Bonitas – innovation, life stages and quality care

Medical Aid – making the right choice

Private and public healthcare has been in the news lately and will continue to be a topic of discussion around the Department of Health’s proposed National Health Insurance (NHI) Bill as well as the current socioeconomic landscape.  Traditionally in September, private medical aids present their products, plans and pricing for 2020 to existing members, or potential members, so that they can make informed choices. ‘It is imperative that the decision you make regarding you and your family’s health and wellness is balanced against affordability,’ explains Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘For existing medical aid members, it’s the time to analyse the plan they are on, whether it meets their health needs and compare it to the various options available.  If you’re joining a scheme for the first time, you need to consider your specific healthcare needs and spend time investigating which plan will be best suited to deliver on this.’ However, medical aid plans can be confusing which is why it’s important to compare the various options and schemes to ensure you find a medical aid that works for you and your family’s health and that is within your budget. For people who have a broker, that should be the first point of call to help you can make an informed decision. Here are some steps to help simplify the decision.  Analyse your healthcare needs Completing a quick personal healthcare needs’ analysis will help you determine what level of cover you need. If you have dependants, you need to factor in their healthcare needs too.  Consider how much you and your family spent on medical expenses over the past year as a guide and then ask the following: How often did your family visit a doctor Do you require medicine often Did you or the family need to visit a specialist Are any of you in need extra cover for cancer, HIV, renal failure or any other specific conditions How much did you spend on dentistry, optometry and over-the-counter medicine Then consider which of the expenses were once-off and won’t come up again soon (like childbirth) and which are likely to come up again and again (such as flu) as well as chronic conditions like high blood pressure and diabetes.  Check how much cover you require If you find you hardly claimed (if you are on a medical aid) or have very a few medical expenses, then you will need a lower level of cover. However, if you have a large number of medical expenses, you will require one of the more comprehensive plans.   Once you’ve established this you can decide whether you require a full medical aid or a hospital plan.  Are you happy to use a network Some plans require you to use a specific GP, hospital network and have a list of preferred providers. This helps to keep costs as low as possible because the Scheme will have negotiated special rates with these services providers. Check whether there is a wide enough network in your area to cover your specific needs. Check your budget Once you have an idea of what you might need for the year ahead in terms of healthcare, then it’s time to look at your budget. Decide what you can afford and remember that the rule of thumb is that contributions should not exceed 10% of your monthly income.  Read the small print  Make sure you read all the details including the benefits. These vary from plan to plan so establish what is covered and look at whether it offers additional risk benefits which can potentially save on the day-to-date expenses. These could include anything from free wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to maternity benefits, flu vaccinations, mammograms, pap smears and HIV tests. All of these are costly if you have to pay for them yourself. What about savings Medical savings are a fixed amount medical scheme gives you at the beginning of the year.  You can use your savings for daily out-of-hospital medical expenses, such as GP and specialist consultations and over the counter medicine. There are ways to maximise your savings but first you need to know what you annual allocation is.  Age can influence the decision If you have young children, ensure that the medical aid option you select provides sufficient child illness benefits. For young couples looking to start a family, ensure the option provides sufficient cover for maternity benefits. However, if you aging then you need an option that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation. Some additional advice Remember to be honest on your application form, disclose all information about you and your dependents’ health. Membership can be suspended or cancelled if you fail to do so Any waiting period or exclusions? Schemes may impose certain waiting periods for new members joining or for a pre-existing medical condition. This is based on the guidelines of the Medical Schemes Act and the specific scheme’s rules. Finally, get expert advice ‘Your health and that of your family is important so it is vital that you are comfortable with the choice you make and are confident your healthcare needs will be taken care of,’ says Callakoppen. ‘My advice is to make sure you are informed. Read the information and fine print and compare what the different plans are offering before you commit. If you are still unsure, phone the scheme and ask questions or check with your broker or financial advisor.’

September 24, 2019
Bonitas – innovation, life stages and quality care

Addiction – a dangerous trend gripping the nation

It is estimated that around 10 million – or 20% – of South Africans are abusing substances. This is according to the South African Society of Psychiatrists. Whether it is alcohol, codeine, dagga, heroin or other drugs it’s a very worrying statistic that costs the private and public healthcare industry millions annually in rehabilitation and recovery.

September 20, 2019
Bonitas – innovation, life stages and quality care

Medical aid non-disclosures: What you need to know

Be honest and disclose all information. Don’t forget to read the questionnaire carefully and regardless of whether you think it’s important or not, or whether the medical condition was years previously, include it in your application

August 28, 2019
Bonitas – innovation, life stages and quality care

Combatting rising healthcare costs

Access to quality healthcare remains a priority for South Africans. However, with healthcare costs consistently outpacing inflation, the challenge for private medical schemes remains finding the right balance between providing a high level of value and care for members, while managing costs effectively.

August 12, 2019
Bonitas – innovation, life stages and quality care

The big four – know your numbers

‘South Africa is heading for a disaster if the number of people living with chronic lifestyle diseases does not change.’ That’s what both the Human Sciences Research Council (HSRC) and the Medical Research Council warned two years ago. The Council described the problem of these non-communicable diseases as an ‘emerging epidemic’.  If you look at the exponential growth of chronic lifestyle diseases then it is not difficult to understand why former Minister of Health, Dr Aaron Motsoaledi, said chronic diseases such as hypertension and diabetes are putting a huge strain on the country’s health care system. Obesity and being overweight are major risk factors for the development of chronic diseases.  Testing for lifestyle diseases such as diabetes and heart disease is essential in the face of a steadily deteriorating health status in our country.  Lee Callakoppen, Principal Officer of Bonitas Medical Fund says, ‘Get tested, know your numbers and take action now!’ The Bonitas Clinical Team explain why you need to keep your finger on the pulse of your ‘big four’ wellness numbers and what they are. Cholesterol What is cholesterol? It is a soft, waxy substance – one of the blood fats made naturally in the body. It helps to form cells, hormones and bile (that helps us digest food). Cholesterol is found mostly in animal products such as meat, cream and butter. What is high cholesterol? This is when you have too much ‘bad’ cholesterol in your blood. This, in turn, can cause narrowing and blockages of the arteries – the blood vessels that carry blood to your heart muscle and to other parts of your body. In time, the narrowing of the arteries to your heart can lead to a heart attack, while blockages in the arteries of your brain can cause a stroke. The test Called a fasting lipogram it measures the exact amount of different types of cholesterol you have. Good to know If your total cholesterol is greater than 5mmol/L on your fasting lipogram this indicates raised cholesterol Your low density lipoprotein (LDL) – the ‘bad cholesterol’ – should not be greater than 3mmol/L.  LDL causes the build-up of cholesterol in the arteries which means a greater chance of heart disease High density lipoprotein (HDL), if  less than 1.2mmol/L, means you don’t have enough good cholesterol which prevents build up in the arteries and transports cholesterol to the liver If your triglycerides (fat stored in the body) are higher than 1.5mmol/l, this is also indicative of a possible cholesterol problem.  Weight and BMI Your Body Mass Indicator (BMI) calculator checks if you’re at a healthy weight.   The test You can calculate yours by: Dividing your weight in kilograms (kg) by your height in metres (m) Then dividing the answer by your height again to get your BMI. Underweight less than 18.5 Normal weight 18.5 – 24.9 Overweight 25 – 29.9 Obese 30 or greater Diabetes What is diabetes? Our bodies produce insulin all day – a hormone that creates energy by converting sugar, starches and other foods.  Without insulin, cells cannot absorb sugar (glucose), which they need to produce energy. When there isn’t enough of this hormone in your body, or it’s not used as it should be, sugar (or ‘glucose’) can’t be moved to your other body cells to supply them with energy. This means that you have higher than normal blood-glucose levels, resulting in diabetes.There are two main types of diabetes: Type 1 and Type 2. They are different conditions but are both serious and need to be treated and managed properly. Type 1 diabetes occurs when the pancreas stops producing insulin. It usually starts very quickly and in younger people. If you have Type 1 diabetes you need insulin injections to survive as well as having a carefully balanced food intake and exercise programme Type 2 diabetes (formerly called adult-onset or non-insulin-dependent diabetes) occurs when the pancreas makes too little insulin or your body can’t use the insulin effectively. It usually develops in adulthood and is often caused by being overweight and not exercising. Approximately 85–90% of all people with diabetes have Type 2 and many people who have this condition are undiagnosed. This can result in serious damage to the delicate parts of the body and lead to blindness, heart attackstroke, kidney failure, impotence and amputation so it’s vital to be checked.  The tests  Test 1: The Fasting blood glucose test – blood glucose is taken before you eat in the morning. Normal 3.9 to 5.5 mmols/l Prediabetic or Impaired Glucose Tolerance 5.6 to 7.0 mmol/l Diabetic More than 7.0 mmol/l Test 2: HbA1c test. The HbA1c levels determine your blood sugar control over time.  Normal Less than 6% Prediabetic  6 – 6.4% Diabetic 6.5% or more Blood pressure What is blood pressure? Blood pressure is the pressure of blood in your arteries – the blood vessels that carry blood away from your heart.  The blood pressures numbers mean the following: The first (or top) number is your systolic blood pressure. It is the highest level your blood pressure reaches when your heart beats. The bottom figure is your diastolic blood pressure and is the lowest pressure exerted as your heart relaxes between beats. What is high blood pressure? High blood pressure or hypertension is when blood pressure stays elevated over time. Hypertension is often known as the “silent killer”, since nearly 33% of people who have it, don’t know it. The only way to know if you have high blood pressure is to have yours measured.    Range Normal 120/80 to 129/84 Upper end of Normal 130/85 to 139/89 Mild hypertension 140/90 to 159/99  Moderate hypertension 160/100 to 179/109 Severe hypertension More than 180/110 If your blood pressure is too high, it puts extra strain on your arteries (and your heart) and  if it’s not treated, hypertension can cause kidney failure, eye problems, heart disease and stroke. Callakoppen says, ‘When you consider that 1 in every 3 people in South African has high blood pressure and every 8 minutes 1 South African has

