TopMed and Pharos are Merging in 2014
Read All about it Here
Pharos members have enjoyed REAL value for money, benefit rich healthcare products since 1994.
Pharos is committed to sustainable and innovative healthcare solutions. The Scheme is founded on the principles that MEDICAL AID IS FOR WHEN YOU ARE SICK and that MEMBERS SHOULD BE IN CONTROL OF THEIR HEALTH RAND.
For this reason Pharos dedicates a Registered Professional Nurse to every member to guide each member to be in complete control of their health and healthcare spending. The goal behind this innovative service differential is not to restrict access to care, but rather to positively assist members to access their benefits to their best health advantage. Pharos ensures you receive personalised attention from a clinical professional who understands your health needs.
MAIN OBJECTIVE OF PHAROS
Our mission is to provide you with the means to obtain quality healthcare, whilst working with you to maintain both affordability of contributions and sustainability of the scheme, without a reduction in benefits. This means Pharos will:
* Assist you and your dependants to stay healthy
* Care for you and/or your dependants when you are sick
* Reward responsible healthcare behaviour
ACHIEVING THE OBJECTIVE
* Pharos is administered by Private Health Administrators™ (PHA), an independent, hands-on and integrated healthcare management company that is accredited as both an Administrator and a Managed Care Organisation. This ensures that you receive prompt and efficient service, good disease management and excellent healthcare.
* Your specially trained Dedicated Professional Nurse assists you with case management and decision support, helping you to manage your health and understand the treatment, costs and alternatives. This enables you to make an informed choice about the treatment you require and receive.
* This process is called Demand Management®* and is focused on putting you, the healthcare consumer, back in control of your healthcare spend through appropriate education and provision of information.
* Your Dedicated Professional Nurse assesses and case-manages all your claims. If appropriate, this administration of claims will take place during scheduled visits to your place of work, this is called “outbound administration”.
* Benefits paid from the Yearly Limit are paid at cost of treatment, excepting dentistry, which is paid at the Pharos Rate.
* Should you exceed your specific option benefits, Pharos provides generous above threshold benefits on Rainbow Comprehensive and Paladin Comprehensive at 100% of cost for confirmed Prescribed Minimum Benefit (PMB) conditions according to protocol and at 80% of Pharos Rate for non PMB conditions.
* At the end of the benefit year (31 December), members on Rainbow Comprehensive or Paladin Comprehensive who have managed their health care budget and as a result have accumulated funds in their Private Fund will be rewarded by being allowed a percentage of these funds to be rolled over for future year’s claims. This allows members to accumulate funds for specific services that would not normally accumulate to threshold.
* Rainbow Plus members who have not utilised all of their Plus Account will be able to roll over the full amount remaining in the Plus Account and can accumulate these savings for future medical needs.
* We guarantee to pay claims within fourteen days of your predetermined administration date for all service providers other than hospitals. Hospital accounts will be paid within 30 days to allow for clinical audit.
Your membership also provides you access to some very Special Benefits:
* A dedicated Professional Registered Nursing Sister
* “Our Baby” birth management programme
* Our “Fortitude” personalised wellness & disease management programme
* HIV/Aids: Our confidential support line & Individualised Support & management programme
* Pharadigm lifestyle rewards programme
* Pharos “e-Care” interactive web based wellness programme
* Pharos health letter
* Individualised health education
* Group wellness promotions & health days
* The term Demand Management® in healthcare, is trademarked by Sweidan Trust (Pty) Ltd. Permission to use this term was granted for the purpose of this document.