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10 Things a medical aid cannot do

As a medical scheme member, you rely on your scheme to play by the rules. Here are some things which they cannot do.

10 Things your medical aid cannot do:

  1. Turn down your application – no medical scheme my refuse a member. They may not refuse you on race, culture or conditions. They may impose penalties and waiting periods.
  2. Refuse to accept a dependant of yours – as long as you want to add a valid dependant, no medical aid may refuse to add a dependant. This would include a spouse or a life partner, children under the age of 21, a child of any age with a mental or physical disability, or any immediate family members who are financially dependent on you. This includes any parents who are dependent on you, but they can be required to pay full adult membership contributions.
  3. Cancel your medical aid – They may cancel if you fail to pay contributions, fraud or non declaration.
  4. Force you to use network doctors or hospitals – using certain doctors or hospitals may avoid co payments and member portions but no medical aid can force you to use a certain medical provider.
  5. Change benefit options or contributions in the middle of the year – this may be done at the end of the year or in a life changing event.
  6. Give pensioners a contribution discount – no pensioner may qualify for discount because of their pensioner status.
  7. Load your contributions if you are a high risk or high claimer – this may be done by short term insurance companies but not by a medical aid scheme.
  8. Not pay for prescribe minimum benefits – every medical aid scheme according to law and the medical schemes act must pay for prescribed minimum benefits. There are 270 conditions. You however have to use the scheme’s designated service provider.
  9. Pay out medical savings as cash – The only time a medical scheme can pay out the money is when you have resigned as a member from the scheme. You can still submit claims for four months after you have resigned your membership. You will have to wait until that time is over before the money is paid out to you.
  10. Wait more than 30 days to pay out a claim – if a medical aid claim is submitted with all the required information, the scheme only has 30 days to process and pay.
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Hospital plan vs Hospital cash back plan

Health insurance is widely and rightfully considered to be one of the most important forms of insurance by far, primarily because most people consider their health to be their most important asset. As a result, many different insurance options are available that cater to a range of budgets and provide different forms of coverage against the costs of healthcare, should the need arise.

Two of the most popular options that fall under the broad category of ‘medical aid’ are ‘hospital cash back cover’ and the more conventional ‘hospital plan’. While at first glance these may appear to be similar insurance options, the reality is quite different. The importance of understanding the available options cannot be overstated, as a lapse or insufficiency in your insurance coverage can leave you in a financially difficult situation should you or a family member be injured or taken ill. In this circumstance, the last thing you want is for money worries to compound the stress you will no doubt already be under.

Let’s start by looking into hospital cash back cover and the benefits it provides. As the term would suggest, this kind of scheme generally pays out a lump sum to the policyholder in the event of hospitalisation. Usually, the person covered by the policy will need to have spent a predetermined amount of time in hospital before this payout will kick in. The insurance company will most often pay out a set amount of money per day of hospitalisation, for a limited period of time.

The amount of money received by the policyholder will vary depending on the specific policy, but is generally intended to cover the non-medical expenses that may arise during a hospital stay, such as those incurred by a loss of income due to the patient being unable to work. This makes this kind of coverage a welcome financial support in the event that a family breadwinner is hospitalised, making life easier for his or her family in the interim

A hospital plan, on the other hand, is designed to pay the costs of your medical care directly, without giving you any cash (unlike a hospital cash back plan, which pays money direct to the policyholder). Most hospital plans will not cover your hospital bill entirely, but will contribute a percentage of the costs, or up to a set limit. The bills covered by hospital plans are generally limited to those directly related to your hospitalisation, and often exclude things like any medicine or follow-up care you may need thereafter – things usually covered by broader medical aid. The main advantage of hospital plans over this kind of medical aid is that they are of course cheaper.

The above outlines of hospital cash back cover and hospital plans respectively can be boiled down to a simple comparison: with hospital cash back cover, you receive money directly to assist with a loss of income, while with hospital plans, a portion of your hospital bills are covered by the Medical Aid Scheme. Each of these types of schemes has different pros and cons that may affect individuals in different ways.