July 19, 2019
Bonitas – innovation, life stages and quality care

Five tips to stretch your medical benefits

Lifestyles or Non-Communicable Diseases (NCDs) – such as diabetes – have become an epidemic in South Africa which is why preventative and managed healthcare has become all important. Whether you rely on the public or private healthcare system it is critical that you manage your health and lead a healthy lifestyle, to prevent long term illness.  Cardiovascular (heart attacks and stroke), cancer, chronic respiratory disease and diabetes are on the increase and responsible for the high cost burden of healthcare. For the around 20% (just under 8.9 million) South Africans who are on private medical aid schemes, managing their medical expenses correctly is important if they want to avoid unnecessary out of pocket expenses and make their medical benefits last longer. It also helps them understand the cost associated with the healthcare services they receive and the benefits associated with the plan they have elected. Here are the five tips from Lee Callakoppen, Principal Officer of Bonitas Medical Fund on how you can stretch your medical benefits. 1. Use Designated Service Providers 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 the benefits are optimised and the scheme at large is sustainable.  So if you use a network hospital, doctor or pharmacy you will not be charged more than the agreed rate. This will help you avoid co-payments and make your medical aid last longer. So, to reduce co-payments and even avoid them altogether, find a healthcare professional on your schemes network.  2. Go generic Use generic medicines which have the same active ingredient, strength and dosage as the original brands and are as effective. Most pharmacists offer a generic option, especially for chronic medication. Medical schemes are more likely to pay in full for generic medicine. Pharmacists are also able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask and buy the recommended over-the-country medicine to save on a visit to the doctor. 3. Managed Care benefits Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. 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. Know the facts  If you do need to be hospitalised and it’s not an emergency ensure that it’s 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 they are 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 Checking what additional costs will apply (if any), what costs will be covered and how you can avoid these. 5. 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 and make good and less costly healthcare decisions,’ says Callakoppen. ‘Your health is important, so take time to research and understand the medical aid plan you are on. Read the information sent to you by the scheme or your broker, including the fine print and, if you don’t understand some of the terms, speak to your broker or phone the customer care line. Understand and know your rights in terms of healthcare cover, this will go a long way in helping you make the most of your benefits.’

July 3, 2019
Bonitas – innovation, life stages and quality care

Splitting up with your medical aid

Going through a divorce can be extremely harrowing and stressful, not just for the couple themselves but also for their children. And, given the divorce statistics released recently by StatsSA, divorce is on the increase.  More than 25 390 divorce papers were filed in 2017, four in 10 divorces came from marriages that lasted less than 10 years and 55,6% involved children. Part of the anxiety is financial which can be exacerbated, depending on whether you are married in community of property have an ante nuptial agreement with or without an accrual clause. It can be very difficult going through the nitty-gritty details, especially when emotions are high. There are a lot of factors to consider, including how to divide up property and other assets, child care and support and, just as important, healthcare.   Divorce can seriously impact the healthcare cover you might have previously enjoyed, especially if you are your children were on a joint medical aid, with one partner being the main member and the rest of the family listed as dependants.   We put a few questions to Lee Callakoppen, Principal Officer of Bonitas Medical Fund to help you make sure have the right information and follow the correct procedures to ensure your healthcare is not compromised during divorce proceedings. What is the correct process to follow when getting divorced and taking a dependant off your medical aid?  All changes in dependency must be sent through to the medical aid. You are usually required to fill in a form regarding this and provide supporting documents. In instances of a divorce, you will need to provide the divorce settlement to your medical aid together with your form. Is there a notice period required? Usually changes are effected within 30 days, which means you do need to allow time for the change to take place. What are the rights of the dependent being removed in terms of coverage while moving to a new medical aid? The main member is effectively the policyholder when it comes to medical aid and his/her dependants are beneficiaries. Unfortunately, this means the dependant has no rights once they are removed from the membership which is why it is important to obtain cover for you after a divorce with immediately effect. Does moving from one medical aid to another impact continuity of cover and/or will waiting periods apply? The usual underwriting rules apply so check with your new medical aid in terms of waiting periods and/or any exclusions.  What happens if the medical aid cover was always in the ‘husbands’ name and now the ex-wife wants to apply – will she been penalised for not having a medical aid and be charged  late joiner fee (if over 35)? No, however you will be required to prove that you have previously belonged to a medical aid. We advise that you request a certificate of membership showing the period that you belonged to the medical scheme as a dependant on your ex-spouse’s medical aid. What are the advantages and disadvantages of being a dependent on a partner/spouse’s medical aid?  Advantages Reduced contributions, the monthly contributions for an adult dependant is cheaper than that of a main member Disadvantages The main member has to provide access and approval in order for a dependant to access online portals etc Can a divorced couple still share a medical aid scheme or does this only apply to children?  Yes, if one spouse is financially dependent on the spouse. You will need to provide proof of dependency for this. If you are able to remain or your ex’s plan would this be  a recommendation in terms of medical cover and continuity of healthcare? No. You will still have continuity of cover if you join a medical aid as the main member. The bottom line: Although divorce means heartbreak and emotional turmoil you do need to keep your wits about you.  Seek the help of a financial adviser or broker to ensure you don’t compromise on your health or that of your children. Keep copies of your divorce papers, get any additional paperwork required, notify the existing medical aid of the changes and sign up for you own medical aid or hospital plan that kicks in immediately.  

June 20, 2019
Bonitas – innovation, life stages and quality care

What you need to know about Pneumonia

Lee Callakoppen, Principal Officer of Bonitas Medical Fund talks about pneumonia: According to the World Health Organisation (WHO), a child dies from pneumonia every 30 seconds. Which means that around 1.1 million children, under the age of five, die each year. This is more than malaria, AIDS and tuberculosis combined. What is pneumonia? Pneumonia is a lung inflammation caused by a bacterial or viral infection, it’s when the air sacs in the lung fill up with pus and can affect or one or both lungs. The flu shot and pneumonia  Having a flu vaccine is the first line of defence when it comes to protecting yourself, with studies showing it reduces the risk by about 50 to 60%.  The vaccine trains your body to recognise flu and fight it. Pneumonia is a relatively common and serious complication of flu.Supporting evidence from randomised clinical trials indicates that fluvaccines are effective in preventing influenza-associated pneumonia. Signs and symptoms of pneumonia may include: Chest pain when you breathe or cough Confusion or changes in mental awareness (in adults aged 65 and older) A cough, which may produce phlegm Fatigue Fever, sweating and shaking chills Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) Nausea, vomiting or diarrhoea Shortness of breath How are flu and pneumonia different? Bonitas explains that pneumonia symptoms are similar to flu but last longer. The severity of the pneumonia depends on your age and overall health.  In the case of newborns and infants, sometimes they show little or no infection and other times they may vomit, have a fever and cough, have difficulty breathing and eating.  Pneumococcal vaccine  There are a total of 80% Community Acquired Pneumonias (CPAs). These streptococcal bacteria can spread from the nose, throat and ears to cause pneumonia – a severe infection of the lungs.  The vaccine protects you against: Infection that can result in Pneumonia, infection of the blood (bacteremia/sepsis), middle-ear infection (otitis media), or bacterial meningitis. Pneumonia is by the most common of these infections.  Is it an annual vaccination? The pneumococcal vaccination is suitable for those over 65 years of age or immune compromised members a pneumococcal vaccination once every five years.  Who should have the pneumonia vaccination? It is recommended for all individuals aged 65 years or older plus individuals aged 2-64 years with certain long-term health conditions, such as a serious heart or kidney condition. In fact for anyone with an  increased risk, from a  chronic disease, immune-suppressed people particularly those who are HIV positive, cancer sufferers and smokers who are more prone to respiratory illnesses.   The cost of pneumonia In severe cases of Pneumonia, the estimated cost of spending a night in intensive care is R15 000 whereas a Pneumococcal vaccine costs around R1000. Most medical aids do cover the cost. Bonitas offers a free flu vaccine annually to members as well as a once off pneumococcal vaccine for people over 65 years of age. According to the New England Journal of Medicine (NEJM), ‘In addition to reducing the risk of hospitalisation for an influenza infection itself, the flu vaccinations appear to reduce the likelihood of hospitalisation for influenza-associated complications such as pneumonia.  When to see a doctor? See your doctor if you have difficulty breathing, chest pain, persistent fever of (39 C) or higher or a persistent cough, especially if you’re coughing up phlegm. 

