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Resolution Health

Resolution HealthResolution Health

Resolution Health offers individuals and families quality, affordable medical cover options which incorporate real benefits and real rand-for-rand value.

Resolution Health’s Business Purpose is Creative Risk Solutions

Resolution Health’s Vision: An International brand with a diversity of offerings, resilient to financial turbulence – innovative, yet secure.

Resolution Health Values are:

  • Simplicity and Speed of Execution
  • Resolution Health avoid clutter and red tape
  • Resolution Health has a sense of urgency
  • Human Touch
  • Resolution Health are caring in their relationships
  • Solution Driven
  • Resolution Health create solutions to challenges
  • Resolution Health are driven by continuous improvement
  • Ownership
  • Resolution Health believes everyone takes responsibility
  • Resolution Health believes everyone owns the client
  • Value Minded
  • Resolution Health adds value to everything they do

Resolution Health Medical Scheme is a non-profit open medical scheme registered in terms of the Medical Schemes Act 131 of 1998, as amended. In terms of the registration, a guarantee has been issued by ABSA bank in favour of Resolution Health Medical Scheme and lodged with the Registrar.

The trustees of Resolution Health are responsible for the preparation, integrity and fair presentation of the annual financial statements of Resolution Health Medical Scheme.

Resolution Health Medical Scheme is committed to the principles and practice of fairness, openness, integrity and accountability in all dealings with its stakeholders. The trustees are proposed and elected by the members of the Scheme.

Board of Trustees of Resolution Health Medical Scheme
Dr. N.B. Mabuya(Medical Practitioner) Chairman
Mr. M.N. Coetzee(Chartered Accountant) Vice chairman
Trustees
Dr. D.E. Lekalakala(Medical Practitioner)
Mr. S.P. Mohale(Attorney)
Dr. J.C. Jansen(Medical Practitioner)
Mr. J.G. Appelgryn(Chartered Accountant)

  • Resolution Health had extraordinary membership growth for the year 2011 at 20.78%.
  • The international rating agency Global Credit Rating maintained the claims paying ability of Resolution Health at “A-“
  • Resolution Health allows a dependant who studies full-time to remain on the Scheme as a child dependant until the age of 25 years.

Resolution Health offers 5 benefit options to employees and members of the public, namely:

Resolution Health Hospital option;

Ideally suited for the young and healthy or individuals who are able to manage their own day-to-day healthcare requirements.

  • Unlimited hospitalisation
  • Access to the ResoBaby Maternity Programme
  • Casualty benefit for emergencies
  • Trauma Benefit
  • Unlimited Oncology Benefit at Networks
  • Access to Guardian Preventative Care Programme
  • Pharmacist Benefit for limited over-the-counter medication
  • International Travel Cover

Resolution Health Progressive Flex option;

An ideal balanced in-betweener for young couples and / or healthy families that provides sufficient cover for day-to-day expenses as well as hospitalisation.

  • Unlimited hospitalisation
  • Access to the ResoBaby Maternity Programme
  • Casualty Benefit for emergencies
  • Trauma Benefit
  • Unlimited Oncology at Networks
  • Access to Guardian Preventative Care Programme
  • Pharmacist Benefit for limited over-the-counter medication
  • International Travel Cover
  • Professional fees paid at 150% of the Scheme Rate for in-room procedures
  • Dentistry and Optometry benefits
  • Sufficient benefits for GP’s, specialists and acute medication
  • Flexi Benefit for use on the listed sub-benefits (member defines allocation)

Resolution Health Progressive Saver Option;

A hybrid plan, which provides sufficient cover within a fourth generation model and includes the convenience of a limited savings facility. Ideal for families who prefer managing their own day-today benefits, whilst having peace of mind with funded benefits. The Saver option allows for unused money to be carried over and available for use in years to come.