One of the major benefits of having a hospital cash back plan is that the effect of a loss of income as a result of your hospitalisation can be minimised. This means that your family’s lives can continue more or less as normal, without having to cut back on expenses due to financial constraints. This takes a considerable burden off family members who will no doubt be concerned about the hospitalization of a loved one.

Premiums for hospital cash back plans are also designed to be more affordable than conventional medical aid, and your whole family can be enlisted under the same or similar schemes. A wide age range for application also makes this an appealing choice for those who want their family to be protected in the event of serious illness or injury, but need to remain budget-conscious.

Perhaps the main drawback to hospital cash back plans is that they are essentially intended to be a supplementary feature to a broader medical aid. As we have already seen, the money you receive in payouts is intended to cover your loss of income, but is unlikely to be sufficient to cover this in addition to your medical bills. For this reason, it is highly recommended that a medical aid scheme or hospital plan be considered as a priority before entering into a hospital cash back plan.

Hospital plans, on the other hand, come in two forms: they can either be included in a wider medical aid scheme or be entered into as separate insurance policies. This kind of insurance can be invaluable in the event of costly hospital bills, such as those incurred by surgery, long-term care, or other situations where costs are high. By providing coverage of these costs, hospital plans offer an advantage that hospital cash back plans cannot.

While comprehensive medical aid is desirable to absolute peace of mind, hospital plans can be more cost-effective for the young and healthy who want to be covered in the event of a serious and unforeseen accident or illness, but otherwise do not anticipate any serious medical costs in their everyday lives. Hospital plans allow access to the best private hospital care without the higher premiums of broader medical schemes, making them an attractive option for many people.

However, this same advantage does of course bring with it the disadvantage of not covering any costs that may be incurred outside of a hospital. This means that a chronic condition, for instance, which does not require long-term hospitalisation but does mean outside consultation or medication is necessary, will not be covered by a hospital plan. As these costs can be quite significant on their own, this is something to consider when looking at health insurance options.

The above comparison of hospital cash back plans and hospital plans demonstrates that each has its own distinct advantages and disadvantages, which will naturally apply differently to various types of people. It is also important to consider than some medical aid schemes include some or all of the benefits of each, albeit at a higher premium. In choosing between your health insurance options, be sure to consider carefully your needs and limitations to ensure that you obtain the coverage and security you need for yourself and your family.

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Why medical scheme increases are so high

Members are under massive financial stress. To see medical premiums increase annually by more than consumer price inflation, is not easily accepted and members tend to downgrade at the end of the year as their current option can no longer be afforded. 

Household budgets are already stretched to limits and medical aid is no longer affordable for everyone.

The higher increases are mainly due to high increases in service provider fees, a rising number of diseases, increasing of benefits, new medical technology, new medicine, the requirement to maintain reserves of 25% and benefit enhancements.

More members tend to join and remain on the scheme because they have an immediate need for the benefits, as opposed to joining another scheme and getting waiting periods.

On the bright side schemes can negotiate costs for instance with network providers to lower fees for certain services. They are not able to negotiate costs of medicines, as these are regulated.

If schemes can’t fund the increased expenses out of their reserve, they have to increase contributions to carry the costs.

Medical aid can form an important part of a family’s monthly expenses and premium increases are not taken too well. Maybe because schemes announce their increases towards the end of the year, at a time when you realise that the December holiday expenses are coming, it’s even worse.

Don’t change to another scheme or plan just because the premium increase of it is lower than your current option. To get the best value for your money, compare the benefits, exclusions, added value and service delivery and how it will cover your specific needs.

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Medical Aid Assist – Benefits

Medical aid premiums are going up again soon – let us help you find the best solution for your family’s health.

We will find the best medical aid for your needs and budget – AND manage your claims for free.