June 12, 2019
Bonitas – innovation, life stages and quality care

Five facts about ‘flu

Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund gives five facts about flu: Flu strains, like fashion, change every year The latest flu strain South Africa can expect is nick-named ‘Aussie Flu’. This particular strain – H3N2 – is a subtype of influenza A. The virus has, in fact, been around for a whilebut unfortunately the flu strains have a built in survival mechanism, they mutate or change so they outwit the body’s immune response. Which is why each year flu vaccinations are updated, meaning last year’s won’t necessarily protect you this year.  The symptoms of flu? These include high temperatures, body pain, sore throat, tiredness, loss of appetite and are the same year in and year out. However, some flu strains may cause the symptoms to last for a longer time and be more severe. The flu can also bring on headaches, muscle pain, vomiting and diarrhoea. In people with weaker immune systems, the flu is even more serious.  The flu shot doesn’t gives you flu According to the Centre for Disease Control, ‘A flu shot cannot cause flu and serious allergic reactions to the flu vaccine are rare. However, if you are allergic to eggs you need to notify your doctor. Flu vaccines are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious or with no flu viruses at all. The most common side-effects from the shot are small amounts of soreness, redness, tenderness or swelling around the injection site.  Protecting yourself and your family The flu vaccine reduces your chances of getting flu and, if you do get it, it will be milder.The vaccine trains your body to recognise flu and fight it. More importantly, if you are vaccinated you will protect others, via what is called ’herd immunity’. This includes vulnerable members of the family such as such as small babies and the elderly as well as those who are immune-compromised. Some of the reasons people don’t vaccinate Every year there is a debate about flu injections yet up to 11 000 people die from flu in South Africa every year, despite the flu vaccination being readily available and paid for by most medical aid schemes.  There are a number of reasons, including the notion that:  ‘I don’t get flu’, ‘the vaccine doesn’t work’, ‘it will hurt my arm’ or ‘the vaccine will give me flu’.  However, according to Bonitas, there are very good clinical reasons why you should. Bonitas covers one flu vaccine for all members. Members can go Clicks, Dischem or Pick n Pay pharmacies for the vaccine at no cost, or attend a Bonitas Wellness Day.

June 5, 2019
Bonitas – innovation, life stages and quality care

Deciphering Medical Aid Speak

It can be rather daunting trying to understand the terms in your medical aid plan and all the detailed information about your benefits.  Medical Schemes and the Council for Medical Schemes (CMS) use certain terms in reference to benefits.  They can be tricky to fathom. Here are some of the most frequently asked questions, as highlighted by the Bonitas Medical Fund call centre.   Prescribed Minimum Benefits (PMBs) PMBs are confusing even to those in the medical industry but simply put, it is a list of 26 chronic diseases and 270 treatments which have to be covered by all medical aid schemes as outlined in the Medical Schemes Act.  PMBs are in place to make sure all members have access to certain minimum health services, regardless of their benefit option. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable. Above Threshold Benefit Medical Schemes set an annual limit for day-to-day claims. Once you have reached this limit – or threshold – then your claims are paid from the ‘Above Threshold Benefit’. The amount available depends on the plan you are on as well as the number of dependants.  Day-to-day limits Members and their dependants are given a pre-determined maximum amount of money for out-of-hospital expenses during a year. There is a limit to what you can spend after which you move onto the above threshold benefit. Pre-authorisation Unless there is a medical emergency, members are required to obtain pre-authorisation from their schemes before being admitted to a hospital for a procedure. If you do not organise pre-authorisation, the scheme can refuse to pay.  Quotes for procedures Bonitas advises members to not only obtain pre-authorisation but to also ask for a detailed quote from the hospital and medical practitioner prior to being admitted to hospital (if it’s not an emergency).  It means you can submit it to your medical aid ahead of the procedure to find out if co-payments will be required and if so, how much they are. Co-payment Medical practitioners and hospital often charge more than medical aid rates. This means medical schemes seldom cover the entire bill.  A co-payment refers to the outstanding portion of the account, for which you will be responsible.  A co-payment varies from one medical aid scheme to another and is sometimes not necessary if you use a designated service provider or network hospital.  The medical aid can pay from 100% – 300% of the medical aid tariffs, depending on the plan you are on. ICD codes This is a coding system developed by the World Health Organisation (WHO) that translates the written description of medical and health information into standard codes.  It means every medical treatment and diagnosis has a specific code – called an ICD 10 code.  These are important as it allows the scheme to identify the code of the healthcare service you require and to make sure payment is made. The correct ICD Code must be included on every claim to ensure you are paid for the correct benefit and t the healthcare practitioners are paid for their service.   Claim After you have seen a doctor or been in hospital, you can either pay the bill directly and claim the amount back from your scheme or your doctor can submit the claim on your behalf.  Remember to ensure that all the correct information is on your claim, including your membership number and the ICD 10 Code. Chronic Medication Is medicine prescribed by a medical practitioner for an uninterrupted period of at least three months. This medicine is used for a medical condition that appears on your scheme’s list of approved chronic conditions. Payment of chronic medication is usually a separate allowance on your medical aid plan. Formulary Medical Aids have a list of medicines on what they call their formulary – or list – that are recommended to treat different diseases.  If you opt for medication not on the formulary there might be a co-payment. Generic medicine There are a number of generic medicines on the market that are cheaper than the original, patented brands however they contain the same active ingredients and are just as effective.  Most medical schemes encourage the use of generic medicines to save costs and help you stretch your benefits. Check with your pharmacist. Private healthcare in South Africa is not cheap and the best way to make the most of your medical aid or hospital plan is to understand what is and isn’t covered as well as the terms and conditions. Make sure you get to grips with the various terms used by your Scheme and Dr and if you are unsure … ask!

May 10, 2019
Bonitas – innovation, life stages and quality care

Pre-authorisation and payment: Do you know the difference?

