeling of nausea returns Avoid dairy, caffeine, fatty foods and sugar until you feel better You should be cautious of taking over-the-counter medications, unless advised by a healthcare provider, as some can worsen the infection When to treat it seriously and consult a medical doctor? Seek medical attention if you have any of the following symptoms: A bloody stool or vomit Are unable to keep liquid down for 12-24 hours Feel dizzy or light-headed Have a fever above 40°C Are experiencing severe, unrelenting abdominal pain. Fortunately, thanks to the Covid-19 protocols which include wearing masks, social distancing and the washing and sanitising of hands the incidence of stomach bugs has been reduced. However, it is a virus and you may still be susceptible but remember it will run its course and you will recover. During the time you are experiencing symptoms rest, stay hydrated and stay away from others while you are still contagious.

March 10, 2021

Your second trimester – making the most of it

Your second trimester is from the beginning of week 13 until week 28, during this time your pregnancy will begin to show. However, you should feel like you have more energy than you did in trimester one. This is why this trimester is also nicknamed the honeymoon period of pregnancy – your baby isn’t big enough to make you uncomfortable and your pregnancy hormones should have eased up. During this time there are one or two things that you can keep in mind to make the most of this time while you’re feeling better, and to ensure that your baby (and you) are kept healthy and happy. Childbirth classes, preparing your mind and body Even if this isn’t your first baby, childbirth classes can help prepare you for what is to come. If you’re feeling anxious about labour and birth, these classes will help ease your worries, by informing you what is to come and how best to manage your mind and body coming up to, during birth and after birth. Prenatal exercise and a healthy lifestyle Stay fit and healthy during your pregnancy is important to both you and your baby. What you eat and regular exercise are both ways in which you can provide needed nutrition to your baby and keep yourself healthy. Low impact exercise, such yoga, swimming, walking and prenatal pilates can help improve your sleep, and increase your strength and muscle tone. Keeping active can even have the added benefit of helping prepare your body for labour and birth. Maternity wear and staying comfortable Not only is learning about your pregnancy and staying healthy essential but staying comfortable is also important. The second trimester is generally when your tummy will start looking and feeling bigger, so invest in some trousers that have more give in the waistline. Luckily certain fashion items, such as flowy dresses and layered knits, may even mean you can still keep using your pre-pregnancy clothes.

March 9, 2021

Covid and flu – should you still have the flu shot?

Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund unpacks the differences and similarities between ‘flu’ and Covid-19, how it affects your body and offers compelling reasons why you should consider getting the flu vaccine this year. Every year, seasonal influenza (flu) kills around 11 500 people in South Africa alone. To date, Covid-19 has resulted in around 50 000 deaths in South Africa. While the true mortality of Covid-19 will take some time to fully understand, the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%. For seasonal flu, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of health care. How has Covid-19 impacted on the flu virus? The Covid-19 pandemic has, however, had a significant impact on the 2020 flu season where decreased flu activity has been reported. This is most likely related to lockdown and additional hygiene measures. Bearing in mind that The World Health Organization (WHO) has recommended flu vaccines for 2021, circulating flu viruses evolve constantly so an accurate prediction for the upcoming season is challenging. Should you still have a flu vaccine in 2021? Dr Mkhatshwa recommends you do. Flu vaccines have been shown to reduce the risk of influenza illness, hospitalisation and death. Not only will flu vaccinations reduce the risk of getting flu but is an important conservation measure for scarce health care resources which remains a concern with the ongoing the Covid-19 pandemic. The flu vaccine should be given sufficiently early to provide protection for the coming winter. A protective antibody response takes about 2 weeks to develop. As there is limited evidence on the safety and effectiveness of receiving these vaccines simultaneously, Dr Mkhatshwa recommends waiting at least 14 days between having the Covid-19 and flu vaccinations. How are Covid-19 and flu viruses similar? WHO says, ‘Firstly, Covid-19 and influenza viruses have a similar disease presentation. That is, they both cause respiratory disease, which presents as a wide range of illness from asymptomatic or mild through to severe disease and death. ‘Secondly, both viruses are transmitted by contact, droplets and any material that can carry infection. As a result, the same public health measures, such as hand hygiene and good respiratory etiquette (coughing into your elbow or into a tissue and immediately disposing of the tissue), are important actions all can take to prevent infection.’ What are the essential differences between Covid and flu? Flu is an acute viral respiratory infection, transmitted by the influenza virus. There are three types of influenza, namely Influenza A, B and C. Influenza C is less common and produces milder disease. WHO says there are important differences between the two viruses and how they spread. This has important implications for the public health measures that can be implemented to respond to each virus. The two are essentially different viruses with SARS-CoV-2 being a newly discovered coronavirus that causes Covid-19. The speed of transmission This is an important point of difference between flu and the coronavirus. Influenza has a shorter incubation period and can spread faster than Covid-19. Further, transmission in the first 3-5 days of illness, or potentially pre-symptomatic transmission, is a major driver of transmission for influenza. Although with Covid-19, people can be infected by someone 24-48 hours before the onset of symptoms – this is not the major driver of transmission. The severity of illness While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For Covid-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than that of flu. Who is at risk? The Department of Health (DoH) together with the National Institute for Communicable Diseases (NICD) targeted the following groups for the 2021 campaign: Healthcare workers Individuals age >65 years People with comorbidities like heart disease, diabetes or lung disease Pregnant women People living with HIV and AIDS What are the signs and symptoms? In terms of symptoms, Covid-19 and flu can have varying degrees of signs and symptoms, ranging from none (asymptomatic) to severe symptoms. Common shared include: Fever or feeling feverish/chills, cough, shortness of breath or difficulty breathing, fatigue, sore throat, runny or stuffy nose, muscle pain or body aches, headache, some people may have vomiting and diarrhea, though this is more common in children than adults. Other signs and symptoms of Covid-19, different from flu, may include change in or loss of taste or smell. A Covid-19 test will confirm the diagnosis. Does the flu shot give me a mild flu? According to the Centre for Disease Control (CDC), ‘A flu shot cannot cause flu. Flu vaccines given with a needle are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious, or with no flu vaccine viruses at all. The most common side-effects from the shot are soreness, redness, tenderness or swelling where the shot was given. Serious allergic reactions to flu vaccines are very rare.’ Still not convinced? Flu viruses spread very quickly from person to person Even if the flu vaccine is not 100% effective against the current flu strain it will reduce your chances of getting the flu and, if you do get it, it will be a great deal milder More importantly, by having the flu vaccine you will protect others, via what is called ’herd immunity’. Others may be vulnerable family members such as small babies and the elderly as well as those who are immune compromised. While the world focuses on Covid-19, social distancing, wearing a mask and hand washing or sanitisation can help protect you from both Covid-19 and flu.