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Medical Aid Assist – Benefits

What we will do on your behalf to ensure simplicity with your Medical Aid

  • Medical aid queries
  • Day to day queries
  • Medical aid claims
  • Chronic medication registration and queries
  • Billing / financial queries
  • Benefit limits / balances and queries
  • Benefit usage
  • Option changes
  • Registration (in house) / cancellation of dependants
  • Medical aid membership cards
  • Obtaining documents e.g. Certificate of memberships, tax certificates etc
  • Advice on schemes and options
  • Medical aid updates
  • Medical aid cancellations
  • Complaints against medical aid schemes
  • Legal advice with regards to medical aids
  • Medical aid malpractice
  • Complaints
  • Gap cover queries
  • Gap cover claims
  • Gap cover cancellations
  • Care Line debit order queries
  • Free quotes on life, short term and business insurance
  • Estate planning
  • Group benefits (Employee benefits)
  • Group medical aid schemes
  • Buy and sell agreements
  • Contingency and liability business insurance

Business Partners(Bookings through office)

  • 20% Discount at Arlocraft Mobile dent removal specialists (Gauteng)
  • 20% Discount at Galaxy blinds
  • IN ADDITION, YOU WILL BE ENTITLED TO A ONCE OFF 15 MINUTE FREE CONSULTATION WITH A SENIOR ATTORNEY (Bookings through our office)
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Your Medical Aid and Insurance Careline Group!

0861 45 00 45 
Have you got this number saved?

This is a friendly reminder that we at Careline Group are here to assist you with any of your Medical Aid or Insurance queries. As your advisor is often out of the office and on the road, this line connects you straight to our office where we are ready to assist.

Our friendly portfolio administrators for medical aid queries are:
Tanya (Administration manager) email: admin3@c-line.co.za
Natasha email: admin1@c-line.co.za
Illse email: admin2@c-line.co.za

OR our insurance administrators

Chantel (Insurance manager) insurance@c-line.co.za
Daleen email: insurance1@c-line.co.za
Carelize email: insurance2@c-line.co.za

Please make use of our office to assist wherever you have the need.

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10 Things to ask yourself before choosing a medical aid:

  1. How healthy are you? Your current health has everything to do with the option you choose. You need to look at benefits like chronic cover, specialist visits, pathology and radiology. You need the correct benefits to go with your current health. If you are a young woman you might want to look at pregnancy benefits for future planning.
  2. How much money do you want to spend per month? Affordability is something we all struggle with in life. We can only take the medical aid cover we can afford.
  3. What is your family like? The age of the family makes a difference on what option to choose as you may need child rates until a certain age. The type of sport and activity of the family should be taken into consideration. If you have small babies or children you might want to look at a plan covering child immunisations.
  4. Comprehensive or hospital plan? If you are a healthy individual or family, choosing a hospital might make more sense. A hospital plan might work out a bit more affordable if you choose to pay day to day out of your own pocket.
  5. How financially sound is the scheme? Ask for the latest financial statements and reports to get an indication of how well the scheme is doing financially. Ask for the solvency ratio.
  6. How quickly does the scheme pay out claims? Do a bit of research at one or two different doctors or hospitals to find out if the scheme has issues paying out claims.
  7. Will there be a waiting period when joining? This is a period where contributions are being paid without having full cover.
  8. Have you read the fine print? Make sure you are aware of all co-payments, limits, and exclusions.
  9. What is the scheme’s payout rate? If a medical aid says they pay 100% of scheme rates it is not the same as paying 100% of a specialist’s bill.
  10. Is the scheme registered and does your broker have credentials? Make sure the medical aid is registered with the CMS. Make sure your broker is registered with the FSB and accredited by the CMS.

Careline Group can assist you in comparing medical aids and finding the one that fits your needs. Call us 0861 45 00 45

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WHEN CAN I CHANGE MY MEDICAL AID PLAN?

Determining when you can change your medical plan depends on whether you want to stay with the same medical scheme or not.

If you are considering changing your plan, but not the Medical aid scheme you are currently with you could only do that at the end of the year to start from January of the following year.  Depending on the rules or your current scheme.

