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What to do when you have lost your medical aid cards

You can simply phone your medical aid scheme at their call center and request for them to post you a new set of medical aid cards. Or you can call Care Line on 0861 45 00 45 and we will happily assist you.  You are allowed to order up to three  cards for your family.  The agent from the call center will confirm your physical or postal address for where cards must be delivered.What to do when you have lost your medical aid cards

What to do in the meantime while an emergency occurs and you have to make use of a doctor, hospital or get medication.  You can ask the call center to email or fax you your membership certificate as proof of your membership.  This is a legal document and you only have to show it to the pharmacy or doctor’s rooms.  You can also log into your medical scheme’s website and obtain the document immediately.

Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.

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Do you know the difference between your MSA ( Medical Savings Account ) and your self-payment gap ( SPG)

Your MSA, medical savings account is there for all of your medical expenses out of hospital for example, x-rays, claiming of medication and payment of doctor’s and specialists accounts. Do you know the difference between your MSA ( Medical Savings Account ) and your self-payment gap ( SPG)

The Self-payment gap is only a temporary gap in cover when you run out of funds in your Medical Savins Account and you have not reached your annual threshold.  When you reached your self-payment gap ( which means your msa are exhausted ) you are liable for the settlement of all accounts and paying of medication until you reached the limit of your selfpayment gap.  All receipts and detailed accounts in this period must be submitted to your medical aid as proof that you paid out of your own pocket and to fill this gap.  When this gap is filled up the scheme is going to start paying from your above threshold benefit.

The Above Threshold Benefit is like a safety net for all day to day claims that you submit to the scheme.  Some specific conditions and treatments do have limits.

CareLine Group will take the time to assist you with your medical savings account     with our medical aid assist program, click here to read more.

Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.

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Home care and the benefits of using home care

What is home care?Home care and the benefits of using home care

Home care offers you quality home-based aftercare services in the comfort of your own home.  Making use of these services, members receives care from a qualified caregiver and will be continuing living in their familiar surroundings of their homes, despite their condition.

This is an accredited service provide that gives high-quality service to members provided by professional nurses and qualified caregivers, who received additional training.

Home care can be used for the following reasons:

  • End of life care
  • IV drips or infusions
  • Wound care
  • Postnatal care

These treatments will be covered from your day to day benefits or compassionate care benefit.  Some treatments will be covered from hospitalisation.

How to apply for these services?

  • Discuss with your treating doctor.
  • Doctor must provide a motivational letter – which must be submitted to your medical scheme to the medical advisor to investigate.

What is the benefit of these type of services?

  • Patients don’t have to travel to a facility to receive these type of treatments.
  • You get an accredited nurse or caregiver to take care of you in your home.
  • Prevention of hospitalisations and shortening of days in hospital.
  • Some treatment can be rendered in your home without being admitted into hospital.

CareLine Group will take the time to assist any member to find a Medical Aid that will suite your needs.

Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.

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WHO MAY BE REGISTERED AS A DEPENDANT?

All dependants may be registered onto a medical aid from which a new member is enrolled or from a later date.How many people do you want to join on the Medical Aid?

A child who is not self supporting and who is a dependent on his family for care and financial support.

Examples of dependants:

  • Spouse / partner
  • Father / mother
  • Brother / sister
  • Grandchildren
  • Newborn of a member

Other children:  ( Legal documentation must be submitted with the registration of the following children ).

  • A grandchild adopted by grandparents as a foster child in safe care
  • Stepchildren
  • Adopting of a child, being placed in foster care
  • Foster child
  • Child temporary in safe care

WHO MAY NOT BE REGISTERED AS A DEPENDANT?

  • Godchildren
  • In-laws
  • Step grandchildren
  • Step parents
  • Stepbrothers and stepsisters who are not children of the member
  • Children under guardianship

THE REGISTRATION PROCESS

There is certain forms to be completed to get the process in place:

  • Registration of child dependant
  • Registration of dependant
  • Registration of new-born baby
  • Birth certificates or a copy of id document must accompany these forms
  • Marriage certificates ( on request only )

These documentation must be submitted to the medical schemes for processing.

WAITING PERIODS AND LATE JOINER PENALTIES

In case of a new-born baby, during an existing membership, no waiting periods will apply.

But with other cases with the registration of children the following may apply:

  • 3 Month general waiting period
  • 12 Month condition specific waiting period
  • Remainder of any waiting periods will be applied by the next medical scheme

CareLine Group will take the time to assist you in adding a new dependent on your Medical Aid.

Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.

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THE MEANING OF NON DISCLOSURE INVESTIGATION

What happens with a non disclosure investigation and when does it happen?THE MEANING OF NON DISCLOSURE INVESTIGATION

This happens when a new member is being admitted into hospital, and the hospital needs to get an authorisation number.

The meaning of a non disclosure investigation from all medical aid schemes,  is that when a member joined a new medical aid and have been on the medical aid for less than a year and get admitted into hospital, the medical aid have the right to do a non disclosure investigation on that patient.

This means that if that member, who has been admitted into hospital, didn’t disclose the condition being admitted for on the medical aid application, the medical advisors from the scheme will do an investigation.  This is mostly for existing conditions, for example, diabetes, high blood pressure or hyperlipidaemia.

The doctors from the medical scheme will fax a non disclosure form to the patient’s doctor, requesting a year’s clinical history regarding treatment received for that specific condition (that the member has been admitted for).

The information must be provided to the scheme in the next 24 -48 hours to be processed and finalised.  If it is found that the patient did received treatment in the last year for that specific condition he has been admitted for,  and didn’t mentioned it on the application  the scheme has the right to terminate that whole new application.  The scheme can also  impose a 12 month specific condition waiting period or an exclusion.

The application may be terminated immediately and the member will have to re-apply again.

This will be the members decision to join the same medical aid scheme again or a different medical scheme.

CareLine Group will take the time to assist any new joiners to Medical Aid Schemes. Contact CareLine Group on 0861 45 00 45 or compete our Contact Us form and we will get back to you.

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