March 4, 2021

New Head of Operations for Bonitas

Bonitas Medical Fund has announced the appointment of Dr Morgan Busuku Mkhatshwa as Head of Operations. Dr Mkhatshwa is a medical doctor with extensive experience in the healthcare sector. He has a proven track record of spearheading the introduction of enhanced comprehensive healthcare services and programmes including occupational healthcare services. In addition, he has led organisational restructuring efforts within highly unionised environments, launching accelerated business expansion and improvement initiatives to maximise revenue growth. Compassionate about management, business development and stakeholder engagement, he began his career as a science teacher before he pursued his medical studies. He worked as a medical officer before progressing to principal medical officer in the public service. He spent some time as Hospital Manager at Life Healthcare and went onto become MD of one of the divisions in the company. After Life Healthcare he joined Lenmed Health as Group Business Development Manager and later became Group Head of Operations. ‘We are delighted to have Dr Mkhatshwa joining our management team,’ said Lee Callakoppen, Principal Officer. ‘He brings with him a wealth of knowledge and expertise, not only as a medical doctor but also years of experience in strategic planning and execution, general operations management, project management, coaching and mentoring. We know he will be a valuable asset to our team and our members.’ Dr Mkhatshwa has a BSc. (Biological Sciences), Bachelor of Medicine and Surgery (MBChB), Hons BSc (Limnology), Master of Science (Medical Microbiology) and Master of Business Administration (MBA). Oher achievements include the completion of the Harvard Business School – General Management Program.

February 26, 2021

The low down on Covid-19 test protocols

As South Africa finds itself starting to move out of the second wave of a Covid-19 outbreak, over 8 million Covid tests have been carried out in the public and private sector since the start of the pandemic. The global gold standard method to diagnose Covid is the Reverse Transcription Polymerase Chain Reaction (RT-PCR) test. It is currently the most accurate way to detect SARS-CoV-2, the virus that causes Covid-19. Will your medical aid pay for the test? According to Lee Callakoppen, Principal Officer of Bonitas Medical Fund, ‘Funding is in accordance with the Council for Medical Schemes (CMS) guidelines, all clinically appropriate and referred diagnostic testing for suspected Covid-19 cases will be funded as a Prescribed Minimum Benefit (PMB) condition.’ Bonitas pays for up to three Covid-19 diagnostic tests from risk, whether the result is positive or negative. However, this is subject to the member or beneficiary being referred by a registered healthcare practitioner (doctor or nurse). This referral is dependent upon whether the member is showing symptoms, has been in contact with anyone who has Covid-19 and prior to hospitalisation. It should be noted that laboratories will not normally accept walk-ins for testing and require a referral or request from a healthcare practitioner. This is to ensure that we don’t test unnecessarily and jeopardise the availability of these tests for those who really need them. ‘Despite the PCR being arguably the most accurate laboratory methods for detecting, tracking and studying the Coronavirus, there are limitations in its widespread use,’ says Callakoppen. ‘These include: Access to the test kits; the complexity of performing them; the need for specialised staff to administer them; potential global shortages; high costs; the requirement for laboratory equipment and the delayed turnaround times. For this reason, testing should only be done when it is clinically necessary.’ What about Rapid Antigen Tests Immunoassay devices that detect the SARS-CoV-2 antigen within 15-30 minutes have also been promoted as a possible solution when access to PCR tests is a challenge. An antigen – detected in the blood or any other fluid – is any substance that makes the immune system produce antibodies. Viruses and bacteria are antigens. However, these tests are not as accurate as the PCR tests and have shown variable performance during evaluations, with sensitivities ranging from 0 to 94%. Test specificity has been high, but sensitivity has been erratic, which we need to bear in mind. Why is specificity and sensitivity critical? Sensitivity is the percentage of true positives (e.g. 90% sensitivity = 90% of people who have the target disease will test positive). Specificity is the percentage of true negatives (e.g. 90% specificity = 90% of people who do not have the target disease will test negative). These allow you to rule conditions in or out but not definitively diagnose a condition. What does the Council for Medical Schemes (CMS) say? The CMS currently still advocates the PCR test to diagnose Covid-19. The World Health Organisation (WHO) has also previously advised that the role of these rapid antigen tests must be evaluated and are “not currently recommended for clinical diagnosis pending more evidence on test performance and operational utility”. However, the WHO has now approved the use of antigen tests (and this is the South African approach as well) as an alternative to the more expensive PCR tests. This is however, in certain defined scenarios such as testing confirmed people in communities where infections have been detected, screening of high risk groups and individuals and for contact tracing purposes. They have also provided conditional recommendations for the use of these tests such as screening at ports of entry, routine screening for employees at their place of work, schools, prior to certain urgent medical procedures, etc. The challenge with these tests is that they are most accurate in patients between 5 and 7 days after showing symptoms – therefore the timing of testing becomes critical in order to ensure accuracy of the result. What about Rapid Antibody Tests? Many countries, including South Africa, are using antibody or serology tests such as the ones offered at various drive-throughs. These can detect whether someone has previously been infected and estimate how widespread the infection is but they are not recommended for diagnosis of Covid-19. For this reason, these are not funded by Bonitas Medical Fund as the use for these tests is limited for purposes of government surveillance and research rather than diagnosing Covid-19. If individuals want to know whether they have previously had Covid-19, for their own information, this test would be able to confirm that – but it is not used to identify whether you currently have the infection. If these tests are done too soon after the infection, they produce incorrect results as the antibodies (IgM and IgG) will not be detectable. There is also no scientific evidence that it provides any immunity to another Covid infection. ‘What is clear is that laboratory testing plays a vital role in the diagnosis and the prevention of the spread of the virus,’ says Callakoppen. ‘Nevertheless, it is important to understand that the timing and correct use of the different types of tests is crucial to gain the best results. We reimburse up to three PCR or rapid antigen tests done in or out of hospital for our members and recommend that this protocol for testing remains, until further research is conducted and evidence provided.’