Medical aid members know that pre-authorisation ahead of a medical procedure is always required but does pre-authorisation mean it’s an agreement to pay in full? No, not necessarily. This is the cause of a great deal of confusion and unhappiness from medical aid members as well as doctors and hospitals. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Funds says, ‘Pre-authorisation is required for all hospital admissions, including emergencies. However, it is not an agreement to pay all the costs and expenses in full.’ Why not? Let’s take you through the Ts and Cs.  Why do they differ? Most medical aid plans have varying hospital benefits according the level of cover you have chosen. Van Emmenis says, ‘All of our plans provide hospital cover for major medical events when you or your dependant is admitted to hospital. But, each plan has different hospital benefits available. We encourage you to use the healthcare providers on our network and to get pre-authorisation for your hospital stay so the providers of your treatment or procedure are paid to the full extent of what your plan offers.’ Understanding your medical aid rate of payment‘ For example’, says Van Emmenis, ‘The Bonitas Rate is the rate at which we reimburse healthcare providers. Where we pay 100% of the Bonitas Rate, this is NOT necessarily what the healthcare provider charges. They may charge 200% of your medical aid rate which means you are responsible for half the payment. Each plan has a different rate according to the premium you pay. If you visit a healthcare provider that charges the Bonitas Rate, we will pay the bill in full (provided that you have benefits available). For this reason it is important to use designated service providers with whom Bonitas has negotiated rates.’ How much will your plan cover? If it is not an emergency the best way to find out how much your medical aid will cover is by asking the hospital and medical practitioners for a detailed quote.  Submit this to your medical aid to check what they will cover and how much the shortfall, if there is one, will be.   Co-payments The shortfall will be in the form of a co-payment. These co-payments differ from one medical aid scheme to another, and are often higher than anticipated, mostly due to medical practitioners and hospital charging higher than the medical aid rate. Minding the gap When there is this shortfall between what the medical scheme pays and what the hospital or specialist charges, it helps if you have taken out gap cover. Even if you have a top of the range medical aid plan, it doesn’t mean there will not be ‘gaps’ between the tariffs your scheme is prepared to pay and the amount your specialist charges. GAP cover is not a medical aid product but an insurance policy taken out to reduce or eliminate co-payments. Again the amount you receive depends on your GAP policy  It is important to note that Gap Cover is an insurance ‘policy’ and is regulated under the Long and Short Term Insurance Act (1998). Medical schemes, on the other hand, are overseen by the Council for Medical Schemes Act (1998) and are not for profit. Ensuring you are covered 1. Make sure you get a quote.  Medical aid members are advised to not only obtain pre-authorisation but a quote from the hospital and medical practitioners prior to being admitted to hospital (if it’s not an emergency).  Submit this to your medical aid to find out if there are any co-payments and if so, how much they are. 2. Find a hospital on your medical fund’s preferred network in order to ensure maximum payment 3. Make sure you fill in provide all information required for pre-authorisation correctly: Have your correct membership number and the details of the member who the request is for The date you are going into hospital and the date of  the treatment or procedure The name of the doctor who will be treating the member, their telephone number and practice number The name of the hospital where you will receive treatment, their telephone number and practice number The relevant procedure and diagnosis (ICD-10) codes for the treatment (ask your doctor for these) If your request for authorisation does not include all the information listed above, your request will not be approved. If your pre-authorisation is declined the reasons for doing so will be listed on the correspondence. If it is approved, you will receive a pre-authorisation number and this will also outline the approved length of your hospital stay and the status of all codes. However remember the pre-authorisation is not a commitment to pay the full amount.  4. Gap cover If you have Gap Cover, notify them of the co-payment required prior to being admitted to hospital as there are limits to the amount they will pay. What about emergencies? Emergencies must be pre-authorised within 48 hours of going into hospital or on the first working day after a weekend or public holiday. If you don’t get pre-authorisation, your account won’t be paid by the Scheme. ‘The most important thing’, says Van Emmenis, ‘is to find out, prior to being admitted, what your medical aid will pay and what payment you are responsible for. It will save a great deal of stress when you are recovering from surgery.’

April 5, 2019
Bonitas – innovation, life stages and quality care

Medical tax rebates stable after budget speech

Private medical aid members can breathe a sigh of relief after the budget speech. Treasury has been hinting for a while that they were considering reducing of the medical tax credit to fund the National Health Insurance (NHI), fortunately, it remains unchanged for the year ahead. Although it was a relief to members it was also a surprise tax sacrifice, considering the need to fund NHI. This equates to over R30 billion this year and around R35/36 billion for the coming year – a large sum indeed.  It is believed the removal of tax credits would have upset too many people who are dependent on it to access private health care and are essentially being rewarded for not burdening the government health care. Before 2012, SARS deducted your medical aid contributions against your taxable income. ‘Originally,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, ‘your medical aid contributions would be a deduction against your taxable income. However, from 2012, SARS introduced a medical credit, a ‘tax credit’ which is deducted from your overall tax liability.’ The medical tax credit consists of the following two amounts: The medical scheme fees tax credit This applies to the premiums paid by you to a registered medical scheme on behalf of yourself and your dependents. The main member, as well as the first dependant on the medical scheme, receive a monthly tax credit of R310 (for the 2018-2019 year).  All additional dependants receive a monthly tax credit of R209 (for the 2018-2019 tax year). There are three categories: 1. Under 65 (without disability) 25% of the total contributions paid to the medical scheme  Less (4X medical scheme fees credit) Plus qualifying medical expenses paid less 7.5% of taxable income 2. Under 65 (with a disability) 33.3% of total contributions paid to the medical scheme Less (3X medical scheme fees credit)  Plus qualifying medical expenses paid  3. 65 or over (with or without disability)  33.3% of total contributions paid to the medical scheme Less (3X medical scheme fees credit)   Plus qualifying medical expenses  It is important to note that if your premium is a deduction from your salary or wages, your employer is obliged to use the credit system to adjust your monthly PAYE tax accordingly. If you contribute to a medical scheme independently from your employer, you will receive the tax credit on assessment when you complete your tax return.  2. The additional medical expenses tax credit This means that the overall amount of tax you need to pay at the end of the tax year is reduced. The amount of your tax rebate is made up of a percentage of all out-of-pocket expenses you have spent on qualifying medical expenses that weren’t covered by your medical scheme. This amount accumulates throughout the tax year. You will need to keep the slips for these expenses. To calculate the additional medical expenses tax credit, special formulas are used. The specific formula to use depends on your age and whether you or one or more of your dependants has a disability. The following out-of-pocket expenses qualify: Consultations, services or medications from a registered medical practitioner, arthropod, physiotherapist, dentist, chiropractor, herbalist, homoeopath, optometrist, osteopath or naturopath Admission to a registered hospital, including nursing homes Care at patient’s home by a registered nurse, nursing assistant, nursing agency or midwife Medicines prescribed by a duly registered physician (as listed above) and acquired from a duly registered pharmacist Medical expenses on services rendered or medicines supplied outside of South Africa and which are substantially similar to the services and medicines listed above Money paid towards the treatment of a physical impairment or disability (as long as it is a qualifying expense prescribed by the Commissioner). What about over-the-counter expenses It is important to note that unless these are prescribed by a registered medical practitioner and acquired by a pharmacist they don’t enjoy a tax rebate. Examples include medicines, such as cough syrups, headache tablets or vitamins.  ‘Whether NHI is going to materialise or not’, says Van Emmenis, ‘The Government’s coffers need filling and the approximately 17% of the South African population on private medical should expect their medical aid tax relief to get less and less in the future.’ 

March 15, 2019
Bonitas – innovation, life stages and quality care

Bonitas gives back

Members of Bonitas Medical Fund will now have access to free lifestyle vouchers as well as discounted offers on gap cover and financial services products through the Fund’s new multi-insurer platform. This is not another Loyalty programme. ‘Our members’ health has always been a priority and we strive to make healthcare as affordable as possible,’ says Gerhard van Emmenis, Principal Officer of Bonitas. ‘And while our various plans offer a host of benefits, we know that in difficult financial times money matters can add to stress levels.  For this reason, we have adopted a multi-insurer platform which offers members discounted lifestyle vouchers as well as exclusive offers on gap cover and various insurance products.’ The past 12 months have been extremely difficult for consumers, impacted by the increase in VAT, the fuel levy and the resulting escalating prices. This has increased the burden placed on consumers struggling to make ends meet.  ‘In 2017 a Financial Wellness Indicator revealed that 73.5% of South African households were financially unwell,’ says Van Emmenis.  ‘2019 is no different. Consumers are cash strapped so being able to align with strategic partners to offer a comprehensive and tangible way to relieve the money pressure while helping them find them some ‘extra’ money, will go a long way to keeping them physically and financially healthy.’  A report published last year, which reviewed rewards programmes in South Africa, indicated that there are around 100+ existing loyalty programmes with the average consumer subscribed to about nine. ‘The economic landscape is tough to navigate and we didn’t want to add to the pressure already placed on our members by offering a loyalty programme for which they would have to pay an additional monthly fee for. Our multi-insurer platform is premised on negotiating exclusive deals to the benefit of our members.  ‘They are designed to add real value aligned to member needs.’ Van Emmenis explains. In brief: These do not cost anything  There are no points No levels of membership You don’t have to work for rewards The model is split in two.  One: Free monthly discount lifestyle shopping vouchers to offset daily living expenses These are available from over 30 retailers and 6 000 outlets countrywide, such as Shoprite, Takealot and Edgars, as well as for airtime and data purchases and electricity. ‘The deals are aimed at the average South African, with discount vouchers for groceries, data, airtime and electricity. There are also discounts on activewear and gym membership to encourage a healthier lifestyle,’ Van Emmenis says. Two: Discounted financial service products through Medgap and Indie MedGap offers comprehensive gap cover at a discount of up to 26% exclusively for Bonitas members.  Indie offers various financial products such as a funeral, critical illness or disability cover, as well as income protection at a discounted premium, together with a free investment at no extra cost.  Indie will match and invest up to 110% of Bonitas’ member’s life insurance premiums, with cash drops every five years. The multi-insurer platform is supported by a new, revamped member zone to allow members to manage their medical aid 24/7, on any device. This includes submitting claims, applying for chronic medicine and viewing benefits clearly signalling a new era of medical aid has dawned. 

