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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