As you are no doubt aware the increase in the VAT rate that we expected last year has been announced effective from April.
Click here to see a note sent out by SAIA on this, along with the FIA’s previous circulation dated 15 December attaching the KPMG document dated 6 December in which the difficulties are set out in some detail. (This is expected to be the basis for the requested ruling.)
Our joint working team will now look to activate the agreed requests to ease the transition.
Any queries in the interim may be directed to Care Line Group on 0861 45 00 45
The Council for Medical Schemes (CMS) would like to provide stakeholders with an update on developments on the review of the Prescribed Minimum Benefits (PMBs) project. To read the complete document Click Here
CareLine Group is here to assist you in looking at many different medical aids. Seeing what medical aid would suite you best.
Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.
Council for Medical Schemes (CMS), regulator of the medical schemes industry, advises medical scheme members to use their benefits wisely – especially at the beginning of the year – with the aim of making their benefits last longer.
The most common advice is to not use your benefits to buy sunglasses, multivitamins or other lifestyle items over the counter, but instead use it for essential medicines when the need arises. Members are also advised to ask their doctors to prescribe in formulary drugs (this is a list of drugs that will be funded by medical schemes for each condition).
A formulary regularly consist of generic medication, especially in higher schedule categories, which is generally cheaper and thereby save funds while it is just as effective as the more expensive alternative.
Members are encouraged to make use of the preventative screenings and tests which many schemes offer. Members should also seek to register on the relevant chronic management programmes if they have certain illnesses, thereby ensuring their condition is monitored and that they receive all the necessary care.
The following advice will assist members to determine if and how much they are likely to pay out of their own pockets:
Contact your medical scheme and ask who the DSP (designated service provider) is for the service or product that you need.
If you need to undergo an operation, ask your surgeon for the codes that will be charged. This will include the procedure codes and those for any other products that is needed, such as an internal prosthesis that will be used.
Discuss the medical scheme tariff with your surgeon and if possible the anesthetist and negotiate the price that you will pay.
Contact your medical scheme and ask whether the specific type of product will be funded in full. If not, make sure that you know what part of the cost will be for your own pocket.
Ask your scheme to provide you with a list of DSPs for the product or procedure you need to undergo. The scheme may appoint a surgeon, hospital and anaesthetists as designated service providers. These providers usually have agreements with the schemes for non-PMBs as well.
Determine if there is a shortfall and make plans how this will be funded.
Obtain pre-authorisation for procedures as provided for in the rules of your medical scheme
Careline Group can assist you, by helping you manage your medical aid, call us on 0861 45 00 45
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:
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.
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.
Cancel your medical aid – They may cancel if you fail to pay contributions, fraud or non declaration.
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.
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.
Give pensioners a contribution discount – no pensioner may qualify for discount because of their pensioner status.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Will there be a waiting period when joining? This is a period where contributions are being paid without having full cover.
Have you read the fine print? Make sure you are aware of all co-payments, limits, and exclusions.
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.
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
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
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
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:
Contact your financial adviser.
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.
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.
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.
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
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.
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.
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
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
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.
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
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.
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.