March 2, 2019
Bonitas – innovation, life stages and quality care

Medical aid unpacked

When it comes to medical aid, affordability is usually the biggest consideration.  However, monthly premiums should be weighed and balanced against the actual benefits and healthcare coverage being offered in order to make an informed decision.  The biggest question around medical aid costs is why healthcare inflation is rising at such an alarming rate and how schemes deal with this. ‘Currently, medical inflation is outpacing general economic inflation by between 3 and 4%,’ says Gerhard van Emmenis, Principal Officer of Bonitas Medical Fund.  ‘And while the jury’s still out in the form of the Health Market Inquiry into the private healthcare sector, fingers are being pointed at all role players from private hospitals and specialists to medical schemes.  However, you need to remember that the former are all about the bottom line, while medical schemes are not-for-profit.’ Consumers, unable to make Rands or sense of the many plans available and what they’re actually offering, are often tempted to migrate to what is perceived as a more affordable plan, but with less coverage.  ‘Comparing the average percentage increase in isolation is not an indicator of the value of the healthcare being provided,’ says Van Emmenis ‘We urge consumers to compare monthly contributions with the benefits to ensure they are getting the cover they need.’ He maintains that simply comparing the average percentage increase announced by the various schemes is not a litmus test for value for money, since it does not take into account the basis on which the increase applies.  Here is a simple maths example:  Two schemes offer the same benefits however, Scheme A costs R1 000 pm while Scheme B costs R1 100pm. If Scheme A announces a 10% increase  (R1 100pm) and Scheme B announces a 7% increase (R1 177) but neither change or increase the benefits, then Scheme A is still providing the same benefits, at a lower cost, even though it announced a higher contribution increase.  ‘That’s why it’s important to compare the actual benefits and contributions rather than only looking at the percentage increase,’ says Van Emmenis. This is where a Broker can be invaluable. While consumers are becoming more savvy and educated on the inner workings of the medical scheme industry there is confusion. Brokers assist consumers by making informed recommendations that take into account their specific needs. They also play a vital role in education around the offerings, how to maximise your benefits, how to benefit from Managed Care, both financially and in terms of quality of life, various healthcare terminology and assisting members with claims. Van Emmenis explains that schemes with a growing membership base will require additional loadings in the monthly contributions to increase the reserves in order to meet the statutory solvency requirement of 25%. ‘This is a legislative requirement and does not imply the scheme is performing poorly – in fact the opposite is true in this context,’ he says. According to data released by the Council for Medical Schemes (CMS), the market has not been successful in attracting young, healthy people who are less prone to chronic health conditions like diabetes or hypertension: Lifestyle diseases that adversely effect of the pool of contributions. The increasing age of beneficiaries is also a huge concern. The CMS reported that the industry average beneficiary age increased from 31.9 years in 2013 to 32.5 years in 2016. The pensioner ratio increased slightly to 7.9%, with a general rise in the ratio for both males and females.  Schemes with an ageing membership base generally experience increased claims costs, in excess of inflation, due to the higher use of benefits. ‘We have seen around a 2% increase in claims by members annually as they age,’ says Van Emmenis.  ‘In addition, all chronic conditions, except Type 1 Diabetes, have shown an upswing, ‘says Van Emmenis. ‘These conditions are PMBs that need to be paid in full by all schemes. So, although the regulation is well intended, it is without doubt one of the factors driving up the cost of healthcare. At the same time, there have been particularly steep increases in the cost of specialists and hospitals, which together account for more than 61% of total claims paid.’ Runaway healthcare costs are difficult to contain because of a myriad of contributing factors.  Most rooted deeply in a complex health system where much of what happens is beyond the influence of the schemes. Take for example the over-regulation in the form of exclusion from collective bargaining by the Competition Commission. This leaves schemes with no option but to negotiate individually with service providers, blocking the development of a more efficient and cost-effective healthcare sector.  Open enrolment also impacts costs as schemes have to accept anyone who wishes to join, regardless of their health status, which does maximum damage to risk equalisation.  So what is the best approach for medical schemes going forward? Van Emmenis says that schemes need to continue to explore and implement cost containment strategies and offer value for money to members. ‘Access to quality healthcare remains a concern and priority for the majority of South Africans. Our mandate has always been to provide quality healthcare at affordable prices and this will continue.’

October 30, 2018
Bonitas – innovation, life stages and quality care

Medical Aid choices

It’s business as usual for medical aids… While the NHI remains a work in progress in terms of policy and planning, currently nothing changes in terms of medical aid schemes. As the NHI White Paper stipulates: Until the new system is fully implemented and operational, it is ‘business as usual.’  And, even when NHI is implemented, medical aids will still exist.  According to Gerhard van Emmenis, Principal Officer of Bonitas Medical Fund, South Africa’s second largest open medical scheme, one of the changes that will be seen once the NHI is a fait accompli, will be a decline in the number of medical schemes. ‘From what I understand, and we are talking of the future, there will be three or four medical aids which will serve as complementary health product providers and fill the gaps left by the NHI.’ Medical Aid ‘launches’ will go ahead in September – when schemes announce amended plans and premium increases for 2019.  Costs of medical aid It is also the time when new members sign up and existing members scrutinise and review their existing cover, whether it’s a full medical aid or hospital plan.  Medical aid may seem like a grudge purchase until you find yourself faced with unexpected and expensive medical cost. Unfortunately, healthcare inflation continues to outpace general inflation by about 5%. So while consumers are struggling in the economy generally, medical aids have to explore ways to contain costs without compromising the level of health care offered to members. Time to scrutinise the small print The medical aid landscape can be tricky to navigate so it’s important to compare all the available options and schemes to make sure you find a medical aid that works for you and your family’s health and is within your budget. Bonitas offers some advice on what to look out for and consider ahead of making a final decision.  If you are already on an existing medical aid  Before you decide on the best medical aid option, you need an idea of what your typical health care costs are. Reflect on the following over the past twelve months: How much you spent on day-to-day healthcare expenses  Were you or any of your dependants admitted to hospital  Did you need to visit a specialist regularly  How often did you visit a GP Do any of you have any chronic conditions How much do you spend on dentistry, optometry and over-the-counter medicine  Did you exhaust your day-to-day benefits and/or savings in the year How much did you pay in co-payments and/or deductibles Then consider which of the expenses listed above were once-off and won’t come up again soon (such as childbirth) and which are likely to come up again and again (such as flu).  Empowering yourself with information Also take the time to read the information sent to you by the scheme and/or your broker to ensure you understand what it being offered so that you can make informed choices.   The day-to-day detail for new or existing members Often the cost containment measures medical schemes apply for the day-to-day benefits are broad. So investigate, or bear in mind, the following: Does your medical aid contract with hospitals, doctors and specialists and, if so, are you willing to use them and are they close by? Using contracted or network providers usually means obtaining full or improved cover levels. It also helps ensure you are getting more value for money as doctors on your medical scheme’s network will not charge more than the rate agreed with your medical scheme. 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?  Additional benefits Ask what supplementary benefits might be available that can potentially save significant day-to-day expenses. These could include the following: Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and body mass index measurements) through to mammograms, pap smears, prostate testing. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more. These usually require authorisation from the scheme, failing which they are simply met from your day-to-day benefit limits.  Ways to get more value for your money Use generic medication wherever possible – ask your doctor and pharmacist about this Try to keep your claims within any specified sub-limits, e.g. optometry Find out if your option has any day-to-day benefits that are paid by the scheme from risk (not from your day-to-day sub-limits or savings) Using network doctors is an invaluable tool to make your medical aid last longer. It means that doctors can’t charge you more than a specific amount. At present, Bonitas has the largest GP network in the country.  Age impacts your decision If you have young children, ensure that the medical aid option you select provides sufficient child illness benefits Check the maximum age of child dependents.  Some allow students to remain on the scheme until they are 25, while others cut off at 21 or 23 However, if you are slightly older, then check that the option you select covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation. Also keep an eye out for programmes that help you to manage chronic conditions such as diabetes and cancer.  Ensure the affordability of the medical aid plan selected When comparing the different medical aid options available, consider all the costs involved before you make your final decision, such as: Affordability of the monthly contributions given your monthly income and expenses.  As a rule of thumb, your medical aid contributions should be around 10% of your monthly income at an individual or household level As a general rule, the lower the cost of the option the fewer the choices available to the member regarding medical treatment, healthcare providers and medications. However, this can greatly benefit people who have very limited resources available to them for healthcare, or for people who don’t have chronic and existing