February 12, 2021

Pregnancy and Medical Aid

Motherhood and pregnancy are times of great anticipation and joy. Each experience is unique but what is probably high on the agenda is that you have a trouble free pregnancy, a healthy baby and then know and anticipate the cost involved for pre-natal check-ups and the birth. ‘Choosing the right medical aid is critical in ensuring the healthcare needs of you and your loved ones are taken care of. More so, when you’re looking at expanding your family. For those who are on a medical scheme or wish to join one, here are some important points to consider when you fall pregnant,’ says Lee Callakopen, Principal Officer of Bonitas Medical Fund. When you are already a member of a medical aid scheme When should you advise your medical aid of your pregnancy? If you are already a member, you can access the out-of-hospital maternity benefits without advising your medical aid that you are pregnant. However, please ensure that your doctor uses the correct ICD-10 codes on your claim to ensure that it is processed correctly. Bonitas pays for maternity benefits in addition to savings and day-to-day benefits, which help members get the care they need during pregnancy while limiting out-of-pocket expenses. Remember that pre-authorisation is needed for the delivery of the baby, which can usually, be done from 20 weeks onwards. Pre-authorisation will help you understand the benefits you have available on your plan and ensure that you are aware of what is covered. Bonitas members can also register for the Bonitas baby bag once pre-authorisation is obtained. The baby bag is packed with of useful goodies for the baby to make parenthood a little easier. When do you advise the medical aid that your baby has been born and needs to be added onto your medical aid? For our members, the baby needs to be registered within 30 days from the date of birth to ensure there is no break in cover and that your child will be covered from the first day of life. Are there Designated Service Providers (DSPs) in terms of gynaes and hospitals for childbirth? We strongly advise members to use DSPs to get maximum value and avoid co-payments. We agree special rates with these providers, which are covered within a member’s benefits so that they can focus on taking care of their health and wellbeing during pregnancy. What is normally covered in the maternity benefit? This differs from scheme to scheme and according to the plan you are on. Bonitas pays for up to 12 maternity consultations (paid for from a separate benefit), an amniocentesis, antenatal classes, 2x 2D ultrasounds and the delivery. In addition, there are additional benefit for newborn hearing screening tests and childhood vaccination. Does Bonitas cover the cost of a Caesarian birth? Yes, medically necessary Caesarians are covered on all plans. Some expectant mothers do prefer home births – is this covered? Yes the cost for a home delivery is covered. Are all the childhood vaccinations covered by Bonitas and if so, are there any conditions attached ie where the vaccinations should be done? Vaccines are covered as per the EPI schedule on immunisation. Please note this benefit is available on specific plans. The vaccines can be done at any clinic or pharmacy. If an administration fee is charged by these providers, it will be paid from your savings or day-to-day benefits. The vaccines covered are as follows: The Bonitas Babyline – a dedicated children’s health advice line In 2016, Bonitas introduced Babyline – a 24-hour children’s health advice line manned by paediatric trained registered nurses. They are on the other side of the phone to assist with any parental concerns, vaccination schedules and health related issues, 24/7, 365 days of the year. How does Babyline work? Bonitas parents, or their caregivers, simply call the Babyline number on 0860 999 121 to speak to paediatric trained nurse. Through a series of questions asked regarding the health issue, parents will be provided with professional advice on what to do next. Depending on the symptoms, the advice might be to head straight to the ER or to see a doctor or specialist. The nurse will advise which healthcare provider is the most appropriate, given the health issue. The services offered by the Babyline include: Home care advice Clinic/primary care/GP referral for the same day Clinic/primary care/GP referral for the following day After-hours care within the next six hours Immediate referral to the ER The Babyline service is available to members across all the Bonitas plans, for children under 3 years. Joining a medical scheme when you are already pregnant It is very common for women to apply to join a medical aid scheme when they fall pregnant. But according to the Medical Schemes Act 131 of 1998, medical aid schemes are entitled to impose a 12-month condition specific waiting period for any pre-existing medical condition, such as pregnancy. These waiting periods must be imposed for specific pre-existing conditions to protect the interests of current members of the scheme. When a waiting period is applied to pregnancy, then the pregnancy and birth will not be covered but your baby will be covered from the first day of life – if you register them on your medical aid within 30 days. This will allow you to ensure the needs of your child and the healthcare will be covered. Bonitas has different plans and expectant mothers will be able to select the one most suitable for their needs. Informing the medical aid of your pregnancy Prospective members need to inform their medical aid upon application or within 30 days after you complete the application. What is the policy regarding a member joining Bonitas when they are pregnant? What sort of cover can they expect, if any? The pregnancy would be considered pre-existing and therefore not covered. The baby will be covered if registered within 30 days post-delivery. What happens if someone signs up for medical aid not realising they are already pregnant? At what point is