  • Unlimited hospitalisation
  • Access to the ResoBaby Maternity Programme
  • Casualty benefit for emergencies
  • Trauma Benefit
  • Unlimited Oncology at Networks
  • Access to Guardian Preventative Care Programme
  • Pharmacist Benefit for limited over-the-counter medication
  • Extended Pharmacist Benefit for additional over-the-counter medication
  • International Travel Cover
  • Professional fees paid at 100% of the Scheme Rate for in-room procedures
  • Dentistry and optometry benefits
  • Shield Benefit pays for certain day-to-day benefits from risk
  • Saver Benefit pays for listed day-to-day cover from funds available in savings account
  • Additional chronic conditions covered (limited list)

Resolution Health Prestige Option;

Offers comprehensive cover for larger families. An extended list of chronic conditions for those who need it is also available.

  • Unlimited hospitalisation
  • Access to ResoBaby Maternity Programme
  • Casualty benefit for emergencies
  • Trauma Benefit
  • Unlimited Oncology
  • Access to Guardian Preventative Care Programme
  • Pharmacist Benefit for limited over-the-counter medication
  • Extended Pharmacist Benefit for additional over-the-counter medication
  • International Travel Cover
  • Professional fees paid at 220% of the Scheme Rate for in-room procedures
  • Comprehensive dental and optometry benefits
  • Generous benefit for GP’s, specialists and acute medication
  • Plus Benefit for use on the listed sub-benefits (Subject to overall annual limit, sub-benefits and sub-limits as defined)
  • Additional chronic conditions covered (extended list)

Resolution Health Foundation Option;

An elementary healthcare plan for basic day-to-day cover and in-hospital benefits which is ideal for lower income employees of employer groups.

  • Unlimited hospitalisation, subject to specific exclusion list
  • Access to ResoBaby Maternity Programme
  • Casualty benefit for emergencies
  • Trauma Benefit
  • Unlimited Oncology benefit at Networks
  • Access to Guardian Preventative Care Programme
  • Pharmacist Benefit for limited over-the-counter medication from Network Provider
  • Basic dentistry and optometry covered at Network Providers
  • Specialist Network Providers
  • Unlimited GP access at Network Provider
  • Unlimited acute medication (basic formulary)

Note: All these benefits are subject to Scheme Protocols and pro-rated for members who join during the year

Here follows some benefits of Resolution Health:

Emergency services

Resolution Health in partnership with Europ Assistance offers you access to emergency assistance 24-hours a day to arrange emergency medical assistance, anywhere in South Africa. In the event of an emergency, should the client be unable to get to a hospital, appropriate transportation, such as an ambulance is arranged. In addition to emergency transportation, the Medical

Evacuation product also offers:

  • Emergency telephonic medical advice
  • Dispatch of ambulance and flight
  • Arrangements for compassionate visit by a family member
  • Arrangements for the escorted return of minors after an accident
  • Repatriation to appropriate facility in area of residence after an accident
  • Referrals to doctors and other medical facilities
  • The relaying of information to a family member / acquaintance
  • Telephonic trauma counselling
Prescribed Minimum Benefits (PMB)

The Prescribed Minimum Benefits or PMB’s is a list of diseases or conditions listed in the Medical Schemes Act which schemes are required to pay for. Included in this is the Chronic Disease List (CDL list) of chronic conditions that also fall under the umbrella of PMB’s. In certain circumstances the Scheme may only provide cover for members and their dependants in provincial hospitals or at the Scheme’s appointed private Designated Service Provider (DSP) facilities. All PMB conditions will be funded according to Scheme rules and protocols at the appropriate level of care.

Benefits will be restricted to PMB cover in the following circumstances:

  • Where a member or their dependant/s, who could reasonably have obtained a service from a preferred provider, chooses to use another provider of his/her choice, the Scheme’s liability for the costs of obtaining such services will be restricted
  • Members with waiting periods imposed upon joining the Scheme may or may not have cover for PMB conditions
  • Members should check this on their Terms of Acceptance letter
  • Where a PMB condition requires further treatment but annual benefits have been exhausted
  • Where benefits are limited to PMB

Note: Where specific benefits are limited to PMB conditions, members may be liable for a co-payment if services are obtained from a non-DSP facility.

Dental benefits

Dental benefits can be obtained from any provider, but will be funded according to the Scheme specific dental rates. Preferred providers are contracted to charge and deliver services according to the Scheme specific rates and it is therefore advisable to use preferred providers to ensure no co-payments. Co-payments may be applicable if members choose to use a non-preferred provider.