October 17, 2018
Bonitas – innovation, life stages and quality care

Medical aid payments

It’s a lament often heard. There are, however, two sides to every story and the problem doesn’t always lie with the medical scheme. There are a variety of reasons for non-payment ranging from members not following the correct claiming procedures or rules, benefits not being depleted or even providers not billing correctly. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund gives some tips on what may have gone wrong and how to fix it. The important thing to remember is that medical aid scheme options differ, which means some options cover procedures that others might not, but there are certain rules everyone needs to adhere to. Your medical scheme will usually tell you the reason for non-payment. If you are unhappy you can take it up with them, however, the best advice is to first check that the fault doesn’t lie with you or the medical practitioner. Your membership number This may sound simple but it is surprising how often an incorrect membership number or dependant code is submitted with a claim. In some instances, this information is omitted or incomplete. A medical scheme cannot pay without proof that you had the treatment. Remember to update your details if you have changed your medical aid option or medical scheme. ICD-10 codes ICD-10 codes are used by medical schemes and healthcare providers, including doctors and specialists to identify specific conditions. These must be correct as they are a diagnosis for specific conditions. If there is no ICD-10 code or, for some reasons that condition is not covered by your medical aid, the account won’t be paid.   Schemes also have sub-limits, for example they agree to pay for rehabilitation and the amount they will cover is finite, so check prior to the treatment. Certain dental procedures have definite sub-limits so it is important to read the fine print and check your policy for what is covered and what isn’t. Your contributions are not up to date It sounds simple but check that your debit order has gone through or that your employer has paid your contribution, non-payment of premiums could result in your bill not being paid – especially if your membership is suspended. The claim has expired Be aware that there is a cut-off date for submitting a claim.  It is usually four months from the date of treatment. Ensure that the correct date is on the top of the account. Your benefits are depleted If you do not manage your medical aid benefits carefully you can run out of benefits before the end of the year.  This means that you may have to pay the bill yourself. Different options have different limits for various procedures so, once again, make sure you understand what your option covers. Medical schemes are required to pay for Prescribed Minimum Benefits in full but you may have to use a specific provider. Waiting periods may apply When you join a new scheme there is a waiting period of three months and sometimes, based on your medical history, a twelve month exclusion could be enforced for certain conditions.  If you claim before the waiting period is up, the bill will not be paid. Your hospital/doctor is not on the network  Most schemes have hospital and doctors networks who agree on certain rates for their members. If you choose to go to another hospital or a private doctor you could end up paying a large portion of the bill. You didn’t use a Designated Service Providers A Designated Service Provider is a specific provider that has been appointed by a medical scheme for a specific service. If you choose not to use a Designated Service Provider, you may have to pay a co-payment or not be covered – depending on the Scheme Rules or your specific plan limits. Pre-authorisation was not obtained If you are going to undergo a procedure you need to get authorisation from your medical aid ahead of going to hospital and, once again, make sure you have the right information and ICD-10 Codes for this. You’re using medicine that’s not on the formulary Every scheme has a formulary, which lists chronic medication approved by your medical aid. These are often generics which are copies of the original medication but more affordable. Ask your pharmacist for a generic as a matter of course as it will ensure your benefits last longer. The procedure or treatment may be an exclusion All medical schemes have a list of exclusions which are not covered. This often includes cosmetic surgeries and non-medical expenses. Van Emmenis says, ‘If you read the small print and know exactly what the rules are for your medical aid and the plan you are on, you will be able to ensure that your benefits last as long as possible and that the bills are paid.’

April 24, 2018
Bonitas – innovation, life stages and quality care

Medical Aid and VAT

Since the announcement of the 1% Value Added Tax (VAT) increase by the Minister of Finance last month, there has been much debate around its impact on consumers and just how this will affect the money left in their pockets at the end of the month. With the revised general fuel levy, it’s clear that consumers will have to tighten their belts and adhere to stricter budgets. The rising costs of healthcare One area of concern is the cost of private medical aid and VAT. For years increasing healthcare inflation and economic pressures have been a challenge for the healthcare industry. ‘The reality is that when consumers are struggling, medical aid, which is essentially a grudge purchase, is often viewed as unaffordable,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund. ‘In addition healthcare costs are not regulated which is why it is crucial for medical aid schemes to continue to explore ways to contain costs without compromising the level of health care offered to members.’ Members’ contributions However he says there is some good news regarding VAT and medical aid because the 1% increase will not impact monthly contributions or annual benefits. ‘Many members are confused as to whether VAT is payable on medical aid contributions but let me reassure you it is not,’ says Van Emmenis. ‘The VAT increase will have no effect on members directly and what they pay every month. Medical aid contributions for 2018 are already set and Bonitas will not increase contributions mid-year to accommodate the change in VAT. So, while the increase in VAT may influence the price of services, it will not impact benefits.’ Van Emmenis says: ‘If your plan covers you at 100% of a Scheme’s Rate, you are still covered at 100% of that rate, no matter what the cost to the Scheme because the Scheme will absorb the VAT when paying for member’s benefits. The only impact is when it comes to savings and day-to-day benefits with members having a 1% lower buying power.’ The Council for Medical Schemes In fact changing contributions in the middle of the year can only be done with the permission of the Council for Medical Schemes following a request from the Trustees of the medical scheme. This is a rare occurrence and most schemes generally put through contribution increases in January each year. The law He adds that VAT is never the property of any private entity but belongs to the Government. ‘We are therefore only vendors that collect the monies on their behalf. From April 1, Bonitas will increase the VAT to all providers of the Scheme by 1%. However, although this will have a direct impact on the budget of the Scheme for 2018 it will be absorbed by operational surpluses and not passed on to members.’ Tax credits One positive announcement out of the budget speech regarding medical aid was around tax credits. ‘Medical tax credits are effectively used as an ‘expense’ when calculating tax and reduces the amount of tax payable by a household belonging to a medical aid,’ says Van Emmenis.  ‘There are eight million people who rely on these credits to make medical aid more affordable. Speculation was rife that the tax credit would be removed but it is a relief that private medical aid members have some reprieve.’ Conclusion The bottom line: The 1% VAT increase and the additional 52 cents general fuel levy will have a knock-on effect for South African consumers, things will cost more.  However, it will not affect monthly medical aid premiums or member benefits although it will have an indirect impact in terms of healthcare services being more expensive, which will reduce buying power.

April 12, 2018
Bonitas – innovation, life stages and quality care

Bonitas Talks Babies

When do advise your medical aid that you are pregnant? If you are a prospective member, you need to do so upon application or within 30 days after the completion of your application. If you are already a member with no waiting periods, you can access the out-of-hospital maternity benefits without advising the medical aid that you are pregnant. However, you need to obtain pre-authorisation for the delivery of the baby, which can be done from 20 weeks onwards. Are there waiting periods? Waiting periods may apply to members who join a medical aid while already pregnant. If you join while you are pregnant the pregnancy will not be covered. When do you advise the medical aid that the baby is born and needs to be added onto your medical aid The baby needs to be registered within 30 days from the date of birth to ensure there is no break in cover and your child will be covered from the first day of life. Are there any things you need to know or be cautious about when pregnant regarding medical aid so that you do not find yourself out of pocket We advise members to use doctors and hospitals on the network to avoid out of pocket payments. Bonitas offers a wide range of maternity benefits which includes cover for consultations, amniocentesis and scans as well. These benefits are in addition to savings to give members more value for money. Bonitas advises that any false information or non-disclosure of any material information provided upon application will result in the membership being declared null and void. In addition Bonitas Medical Fund offers 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, or health related issues, 24/7, 365 days of the year. How does it work? Bonitas parents, or their caregivers, simply call the Babyline number on 0860 999 121 to reach a 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. Sharing our content with parents you know will go a long way to making us smile for the day 