February 3, 2021

What vitamins and minerals are needed during pregnancy

As an expecting mom you’ll want to do your best to make sure that your baby is as healthy as possible. What you eat is critical during this time, as everything your baby needs comes from you. Prenatal vitamins are supplements which can be taken during pregnancy which contain needed vitamins and minerals. What vitamins and minerals are essential and why? During pregnancy your vitamin and mineral needs will change as you now have a growing baby to provide for. Your food should contain much of the vitamins and minerals needed during pregnancy, particularly if you are already following a healthy, balanced diet. Folic acid and iron are typically found in most prenatal vitamins and are essential in a healthy pregnancy. Folic acids helps to prevent neural tube defects and iron supports healthy growth, helping prevent anemia and blood (in both mom and baby) carry oxygen Vitamin D, calcium and iodine are other important nutrients that are needed during pregnancy. Vitamin D aids in the development of the bones, teeth and nervous system, calcium helps bone and teeth development and iodine is important in brain development. Getting the correct micronutrients is important. Deficiencies can lead to complications such as hypertension and a low birth weight. However, it’s also important not to exceed the healthy amount of certain vitamins and minerals – too much vitamin A, for example, can cause birth defects. What foods should I be eating? Prenatal vitamins are a good idea to cover any nutritional gaps you may have, while they may supplement your diet they don’t replace a healthy lifestyle. Therefore, eating correctly also greatly benefits you and your growing baby. Foods you should try include in your diet are dairy products, such as milk and yogurt, as they contain extra protein and calcium, as well as probiotics. Legumes, such as lentils and soybeans are another good food to include – these contain protein, fibre and folate (which is very important during pregnancy). Sweet potatoes, high in vitamin A and fibre, are another good veggie to add to the shopping list. Eggs, broccoli, lean meat and berries are other wholesome foods you should be including in your diet. A healthy pregnancy benefits both you and your baby in the long run, not only does it ensure that you deliver a healthy baby, but helps your child throughout adulthood development.

January 4, 2021

Working and pregnancy – when to stop and how much is enough

As an expecting mom with a career you may be wondering when the best time would be to stop working and how you can stay comfy and productive when you are still in the workplace. Morning sickness, back pain, frequent bathroom breaks and other pregnancy related symptoms can make working as you used to a more challenging task for you. It’s important that you calculate the risks that your job could possibly have to you and your baby. For instance if you are working with chemicals, heavy metals or radiation you’ll need to either stop working or take extra precautions. Heavy lifting or labour intensive jobs and lots of travel for work are also jobs that’ll become more difficult as your pregnancy progresses. Desk work and computer work are generally regarded as safe, whereas jobs that require lots of standing will become more difficult in later pregnancy. Dealing with work and pregnancy Working can be stressful without having a growing baby in your belly. The physical and emotional changes that you experience can make meeting your body’s and workplaces’s demands a challenging task. However, some moms with healthy pregnancies are able to work almost until they go into labour, how much you can do will depend on your pregnancy. Morning sickness is something many moms have to deal with. There are ways you can help manage nausea at work. Avoiding dining areas, packing mouthwash and a toothbrush and packing in soothing lemon and ginger are all things you can do to make yourself more comfortable. Eating and drinking little and often can also help keep the nausea at bay. Be sure to dress comfortably, and try to take frequent breaks and walks, as this’ll also help you stay more comfortable. What rights am I entitled to as an expecting mom in South Africa? As a pregnant employee, you are probably wondering what rights you’re entitled to. It is a good idea to inform your employee as soon as you can, so that your employer can manage the situation as best as they can (for both of you) – they are required by law to maintain a work environment that is safe for their employees. As an expecting mom, you will be glad to hear that you’re well protected under South African law – you may not be discriminated against or dismissed due to your pregnancy. You also have the right to four consecutive months unpaid maternity leave, anytime from four weeks before your expected birth date. Unfortunately employees are not obligated to pay you during this period, however, your job will be kept open for you until your return to work after maternity leave.

December 21, 2020

Travel tips during Covid-19

With the increasing number of local Covid-19 cases – over 10 000 in the past 24 hours – we need to be mindful that the pandemic is not on vacation. The statistics are worrying. South Africans need to shake off their Covid-fatigue and get back to making informed choices about their wellbeing and adhering to the protocols: Wear a mask when you leave your home, sanitise and socially distance – if we want to flatten the second wave curve, especially over the holiday season. We have also been asked to remember the 3 Cs: Avoid crowds, confined spaces and close contact. Bonitas Medical Fund, says, ‘Internationally many countries are reinforcing lockdown rules as the cases spiral, with reports too of coronavirus symptoms changing. Some medical practitioners are also saying the second wave is even more dangerous than the first. ‘Over the past month, within our membership community, we have seen an increase in the number of tests, the percentage of positive results, people requiring treatment and those being hospitalised. Through our free virtual consultations we have noted an increase in non-members consulting with doctors around the pandemic, with our call centre load having also increased.’ Here are some tips for travel during the festive season whether within our borders, to neighbouring states or abroad. Medical aid card Remember to carry your medical aid card and details with you. In the case of an emergency, it will streamline the process of getting care quickly or being admitted to hospital. Bonitas also advises that you put the Covid-19 emergency hotline (0800 029 999) or call centre number (0860 002 108) into your mobile phone so it is at hand. Virtual consultations Bonitas continues to offer free virtual consultations to all South Africans – not just its members – until 31 December 2020. If you are on holiday and concerned about your health, download the Bonitas Virtual Care App and make an appointment. The doctor will engage with you in a virtual video consultation wherever you are. The consultation includes any medical issue, Covid-19 or unrelated and advice on the most clinically appropriate steps for further care. These consults are available 24/7. Sanitise, sanitise, sanitise Pack your own soap and sanitiser. The hospitality industry has stringent health and safety protocols in place and most establishments have enhanced their deep cleaning regimes. However, it is still recommended that you keep your sanitiser with you always. If you are taking a road trip, make sure you have waterless soap and sanitiser in the car and limit your pit stops without compromising on taking the necessary rest breaks. Perhaps pack a picnic, to avoid crowded fast food outlets and restaurants on the main routes. Travelling internationally Remember that if you are leaving the country and crossing a border you will need to produce proof of a negative Covid-19 test and will also complete a travel health questionnaire. Minister of International Relations and Cooperation, Dr Naledi Pandor, has warned South Africans travelling abroad to make sure they know what the respective countries’ Covid-19 protocols are to avoid being stranded – various countries have different protocols and some have also introduced new stricter lockdown measures. She has urged travellers to familiarise themselves with the immigration and health entry requirements of the country they are visiting, as well as South Africa’s re-entry health requirement upon their return. If you are uncertain, contact the local embassy for clarification or the Department of Health. Alert your medical aid It is important that you notify your medical aid scheme ahead of any international travel. Firstly, to check what medical conditions will be covered and, secondly to activate the international medical travel cover. Travel insurance policies Medical expenses that you might encounter when travelling in Africa or other international destinations can be prohibitively expensive. To avoid having your holiday and finances totally ruined, look at what your current medical aid scheme offers in terms of medical travel cover and, if necessary, top this up with additional travel insurance. Carry your policies Travel insurance policies give detailed information about what to do in an emergency situation and have international call centres to assist you. Make sure everyone in the family has these numbers handy. The claiming process Most medical insurance requires an invoice as well as the proof of payment or receipt in order for them to reimburse you. Make sure you are familiar with the claim process. ‘One thing 2020 has taught us, is that life is unpredictable. And although additional, tougher lockdown regulations were recently announced in an effort to curb the second wave of Covid-19 infections, the burden of responsibility remains with each and every one of us,’ says Bonitas. ‘There are real concerns around the current rate of transmission, not only in South Africa but globally. In order to minimise your risks and to stay healthy and safe these holidays we all need to do our bit and stick to the protocols.’