Most schemes allow you to downgrade your plan at any time.  Some schemes might allow you to upgrade your plan, but in this case only life changing situations like cancer for instance. This you can arrange with them directly or through your financial advisor.

Some schemes will place a time limit on this upgrade ( for example, you need to change plans within 30 days of a new diagnosis ).

CHANGE OF MEDICAL SCHEMES

If you decide to change medical schemes, you can do this at any time. You are not allowed to be on two medical aids at the same time, so you need to take your time when you change. You need to resign from one scheme before you can be a member on a new medical aid. There is one month cancellation notice period to give before your membership will be terminated.

If your current plan has a savings fund and you change plans in the middle of the year,   your scheme will calculate how much savings you were entitled to on a pro-rata basis. If you have used less than this, they will refund you. If you have used more, you will need to pay it back.

When you change plans in the middle of the year, know that your benefits will be worked out on a pro rata basis for the rest of year. When changing plans, be aware of waiting periods.

Careline Group has many years of experience in a big variety of different medical aids, let us assist you in matching up your family with the medical aid that will meet your needs. Give us a call 0861 45 00 45

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What should you do when you change your GP and have a chronic condition?

First you need to inform the medical aid that you are changing GP’s as they need to update the GP on their system.

If you change your GP it is important to inform him that you have a chronic condition and what type of medication you are using. It is very important to also inform your new GP on your history and when your condition started, what medication you first used and what type of treatment plan you are on.

You can always ask your previous GP to give you a report on your condition and treatment plan he referred you to go onto. Giving your GP all that information can help him see if you are using the correct medication to improve your health.  If your new GP is not happy with the medication you are using you can get a new chronic script from your GP and send it to your medical aid to process and update their system correctly.

Remember to get a new script every 6 months, the script needs to be sent to the medical aid to be updated.  This is to ensure that the dosages or change of medication is noted with the medical aid scheme to avoid any discomforts when you next collect your medication from the pharmacy.

Careline Group can assist you, by getting you registered for your chronic condition, call us on 0861 45 00 45

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Support your family – get your free will

Despite the importance of having a will, statistics indicate that most South Africans don’t have wills. The employee value proposition (EVP) has highlighted having an executable will as a critical component of your overall Financial Wellness. A will enables you to support your family when you are no longer there and ensures that your last wishes are respected.

Did you know?

  • If you die without a will in place there are delays in dealing with your estate, which could affect your family if they are relying on their inheritance for an income.
  • If you live with someone but are not married to that person, the law will not necessarily recognise your ‘common-law’ spouse as a beneficiary of your estate, unless you have a will naming your partner as a beneficiary.

MMI employees who do not have a will or need to update their will, can contact their financial adviser about drafting a professional will or updating an existing one. This is a free service that MMI offers to all its employees. Through Momentum Trust you can draft a free will if the trust is the nominated executor. If it is not the nominated executor, then you will get a 50% discount on drafting the will. The only fee that is payable is the annual R85.50 safe custody fee.

Steps to follow to draft your will:

  1. Financial planning

Contact your financial adviser.

  1. Draft a will

Momentum Trust will be appointed by your estate adviser who manages the relationship on your behalf. The Momentum Trust team will meet with you and your financial adviser to give you points to follow to ensure that your will is understandable and not misinterpreted.

  1. Custody

Once your will is drafted, it is kept in a safe place together with other related documents. This prevents any loss, theft or damage.

Take advantage of this opportunity through the MMI EVP and make sure you get a will drafted today! The future is unpredictable, so ensure that you are prepared and your family is supported.

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Momentum Health takes gold at the 2017 FIA Awards

Momentum Health took first place in the Product Supplier of the Year – Healthcare category at the Financial Intermediaries Association (FIA) Awards last night.

The FIA Awards recognise brands that intermediaries in the industry choose to do business with. These awards survey how financial advisers experience the quality of our products, service and overall satisfaction with our client-facing brands.