January 17, 2018
Bonitas – innovation, life stages and quality care

Medical Aid Made Easy

Access to good healthcare remains a concern for most South Africans and choosing a medical aid to suit your financial status and needs, can be very confusing. Not surprising considering that, according to the Council of Medical Schemes, there are 83 medical aids operating in South Africa. Added to the mix is the recent announcement by the Minister of Health of the proposed National Health Insurance (NHI) scheme. With all the options offered by medical schemes, which include everything from comprehensive cover to a simple hospital plan, how do you make a choice? Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, provides some pointers to help make the decision easier. He cautions, however, that due diligence and some homework is required ahead of making a final decision. Your needs The most important factor is to know what you and your family need in terms of cover and what suits you best: Reflect on your family’s health history to gauge the number of visits you make to the doctor and the cost of medication Whether anyone has a chronic condition or needs to see a specialist How much you spent – or need to spend –  on dental or eye care If you already have a medical plan check what was covered, how much your co-payments (if any) were and whether your savings for the year were adequate. Your budget Once you have an idea of what you might need for the year ahead in terms of healthcare, then it’s time to look at your budget.  What can you comfortably afford to spend to get the medical cover you need? (The rule of thumb is contributions should not exceed 10% of your monthly income). ‘Once you have these two scenarios then it’s time to compare the various plans and see which best matches your needs and budget,’ says Van Emmenis. The benefits Benefits vary from plan to plan so check what is covered by the one you are considering and look at whether it offers supplementary benefits which can potentially save significant day-to-date expenses. These could include anything from wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to maternity benefits, flu vaccinations, mammograms, pap smears and HIV tests. All of these are costly if you have to pay for them yourself. In terms of the Medical Schemes Act, there are 26 common chronic illnesses, known as Prescribed Minimum Benefits (PMBs), which all options on all schemes are required to cover for medication and treatment. What are savings? One of the most misunderstood elements of medical plans is how the day-to-day benefits work. ‘Medical savings are a fixed amount that the medical scheme gives you at the beginning of the year,’ explains Van Emmenis. ‘You can use your savings for daily out-of-hospital medical expenses, such as GP and specialist consultations and over the counter medicine. It is imperative that members use their savings and day-to-day benefits wisely to get maximum value for money.’ How can to make the most of savings? Always use partner networks Medical schemes negotiate preferential rates with these partners. This means if you use a network hospital, doctor or pharmacy you will not be charged more than the rate agreed with the scheme. This will also help you to avoid co-payments, deductibles and additional out-of-pocket expenses. Find a GP on your medical aid’s network Using network doctors is an invaluable tool to make your medical aid last longer. It means that doctors can’t charge you more than a specific amount. At present, Bonitas Medical Fund has the largest network of GPs in South Africa – with over 5 500 doctors. Register all chronic diseases If you’re on regular medication to treat a chronic illness (such as Diabetes, hypertension or hypothyroidism) you could qualify for chronic medication benefits. This means that your medical scheme pays for it out of the risk portion of your medical aid and not your medical savings account. All you need to do is register your condition as chronic. Make use of preferred providers Medical schemes often have providers that are contracted to them. Members are then given better rates for specific benefits. For example, Bonitas has contracted the services of DENIS for dental benefits. Use formulary meds All medical schemes have a list of medication they cover called a formulary. Another way to avoid co-payments and out-of-pocket expenses is to ensure your doctor treats you with medication listed on your plans specific formulary. Where applicable, you can also use a Designated Service Provider to obtain your medicine and stretch your benefits even further. Managed care benefits Some schemes offer preventative care benefits, which are paid from the risk portion of your medical scheme and are not funded from your savings account. This includes Oncology, HIV and Diabetes management programmes. Ask your pharmacist Pharmacists too can provide sound medical advice on problems such as rashes, colds or illnesses that are not severe. Buy over-the-counter medicine to treat less serious ailments and consider using generic medicine which is cheaper but effective. What is Gap Cover? Gap cover is an insurance policy you can take out to help pay for the shortfall between what your medical scheme pays and what the hospital or specialist might charge. The amount paid out depends on your policy but most people usually combine Gap Cover with a hospital plan. It is important that note that Gap Cover is not offered by medical schemes and is a separate health insurance product. As of 1 April this year, the same requirements for a medical scheme have been introduced including a waiting period of between 3 and 12 months for certain conditions and payout limit of R150 000 a year for each person. And a hospital plan? This provides you with basic, yet important medical cover and essentially covers all your required in-hospital procedures and check-ups, including the 27 chronic conditions (or PMBs). However, a hospital plan does not provide cover for day-to-day doctors’ visits, prescribed medications, chronic medication

October 13, 2017
Bonitas – innovation, life stages and quality care

Introducing BabyLine

Parenting is a joy but it can also be overwhelming and just a little daunting. There is no degree or diploma, you are simply launched into it and there’s a steep learning curve.  You instantly have a new life depending on you and, combined with sleep deprivation, the challenges of adjusting to being a parent and wanting to do the best for your child, you need all the help you can get. Bonitas Medical Fund is doing just that with the launch of the first dedicated toddler’s health advice line, called Babyline, to its members. Here help is at hand, from professionals, as you take the necessary baby steps along the path of looking after the health of your toddler, up to the age of three. Essentially Babyline is 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, or health related issues, 24/7, 365 days of the year. ‘Parents are often confronted with a host of children’s health issues, particularly in the first three years.  In an effort to help educate and support Bonitas moms and dads and to ensure their medical aid benefits last longer, we have partnered with Paed IQ’s babyline service,’ explains Bonitas Medical Fund.  ‘The service was developed in conjunction with the Department of Paediatrics at the University of Pretoria and is based on a concept used by the top providers of child health advice in the USA.’ ‘The system of telephone advice, guarantees members instant and real time access to pre-eminent, professional advice and standardised paediatric protocols,’ explains Dr Iqbal Karbanee of Babyline. ‘Our aim is to give parents the best possible resources to help them maintain and improve the health of their child.  It’s about giving anxious parents peace of mind when it comes to an urgent health concern and, hopefully, will also alleviate unnecessary trips to doctors or hospitals.’ How does it work? Bonitas parents, or their caregivers, simply call the Babyline number on 0860 999 121 to reach a 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. ‘We do have to stress that although the Babyline is designed to assist parents with health concerns, nurses do not provide diagnosis or prescriptions. They are on call to offer advice on how best to deal with the current health problem or refer you to the nearest healthcare facility,’ concluded Bonitas Medical Fund.

February 15, 2017
Bonitas – innovation, life stages and quality care

Get bang for your buck

Most medical aids have launched their benefits and premium contributions for 2017 and, as in the past, the increases passed on to members are double figures, which outstrip inflation. Bear in mind that your actual increase may be somewhat different because often these are weighted, vary from option to option or even from dependant to dependant. The medical aid landscape can be tricky to navigate. So now, more than ever, is the time to learn how to ‘box smart’ to ensure that you maximise the value you derive from your medical scheme benefits. Dr Bobby Ramasia, Principal Officer of Bonitas Medical Fund, provides some insight into maximising the benefits on your chosen medical aid. Understand your benefits Take the time to read the information sent to you by the scheme and/or your broker. If you have access to information sessions at your place of work, or have a consultant who visits your workplace, attend the sessions to get a better understanding. Getting the best out of your hospital cover: If your scheme has appointed a Designated Service Provider (DSP) network for hospitals, you will usually pay a lower monthly contribution in exchange for using a hospital from this network for planned procedures. In the same manner, if your scheme has an arrangement in place for doctors and specialists, there will usually be an incentive (full cover by the scheme) for using ‘these’ providers. The penalty for using providers not contracted with the scheme is usually the payment of shortfalls or co-payments. For planned procedures, it’s also worth checking with your scheme if you will obtain better cover by using contracted providers or having the procedure performed in the doctor’s rooms or day clinic, where possible If you are going to be admitted to hospital for a planned procedure, always check with your scheme, at authorisation stage, if there are any co-payments or sub-limits that will apply. An example here is for joint replacements, where most schemes have specified sub-limits if you do not use their DSP. Chronic Illness Benefits: In terms of the Medical Schemes Act, there are 26 common chronic illnesses which all options on all schemes are required to cover for medication and treatment. However, here too, schemes have the ability to apply measures designed to contain costs. Almost all options on all medical schemes apply a medicine formulary. This is a list of drugs which the scheme will cover in full. If you use medication that is not on the scheme’s formulary, you will be liable for the difference in cost. So it is best to discuss the formulary medication with your doctor to see if this is appropriate for you The schemes can also specify that you obtain your medication from DSP pharmacies. Check to see if you are able to use the scheme’s DSP – if there are none close to you, most schemes also designate a courier pharmacy which will deliver the medication to you at a preferred address. So, the golden rule for chronic illness benefits is to try to utilise the medication on your scheme’s formulary and to obtain this from a specified pharmacy. Many medical schemes also cover additional chronic illnesses – although this is usually from the more expensive options.  If your particular condition is not covered on your current option it is worth further investigation. It’s important to understand that this cover is at the scheme’s discretion and the additional conditions covered vary from scheme to scheme. Know your rights! In terms of a High Court ruling, Medical Schemes are obliged to meet the cost of in-hospital Prescribed Minimum Benefit procedures at cost, in full. Make sure you know what ‘in full’ means – so you don’t get any surprises. So if you have been admitted to hospital check with your doctor if it’s for one of these procedures. If so, as a general rule, you shouldn’t be saddled with any shortfalls – so ask for your broker/consultant’s assistance if you are! Why you might have co-payments A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. The medical aid would not cover 100% of the costs and the member would have to pay for a certain percentage of the medical service before the medical aid pays their portion. These co-payments usually apply to specialist or elective medical procedures. This will differ from one medical aid scheme to another. It is one of the reasons why you should always do thorough research before deciding which medical aid scheme is the best option for you. The ideal option would, of course, be the one that does not require many or any co-payments from the member. If your benefits and/or savings were exhausted before the end of the year and you had to pay out-of-pocket for some medical expenses; it might save you money to upgrade to a richer plan with more benefits, albeit at a higher contribution amount. Conversely, if you are young, healthy and generally did not utilise your benefits and/or savings, it may be prudent to downgrade to a cheaper medical aid option Talk to your providers!  Talk to your doctor/specialist before being admitted to hospital for a planned procedure.  Check what they are going to be charging and what your scheme will cover. If there is a large difference don’t be afraid to approach your doctor to see if they are prepared to adjust their fee, especially if you could afford to pay upfront.