December 18, 2020

Birth injuries

You only want the best for your baby, but sometimes harm comes to them unintentionally. During the birthing process, your baby can experience harm or physical injury; this is known as a birth injury. Birth injuries are not uncommon, sometimes they are temporary and other times they may affect your baby for a lifetime. But what exactly are birth injuries? And what causes them? What are the chances of my baby getting injured during birth? Birth injuries range from harmless to serve, either quickly healing or causing disability throughout life. Although significant injury or death during the birth process isn’t as likely, birth injuries are not uncommon – according to the Birth Injury Guide, about 29 in 1000 babies suffer a birth injury of some kind. Why would my baby become injured during the birth process? There are several reasons why a baby can experience physical trauma during the birthing process. When you near the end of your pregnancy your baby moves into position for delivery, sometimes babies will move into an abnormal position, such as a breech (feet first), and this can cause them injury when they are born. Other reasons why baby’s may become injured during birth is being abnormally large, the mother’s pelvis is too small, or a long and difficult labour, where the mother’s contractions aren’t strong enough to push her baby out. What happens if my baby has a birth injury? Generally, birth injuries affect the babies head neck and shoulders, as babies are generally born head first. There are a variety of injures that your baby could stain from birth trauma, such as bruising of the scalp, broken bones or brain damage. Sometimes these injuries are temporary and other times they can last a lifetime. Your doctors and midwives will assess the damage to your baby and help you and your baby accordingly. Sometimes babies will sustain trauma during birth, and the injury won’t be noticeable until they have started school or being missing developmental milestones, as they struggle to mentally keep up with their peers or grow at what is considered a normal rate. Sadly most birth injuries aren’t preventable, but even so, moms whose babies experience birth injuries often feel guilty and angry, as if they are too blame. Although feeling this way is understandable, this is not the case and if you are feeling this way after your baby has experienced a birth injury it is best to speak to a health professional and reply on your partner, friends and family for support.

November 26, 2020

Are day hospitals the new trend?

Globally, day surgery hospitals have changed the experience of patients by offering an alternative to acute/conventional hospital surgery. Hospital costs the highest expense In South Africa, the concept of day hospitals is also gaining popularity – particularly as a result of high hospital costs. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, says, ‘Using our hospital dashboard for the full 2019 year, direct hospital costs were 43% of the total scheme expenditure. These excluded doctor and allied services while a patient was in-hospital. The increase in the use of day hospitals Internationally there is a trend in increased day surgery for multiple reasons including: Improved anaesthesia (with quicker recovery period) Improved pain control (anaesthetic blocks and improved medication) Instrumentation and procedures (keyhole surgery). Cost saving initiatives Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+%. They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund. ‘We negotiate special rates through our hospital networks and Designated Service Providers (DSPs) and encouraging members to use our Managed Care initiatives. Encouraging members to use day hospitals is another way in which we can save on costs. That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities. For the Scheme and members this is a win-win as it still translates to cost savings. Examples of price differences ‘There remains a difference in costs between day and acute hospitals,’ says Callakoppen. The table below represents savings across some of the most prevalent surgeries. Procedure Difference in Case-Mix Adjusted Hospital Cost per Event (Acute Hospital Base) Corneal, Scleral And Conjunctival rocedures -6.3% Eyelid Procedures -28.1% Circumcision -13.9% Tonsillectomy And/Or Adenoidectomy (Child) -13.0% Tonsillectomy And/Or Adenoidectomy (Adult) -11.7% Myringotomy (grommets) -15.5% Colonoscopy -15.4% Other advantages of day hospitals Patient satisfaction No overnight stay – patients are admitted, operated on and discharged on the same day Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery Mortality and major morbidity is extremely low (<1%)* Improved surgery scheduling – decrease in waiting lists Why is take up not higher? Day hospitals clearly have marked advantages but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape. There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason.’ The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome. This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities. Safety is foremost Not all patients can go to day hospitals. Callakoppen says, “It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.’ Day hospital options for 2021 Bonitas currently has 68 day hospitals on the BonCap network and 30 day clinics on the Select options. According to Callakoppen, ‘This will be enhanced in 2021 when we implement a day surgery network across all options. A comprehensive list of procedures that should be done as day procedures has been collated for our members. If any of these procedures need to be done then members must use a facility on the day surgery network, or alternatively pay a co-payment. While the day surgery network will be comprised mainly of day clinics, it should be noted that certain acute (conventional) hospitals will need to be included on the network where there are areas of access constraint to them.” Will day hospital use be enforced? The Day Hospital Association of South Africa has proposed that medical aid enforce day hospital use in the future but also caution that there are some cases which cannot be carried out in day hospitals. He says, “The Scheme is in agreement with the concept. Although we do promote the use of day hospitals, we must bear in mind that there are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.”