Receiving multiple nominations from intermediaries is an honour and bears testament to the trust relationship that they have built with our brands.

This year Momentum and Guardrisk were finalists in five out of the ten categories at the 2017 FIA Awards.

Momentum

Short-term Insurer of the Year – Personal Lines

Long-term Insurer of the Year – Risk

Product Supplier of the Year – Employee Benefits

Product Supplier of the Year – Healthcare

Guardrisk

Short-term Insurer of the Year – Commercial

Being finalists in these five categories and winning in the Healthcare category is significant because it means that intermediaries are seeing value in our Financial Wellness proposition. Financial advisers, who partner with our brands, are able to deliver solutions to clients that are best suited to their individual needs. It is this holistic approach that enables us to enhance the lifetime Financial Wellness of people, their communities and their businesses.

Congratulations to Momentum Health for coming home with gold. Thank you to the financial advisers who nominated us, we look forward to continuing our trust relationship with you as we strive to put our clients at the centre of what we do.

And lastly, a big thank you to all staff whose commitment and hard work earned these honours.

MMI Internal Communication

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Now, do your Multiply Health Assessment at independent pharmacies.

At Multiply, we’re passionate about helping you to improve your Financial Wellness by doing the things you already do. We’re also continually looking for ways to make your life more convenient. So, we’re excited to let you know that you can now do your health assessment at any one of our approved independent pharmacies, as well as at any Clicks, Dis-Chem or Pick n Pay pharmacies.

For your peace of mind, the health assessments done at these independent pharmacies meet Multiply’s quality and standard.

By doing your health assessment, not only will you know how you’re doing physically, but you’ll also get your Healthy Heart Score. Remember, with a green Healthy Heart Score, you get:

  • 120 points to boost your Multiply status or reward level;
  • Up to R12 000 a year in HealthReturns with Momentum Health;
  • Up to 60% off your Myriad life insurance premiums; and
  • Up to 60% in EmployeeReturns on your FundsAtWork lump-sum death and critical illness benefits.

As a Multiply member, you get one free health assessment per year. Plus, if you’re on Momentum Health, you get one additional health assessment for free. (Anything outside of this will cost R120 per health assessment, which can be paid out of your HealthSaver.)

Now, no matter where you are, you can go and do your health assessment.

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5 TOP HEALTH THREATS TO MEN

Guys, watch out for these 5 health issues

  1. Cardiovascular disease
    In cardiovascular disease, cholesterol plaques gradually block the arteries in the heart and brain. If a plaque becomes unstable, a blood clot forms, blocking the artery and causing a heart attack or stroke.

    Prevent cardiovascular disease with these steps
    a. Check your cholesterol from age 25 and every 5 years thereafter
    b. Control your cholesterol and blood pressure
    c. Quit smoking!
    d.Exercise 30 minutes per day, most days
    e. Eat more fruits and veg, and less saturated or transfats

  2. Prostate cancer
    The prostate is a walnut-sized gland behind the penis that secretes fluids important for ejaculation. It’s prone to problems as men age.

    Did you know?
    Prostate cancer is the most common cancer in men other than skin cancer

  3. Depression and suicide
    Experts previously thought depression affected far more women than men. But, that may just be men’s tendency to hide depressed feelings, or express them differently than women.

    Three ways depression affects sufferers
    a. Brain chemicals and stress hormones are out of balance.
    b. Sleep, appetite, and energy levels are disturbed.
    c. Research even suggests men with depression are more likely to develop heart disease.

    Most men and women respond well to depression treatment with medications, therapy, or both. If you think you might be depressed, reach out to your doctor or someone close to you, and seek help.

    Did you know?
    Suicide is the eighth leading cause of death among all men; for young men it’s higher.

  4. Diabetes
    Diabetes usually begins without symptoms. Over years, blood sugar levels creep higher, eventually spilling into the urine. Many men finally visit the doctor because of frequent urination and thirst. The high sugar of diabetes is anything but sweet. Excess glucose acts like a slow poison on blood vessels and nerves everywhere in the body.