January 16, 2017
Bonitas – innovation, life stages and quality care

Choosing Medical Aid

Most medical schemes have launched their benefits and contributions for 2017 and it is the time when you should be re-looking at your existing medical aid cover or, if you are wanting to join a scheme, investigating which one suits you best. The medical aid landscape can be tricky to navigate so it is important to compare options and schemes to ensure you find a medical aid that works for you and your family’s health and is within your budget. Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund, helps guide you through choosing the best plan, whether it’s through the open market or through an employer. If you are already on a medical aid scheme Before you choose the best medical aid option, you need an idea of what your typical health care costs are. You should also consider the following for you and your dependants over the past twelve months: How much you spent on day-to-day healthcare expenses Where you or any of your dependants admitted to hospital Did you need to visit a specialist regularly How much often do you or your dependants visit a GP Do you and your dependants have any chronic conditions How much do you spend on dentistry, optometry and over-the-counter medicine Did you exhaust your day-to-day benefits and/or savings this year How much did you pay in co-payments and/or deductibles   Then consider which of the expenses listed above were once-off and won’t come up again soon (like childbirth) and which are likely to come up again and again (such as flu). You should be able to find a list of your medical claims on your current medical aid’s website. The day-to-day detail: Often the cost containment measures medical schemes apply for the day-to-day benefits are broad. So investigate, or bear in mind, the  following: Does your medical aid contract with doctors and specialists and, if so, are you willing to use them? Using contracted or network doctors usually means obtaining full or improved cover levels, while using doctors outside of the network usually results in restricted benefits or co-payments. It also helps ensure you are getting more value for money as doctors on your medical scheme’s network will not charge you more than the rate agreed with your medical scheme. 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? Does your medical scheme offer any additional benefits such as maternity, preventative care or wellness benefits that are paid from risk and not savings or day-to-day benefits? You can also follow these tips to get more value for money: Use generic medication wherever possible – get into the habit of asking your doctor and pharmacist about this Try to keep your claims within any specified sub-limits, e.g. optometry Find out if your option has any day-to-day benefits that are paid by the scheme from risk (not from your day-to-day sub-limits or savings). Two examples where this sometimes applies are dentistry and optometry. Additional benefits: Ask what supplementary benefits might be available to you that can potentially save significant day-to-day expenses. These could include the following; Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and body mass index measurements) through to mammograms, pap smears, prostrate testing. In some cases this extends to maternity programs, dental check-ups, flu vaccinations and more. These usually require authorisation from the scheme, failing which they are simply met from your day-to-day benefit limits. A mammogram costs in the region of R900, so don’t look a gift horse in the mouth! Age impacts your decision If you have young children, ensure that the medical aid option you select provides sufficient child illness benefits. For young couples looking to start a family, check that your option provides sufficient cover for maternity benefits. However, if you are slightly older then ensure that the option you select covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation. Ensure the affordability of the medical aid plan selected. When comparing the different medical aid options available, consider all the costs involved before you make your final decision, such as: The monthly contributions, as a rule of thumb, you medical aid contributions should not exceed 10%of your monthly income at an individual or household level Other costs associated with your medical aid option e.g. if your option only allows consultations with doctors on a network, then you must ensure that the cost of travel to a network doctor (including hospitals and other healthcare service providers) The cost of co-payments for various benefits claimed. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. The medical aid would not cover 100% of the costs and the member would have to pay for a certain percentage of the medical service before the medical aid pays their portion. These co-payments usually apply to specialist or elective medical procedures. This will differ from one medical aid scheme to another. It is one of the reasons why you should always do thorough research before deciding which medical aid scheme is the best option for you. The ideal option would of course be the one that does not require many or any co-payments from the member.

November 15, 2016
Bonitas – innovation, life stages and quality care

Hospital Plans

You know that sinking feeling when you go into hospital for a procedure believing you are covered?  When it takes longer to recover from the shock of the bill than the actual surgery? Thousands of people who have health insurance are waking up to the fact that the term can be a classic contradiction.  Far too many consumers are confused between the terms hospital plan and health insurance. This is not made any easier by the fact that health insurance is available in two forms – GAP Cover and hospital insurance.  According to Dr Bobby Ramasia, Principal Officer of Bonitas Medical Fund, the National Treasury has been approached to make amendments to the Demarcation Act in terms of medical aid schemes and medical insurance. Currently, medical aid schemes and the hospital plans they offer are not considered as insurance because medical schemes are non-profit, strictly controlled and regulated by the Council for Medical Schemes and the Medical Schemes Act 131 of 1998. However, medical insurance policies are ‘for profit’ companies. The recommended changes to policy will also address when insurance is paid out – the industry is pushing for this to come into effect from day one as opposed to a waiting period of a few days. Medical Aid Hospital Plans   A hospital plan provides you with basic, yet important medical cover. They differ from scheme to scheme but in essence this plan – regulated by the Council for Medical Schemes – includes cover for all your required in-hospital procedures and check-ups. So 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. You are required to cover almost all of the other day-to-day out of hospital costs (such as visits to the doctor, specialists and medicine). The law also requires that medication for 27 chronic conditions – known as Prescribed Minimum Benefits or PMBs – must be covered by all medical plans, including hospital plans. These include: Addison’s disease Asthma Bronchiectasis Cardiac failure Cardiomyopathy Chronic obstructive pulmonary disorder Chronic renal disease Coronary artery disease Crohn’s disease Diabetes insipidus Diabetes type 1 Diabetes type 2 Dysrhythmias Epilepsy Glaucoma Haemophilia Hyperlipidaemia Hypertension Hypothyroidism Multiple sclerosis Parkinson’s disease Rheumatoid arthritis Schizophrenia Systemic lupus erythematosus Ulcerative colitis Bipolar Mood Disorder However, at times there may be a shortfall between what the Plan pays and the actual tariffs charged by the hospital and specialists. You will be expected to make up the financial difference and this is where GAP Cover or a Hospital Insurance policy can help cover the shortfall. Health insurance The good cop GAP Cover as the name suggests, assists with additional insurance cover to help pay for the difference between specialist charges and the amount paid by the hospital plan. Again the amount of cover differs from policy to policy. Many consumers purchase GAP Cover in conjunction with a hospital plan to provide for additional cover, however it can only be used for specialist service costs and not general healthcare related costs. Bonitas says that the proposed amendments propose that GAP Cover includes any and all shortfall costs for health related services and products, ie, between the costs that medical schemes are obliged to cover and what is charged by the medical practitioner. GAP cover complements medical schemes – it has never been a problem as it covers the costs between medical scheme tariffs and benefit limits.  It is legitimate and a good cover for shortfalls. The bad cop Hospital insurance is not a medical aid but rather provides you with cash benefits that are paid to you while you are in hospital due to illness, accidents or intensive care of convalescence. You are able to use the money however you please, to cover your medical expenses or daily household costs. In short, hospital insurance is: Governed by the Financial Services Act (Short-term Insurance Act) Does not cover Prescribed Minimum Benefits (PMBs) Can include Personal Accident risk cover such as disability and loss of limbs, inability to work, salary protection, death and/or funeral covers. Paid directly to the Insured Used in conjunction with Medical Aid Not tax deductible So why the bad cop?  Firstly it is a set amount which might not cover your hospital or medical bills, leaving you financially short and, in many cases, it does not kick in until a waiting period of three to five days. You will be responsible for settling all your medical bills and although the thought of being paid R5 000 a day while you’re are in hospital sounds appealing, this usually falls way short of the actual costs charged by surgeons, anaesthetists and hospitals. Turning the bad cop good The new amendments propose introducing payment from day one rather than having a waiting period and, as with gap cover and hospital plans, hospital insurance will be far more regulated going forward to ensure the practical protection of a consumer’s medical needs. The best news though is that the guidelines are opening the door for collaboration between medical schemes and insurance providers to offer a broader product range. ‘We have seen a growth in health insurance products over the past few years,’ says Dr Ramasia. ‘This is mainly due to medical aid being prohibitive for low income earners. For those strapped for cash there are healthcare options though. We suggest you shop around for the best plan that covers your – and your family’s – healthcare needs and your pocket.’

September 22, 2016
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