November 17, 2020

Ten tips for choosing the right medical aid

The medical aid landscape can be tricky to navigate so it’s best to compare all the available options and schemes to find a medical aid that works for your budget and your family’s health. Bonitas Medical Fund helps guide you through choosing the best plan. Analyse your healthcare needs No two people or families are alike, medical needs differ so do a quick personal healthcare needs’ analysis to determine what cover you need. If you have dependants, factor in their healthcare needs too. Factors to consider include: How often you visit your family visit a doctor or specialist Over-the-counter medication or chronic medication required Chronic conditions like high blood pressure or diabetes Specific conditions like cancer, HIV or renal failure Dentristy Optometry This will help you decide on whether you need a comprehensive medical aid or a hospital plan. Read the small print Benefits vary from plan to plan, so establish what is and isn’t covered and look at whether the option offers additional risk benefits which can save on day-to-date expenses. Such as free wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more. Managed Care options Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. What about savings? Medical savings are a fixed amount a medical scheme gives you at the beginning of the year. There are ways to maximise your savings but first you need to know what you annual allocation is. The day-to-day detail Look at what the scheme suggests as a way to make your benefits last, bearing in mind the following: Some plans require you to use a specific GP, hospital network and have a list of Designated Service Providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these services providers. Check the network in your area before making a final decision. Must you be referred to a specialist by your GP? Does your medical aid offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits? Virtual Care and technology Technology and virtual care is being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether it you want access to your benefits 24/7. Age impacts your decision As parents of young children, ensure the option you select provides sufficient child illness benefits If slightly older, select a plan that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation Ensure the affordability Consider all the costs involved before you make your final decision, such as: Monthly contributions: The rule of thumb is that contributions should not exceed 10% of your monthly income. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures and will differ from one medical aid scheme to another. Waiting period and exclusions The Medical Schemes Act and the specific scheme’s rules determine this. Bonitas recommends that you enquire with the relevant scheme about their exclusion list and waiting periods. Brokers Using a broker doesn’t cost you anything. An independent broker will help you work your way through the different options and help choose the medical aid plan best suited to your and your family’s needs. For more information on the product offerings from Bonitas go to www.bonitas.co.za

October 21, 2020

Sunburn in babies, how to prevent and treat it

Living in sunny South Africa, worrying about your baby being exposed to the sun’s rays is a valid concern. Too much unprotected time in the sun can be harmful to your baby, leading to painful sunburn and, even skin cancer later in life. Here’s how to prevent and treat sunburn if your little one has spent too long outside. How to treat sunburn Babies and toddlers are more sensitive to the sun as they have less developed skin than adults. Prevention is better than cure when it comes to sunburn, however, if your baby has spent too much time in the sun, the reddy, painful burn will only show up a view hours later. Those who have darker complexions tend to be less sun sensitive, however, everyone has some risk of sunburn. Redness, swelling of the skin (warmth) and pain are all symptoms of sunburn. If the sunburn has caused fever, chills, blisters and headaches its best to consult your local health practitioner. You can treat mild sunburn with a cooling bath, moisturiser or aloe gel – all of which will help cool irritated and inflamed skin. Giving your baby extra fluid in the days following the burn should prevent dehydration. It is recommended that you keep your baby out of the sun until the burn has healed.x Tips for preventing sunburn Sun is strongest between 10am and 4pm so limit your little one’s sun exposure during this time. When your baby is spending time outdoors in the sun, be sure that they are wearing a hat and sunblock with an SPF of higher than 30, if your baby is older than 6 months (if they are younger you will need to find alternative protection for them). Try to find sunblock that is formulated for kids (as this will work best for sensitive skin) and do a patch test on their skin before using it. If your child doesn’t like the feel of sunscreen (or is younger than 6 months), sun protective clothing is the better option.