    Some of the possible effects of diabetes
    Heart attacks
    Stroke
    Blindness
    Kidney failure
    Amputations

    Prevent Type-2 Diabetes
    Eat a healthy diet
    Exercise 30 minutes per day
    Lose weight if you carry extra kilos

    Did you know?
    Just half an hour a day of physical activity reduced the chance of diabetes by more than 50% in men at high risk, found one major study.

  5. Erectile Dysfunction (ED)
    Up to 39% of 40-year-old men have erectile dysfunction
    66% of men older than 70 suffer from ED

    Men with erectile dysfunction, also known as impotence, report less enjoyment in life and are more likely to be depressed. Despite the impact it has on their sex lives, ED could also be an early warning sign for ardiovascular disease, and as such, should be taken seriously if experienced frequently. ED is most often caused by therosclerosis – the same process that causes heart attacks and strokes. Having ED frequently means that blood vessels throughout the body are in less-thanperfect health.

    Did you know?
    Treatments make a fulfilling sex life possible despite ED, but they don’t cure the condition. If you have erectile dysfunction, see your doctor, and ask if more than your sex life is at risk.

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EVER WONDERED THE MEANING OF THE ICD 10 CODE ON YOUR DOCTOR’S ACCOUNT

You will notice ICD-10 codes on the account received from you medical service provider.  These codes are used to indicate the condition for which you were treated.  Medical schemes use these codes to assess which conditions have been treated, in order to ensure the correct claim payments from the correct benefit, be it chronic,  day to day or dental.

The ICD-10 is a shortened version of the very long name for the code – International Classification of Disease and Related Health Problems 10th Revision. The World Health Organisation issued the code system to enable standardized descriptions for medical information.

When you joined a medical aid, you will contribute towards a specific benefit plan / option offered by your scheme.  With these codes it is possible for the scheme to get accurate information regarding the exact condition diagnosed and treated and for payment according to the terms and conditions applying to payment for the specific condition and treatment plan.

These codes are very important to ensure that PMB treatments are paid.  The standardized codes used on your account is an indication to the scheme whether the condition is a PMB or not. If an incorrect code is used on the account, it can lead to non-payment by your medical aid.  Then the client have to go back to their service provider and obtained the correct ICD-code for the specific treatment and the service provider have to resubmit the account again for processing.

No other person are allowed to request a medical practitioner to disclose the ICD-code.  The code stands for a specific condition or treatment and is confidential information regarding the patient.

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WHAT DOES A HOSPITAL PLAN NORMALLY COVER

In today’s time it is very important to have medical cover as you never know when you might need it. Medical aid cover is not only for cover when you are in a situation of illness but also for any unforeseen situations.  There are so many different types of medical cover available today for you and your family.  A hospital plan is usually a good place to start because this will provides you with basic and important medical cover.

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WHY THE NEED FOR GAP COVER WITH YOUR MEDICAL AID

When you have a medical aid, you need to know what exactly is covered and how about making sure that everything is covered. Without this coverage you will have to pay out of your pocket for every medical expense for yourself and your family.

This can cause you to go into debit and eventually you’r not going to be able take out a loan, credit cards or anything else. That is why a lot of single persons and families should look into gap coverage for their medical aids. Firstly find out what this coverage is exactly and if you need it.

Gap cover is a medical insurance product that can be purchased and added additionally to your existing medical aid. It assist medical aid members to be protected by covering all their short payments regarding in hospital treatments and doctors visits.

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SHORT TERM INSURANCE

The purpose of short term insurance is to assist you, should you be in an accident or for the loss of damage to your vehicle or goods.

You can get cover for your building (house), household contents, all risk items and vehicles.
When insuring your building, confirm with your broker that all fixtures are covered, for an example, pool pump, geyser etc.
You need to provide broker with all means of security taken to protect your property, for an example burglar bars, security gates, alarms linked to security companies, etc.

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