October 21, 2020

Bonitas takes the edge off contribution increases

Financially solid, younger new members, two new plans, virtual healthcare and a renewed focus on Managed Care for chronic diseases are just a few of the insights from the Bonitas 2021 product launch. But it is the annual contribution increases which are highly anticipated and the moment of truth for all medical schemes. Lee Callakoppen, Principal Officer of Bonitas Medical Fund announced an unprecedented 0% increase on its BonFit Select plan and a weighted increase of 4.6% across all plans. The highest increase is 7.1%. ‘Members on our growth options, which contribute to 91% of business, will only experience an increase on 3.9%. I think, looking at the pricing and the benefit richness we offer in comparison to the market, the changes for 2021 will be well received.’ He says, ‘The guidelines received from the Council for Medical Schemes (CMS), clearly highlighted that medical schemes should limit contribution increases as far as possible. We crunched numbers and worked tirelessly to find the sweet-spot between sustainability and ensuring affordability. Not an easy task, especially in a weakened economy. We took a responsible stance, with a long-term view, to ensure that our members wouldn’t have to pay the price of a low increase for 2021 in the coming years. One of our core considerations was finding ways to ensure members could get access to full healthcare cover and avoid out-of-pocket expenses and co-payments.’ Pricing and technology Seven of our current options are priced between R1 500 and R3 000 which is where the medical scheme market is experiencing growth currently. Member behaviour has changed significantly and demand is for innovation, accessibility and technology. This has the benefit of attracting, a younger, target audience and driving sustainability. We can’t talk about 2020 without mentioning Covid-19. Key trends that emerged from a medical schemes perspective were: Changes to benefit structures and PMBs Lower than anticipated investment income as markets slumped Changes in claiming patterns in terms of seasonality and volume, due to the lockdown measures that came into effect And a Consumer Price Index that was lower than previous years which is expected to be at around 3.9% in 2021 In an industry like ours, it’s challenging to be different – to innovate, disrupt…to be better. But not impossible. The Fund needed to make short-term decisions with the long-term view and sustainability in mind. One of the highlights over the past few years, has been the introduction of four Efficiency Discounted Options (EDOs). Plans whereby members use network healthcare providers and pay around 15% less for the same benefits. The EDOs cover over 74 000 lives and the principal members who join are around 10 years younger than the average Bonitas member. 2021 – changes, contribution increases and enhancements Over the past five years, we have proactively driven innovative product design, actuarial modelling and constant engagement with various stakeholders. We believe we offer the ultimate split risk solution, with a comprehensive product range and diversified membership base. To stay at the forefront of innovation we have introduced: Edge – a new category driven by technology, intelligence and innovation, with two plans called BonStart and BonStart Plus. These are designed for economically active singles or couples, living in the larger metros. The plans include access to: A private hospital network and full cover for emergencies; PMB chronic medicine; excellent day-to-day benefits including unlimited GP consultations; layers of virtual care, dental and optical benefits; preventative care; wellness screenings; contraceptives and more. The cost: R1 452 and R1 731 respectively for the principal member. Managed Care One of the leading trends worldwide is the rise in non-communicable diseases, such as diabetes, high blood pressure and oncology. In fact, during this global pandemic, the impact lifestyle diseases and comorbidities had on Covid-19 patients was put in the spotlight. 20% of our members have multiple comorbidities which means, even without the pandemic, we need a stronger focus on preventing and managing lifestyle behaviours. Poor diet, smoking and lack of exercise are the three lifestyle factors that contribute to over 80% of chronic conditions. Managed Care continues to be a focus to empower members to take charge of their health and support them along the way. Home-based care During Covid-19, home-based care received renewed interest and focus. This dovetails with our strategy to move more care to the home and out of hospital. As an example, post-surgery or mild pneumonia, treatment can be effectively provided at home through the assistance of nurses. Not only is home-based care a cost effective delivery of care but it also promotes healing. Studies show that patients recover faster in their comfort of their own home. Day hospitals We believe the use of day hospitals and clinics should be encouraged, where possible. Some procedures such as cataract surgery, circumcisions and scopes are better suited to be performed in day hospitals or clinics versus larger hospitals. There is minimum disruption to members, speedier recovery times, less risk of infection and day hospital are also a more cost effective alternative. Technology One of the key learnings has been adapting to a new way of working – with virtual technology at the forefront. The WhatsApp channel we introduced has the most room for potential. This platform is convenient for members and allows them to manage their medical aid through live chats. Virtual Care There was a positive response to the launch of the new Bonitas Member Mobile App and free virtual care for all South Africans. This provided access to GP consultations for a range of conditions, including Covid-19, as well as free delivery for chronic medicine. At the heart of the model is the GP. This aligns to our care coordination initiatives, ensuring members receive the right level of care and support in managing their conditions. It allows access to a virtual nurse, advice in an emergency, auxiliary and home- based care, ensuring members have comprehensive support for any condition, in any circumstance, through our virtual based model. We’re pleased to announce that this model is unique and

September 23, 2020

Elective surgeries – the disruption, the trends and back to business unusual

On 9 September, South Africa recorded 1990 new cases of the pandemic in 24 hours. The country has now slipped to the eighth worst affected nation in the world in terms of the number of Covid-19 infections. In spite of this elective surgery has been given the green light and its back to business – albeit with strict protocols in place to safeguard staff as well as patients. Almost five months ago elective surgeries came to a standstill. This was reflected in claiming patterns in the private healthcare sector during lockdown – a disruption of the norm globally. In South Africa, elective surgery in both the private and public healthcare space and specialists’ visits are just two of the areas which have been affected by Covid-19. The link between the two is clear: Fewer specialists’ visits mean fewer referrals for surgery. So what exactly is elective surgery? The term can be ambiguous. It does not mean, as the name implies, that the surgery is optional but rather that it doesn’t need to be performed immediately. It can be scheduled at the patient’s and surgeon’s convenience. Some of these surgeries are necessary to prolong life, for example an angioplasty or, as in most cases, improve the quality of life. In brief, elective surgery is ‘A planned, non-emergency surgical procedure.’ Elective surgeries dropped by over half According to Lee Callakoppen, Principal Officer of Bonitas Medical Fund, ‘there has been a 60% reduction in hospital authorisation requests compared to 2019. A study release in March predicted that an estimated 28.4 million elective surgeries worldwide, would be cancelled during the 12 weeks of peak disruption due to the global pandemic. This has been a similar experience to other industry role players and is predominantly due to a combination of member fears related to Covid-19, lockdown and provider caution.’ Surgeries delayed not cancelled The postponement of surgeries was done to prevent patients taking up hospital beds and to avoid unnecessarily exposure to the virus – a strategy that worked well to flatten the curve. Surgeries were delayed based on provider discretion and subsequent patient engagement. Callakoppen says, ‘Providers are best placed to make these clinical decisions in the interests of their patients. If the procedures were emergencies or urgently required to enable member quality of life, those would have proceeded.’ The public sector too experienced backlogs in terms of elective surgeries. Examples are procedures including but not limited to, cataracts, orthopaedic surgeries, scopes, caesarean sections, tonsillectomies and adenoidectomies. BHF cautioned funders In July, The Board of Healthcare Funders (BHF) and its members in the healthcare funding space requested members of medical schemes to proceed with caution in scheduling elective surgical procedures. Dr Rajesh Patel, Head of Benefit and Risk at the BHF, said, ‘While the relaxation of the lockdown restrictions is good news for people, the country and the economy at large, we are still in the eye of the storm.’ The way forward? ‘As we move toward Level one, elective surgeries are almost back to normal,’ says Callakoppen. ‘It’s time to address the backlog of surgeries not considered emergency during lockdown. These include slow-growing cancers, orthopaedic and spine surgeries, airway surgeries, surgeries for non-cancerous tumours as well heart surgeries. We caution against a rush of elective surgeries though. Any surgery has an impact on the immune system which means the patient has a greater risk of contracting Covid-19 and developing complications from it. ‘It must further be noted that in some instances surgery is often recommended by specialists as one of the key courses of action. But we have noted that managed care protocols, in many instances, improve clinical outcomes with lower risk to the patient. One such example of this is spinal surgery, which is often unsuccessful. From a Bonitas perspective, we have noted that in the back and neck programme which enforces functional rehabilitation has been far more effective for our members. In addition, the risk to the member is significantly lower.’ Bonitas recommends the following is taken into account: That elective surgeries should only be resumed in instances where not having the procedure will severely impact the members’ health and quality of life That the current state of a patient’s healthcare is assessed – individuals with chronic conditions such as diabetes, asthma HIV/AIDS and hypertension, are at high-risk of developing Covid-19 complications The patient’s age is taken into consideration (older individuals are identified as one of the most vulnerable groups) The impact of waiting on the patient’s healthcare outcomes (for example, is it essential that the surgery takes place now or can it safely be deferred for a few months) Alternative care protocols – in some cases surgery, which should be a last resort, is prescribed without considering other treatment protocols such as rehabilitation. The most common examples of this include back and spine procedures, elective c-sections as well hip and knee replacements The use of day hospitals and clinics, where possible, to limit the possible chance of infection We may have flattened the curve but we are by no means out of the woods. Current Covid-19 cases in South Africa prove that. What is happening in hospitals? ‘Surgeries are being resumed responsibly with due collaboration and consideration exercised between the surgeon, the patient and hospital staff,’ says Callakoppen. Where there are capacity constraints, surgeries will be classified in terms of priority at the various hospitals. Pre-operative screening will continue. Facilities will continue to utilise separate zones for Covid-19 positive patients, Persons Under Investigation (PUI) and those for whom the status is unknown at the point of admission. Surgeries will be carefully planned and scheduled. Specialist visits on the up ‘Consultations are starting to increase once again but providers in general are likely to remain prudent. However we urge people who have not had their necessary annual check-ups, particularly our high risk members, to consult with their doctors. There may be members who have put these consultations on hold and are now more comfortable to visit a specialist. But care coordination

September 11, 2020

Physical touch & newborns – why is this so important

The birth of your baby is a beautiful and special moment in both of your lives. You may be wondering about your newborn’s senses, while they are born with all necessary senses, some are less precise than others and develop as your baby grows. Physical touch is an important aspect of your child’s growth, coming from your womb, where they are tightly cocooned in your womb. Skin to skin contact offers benefits to both you and your baby, and touch is one of the senses that can help comfort your baby, making them feel more secure and helping strengthen the bond between the two of you. Why is touch important? Touch enables your baby to learn more about the world, bond with their mother and learn communication skills, as touch and body language will be the first way that you can ‘speak’ to one another. Breastfeeding is an important part of this, as your baby then spends time in her mother’s arms. The benefits of touch goes beyond the physical. Contact between mom and baby has been shown to lower cortisol levels, which in turn benefits the functioning of the immune system. Children that are deprived of touch can be more aggressive with other conduct disorder problems. What is swaddling? Coming from a tightly packed womb, you’ll find that your baby is comforted by touch and close cuddles. Swaddling your baby in a blanket is also another technique that you can use on young babies to help them feel more secure, as it stops them from upsetting themselves from their own startle reflex. It’s important that your newborn finds their new world a comfortable and soothing place. Swaddling is an old technique, and beyond helping your little one feel safe and secure, your baby is likely to sleep better and will be kept nice and cosy in their blanket. If you decide to swaddle your baby it’s best to do so from birth, as opposed to introducing it when they are older as this can increase the risk of Sudden Infant Death Syndrome. Using the proper techniques when swaddling is also important, as incorrect wrapping can lead to issues.

September 8, 2020

How does my diet affect my pregnancy?

A healthy diet is always important, but during pregnancy you are eating for both you and your baby so it’s critical that you remain healthy. Eating poorly during pregnancy can have a long term impact on your baby’s health growing up. So that being said, what foods should you be eating during pregnancy? If you eat healthily already you won’t need to go onto a special diet during pregnancy, but it’s important to get the right nutrients for you and your baby through a balanced diet. Don’t be alarmed if you find yourself hungrier than usual, but even if you are expecting twins you won’t need to eat for two. It is also important to note that weight gain during pregnancy is normal, so don’t be alarmed by this. Eating schedules differ between moms, however, it is generally recommended that you eat smaller amounts more frequently when pregnant, especially if you are struggling with morning sickness. What to eat when you’re expecting Fruit and veggies are your friend during pregnancy. Providing much needed vitamins and minerals, as well as fibre which helps with digestion and keeps you feeling fuller for longer. Protein is another important nutrient, and you should try to include it in your diet everyday as it helps your baby grow strong. Sources of protein include nuts, beans, pulses, eggs, lean meat and fish. However, raw, cured and uncooked meat are all risky to consume during pregnancy as they can cause toxoplasmosis. Another important source of energy is carbohydrates, specifically whole grains. They contain vitamin B, fibre and iron, which are all important for the baby’s growth and staying healthy. These include oatmeal, wholewheat pasta and bread, potatoes and maize. If you are suffering from morning sickness, these blander foods fill you and can be eaten little and often. Foods that are rich in calcium should also be eaten regularly. Dairy foods, such as milk, cheese and yogurt are all options containing calcium as well as protein and vitamin D. That being said, some cheeses (such as soft cheese like brie) should be avoided as they can contain harmful (although rare) listeria bacteria. What foods should be avoided during pregnancy There are certain foods that you should take care to avoid during pregnancy. As mentioned, rare meats and certain cheeses should be avoided. Liver and raw fish (i.e sushi) are also on the to-avoid list. Consuming too much caffeine can also affect the baby negatively. Coffee is the obvious drink to avoid, but be aware that soft drinks, green tea, certain energy drinks and chocolate all contain caffeine.

September 1, 2020

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