Optical benefits

Optical benefits can be obtained from any provider, but will be funded according to the Scheme specific optical rates. Preferred providers are contracted to charge and deliver services according to the Scheme specific rates and it is therefore advisable to use preferred providers to facilitate ease of access and ensure no co-payments.
Co-payment may be applicable if members choose to use a non-preferred provider.

ResoBaby

ResoBaby is the Resolution Health maternity programme which is available to all members across all options, free of charge. Benefits include medical visits, 2 x 2D scans and a baby care product benefit, the value of which is determined by the selected option plan of the member.
There is no need to register for the programme as the doctor will submit the necessary claims codes to the Scheme.

How to claim the baby care products
When you reach the 32nd week of your pregnancy call Resolution Health and they will activate a fantastic baby care products voucher, which you can spend at any network pharmacy.

International Travel Cover

The Hospital, Progressive Flex, Progressive Saver and Prestige options include the International Travel Benefit which covers emergency medical treatment while travelling outside of the borders of South Africa. The benefit provides cover for 30 days up to R2 million per beneficiary per incident from the date of departure. If you intend to travel for longer than 30 days or need higher cover you can contact the Resolution Health Scheme.
It is the member’s responsibility to notify the Scheme of any international travel arrangement 72 hours prior to departure.

Health Assist

Professional medical advice 24 hours a day is offered in all 11 official South African languages and offers:

  • Emergency medical advice
  • Appropriate first aid advice in case of emergency
  • Assessing day-to-day symptoms
  • Important health knowledge and counselling
  • Drug database
  • Poison information
  • HIV / Aids and cancer
  • Addiction
  • Trauma counselling
Oncology Benefits

The Oncology Benefit covers chemotherapy, radiotherapy, oncologist fees and blood tests within benefit limits, protocols and guidelines. Other investigative work-up is allocated to out-of-hospital benefits and thereafter PMB according to Scheme protocols.
Benefits for all options (except Prestige) are based on the ICON Network protocols and pre-authorisation is required. A Preferred Provider Network is in place for all options and Scheme protocols apply.
Note: MMAP® pricing is applicable.

HIV

CareWorks manages the HIV programme for Resolution Health. CareWorks provides all the out-patient care including consultations, blood tests, counselling and medication. Voluntary counselling and testing (VCT) is also provided by CareWorks, or as part of the preventative care benefit.
Note: Hospitalisation for HIV positive members is only funded in a provincial facility if you are not registered and compliant on the CareWorks programme. Thus any admission to a private hospital under these circumstances will only be funded at provincial rates and members will be financially liable to the private hospital for any shortfall.
To avoid this, it is important that HIV positive members register with CareWorks.

Childhood immunisations

The following schedule is recommended by the national Department of Health up to the age of 18 months.

Resolution Health Partners:

South African Cricketers’ Association
Resolution Health is the preferred medical scheme of South Africa’s professional cricketers. Resolution Health caters for the specific healthcare needs of the players. Some of the high profile players on Resolution Health include Jacques Kallis, Morne Morkel, Lonwabo Tsotsobe, AB de Villiers, Dale Steyn, Hashim Amla, JP Duminy and Alviro Peterson.

Moonprint Productions NPC
Resolution Health has joined forces with Moonprint Productions NPC in an effort to help educate the youth of South Africa about the importance of conserving the environment.

Resolution Health Ride the Rhino
The Resolution Health Ride the Rhino is a 3 day stage event that stretches for ± 300km, starting in Langebaan, at Nitida in Durbanville with the Season of Sauvignon.

“It’s all about our core principles, education, the environment and quality, healthy entertainment. We support the drive to protect the Renosterveld and rhino from extinction” – Mark Arnold, Principal Officer

Qhubeka
Resolution Health is the proud medical sponsor to Team MTN Qhubeka which is Africa’s most successful and largest multi-discipline pro cycle race team.

Greenest event
The South African “The Greenest Event” conference takes place on 5 June, which is World Environment Day. Resolution Health and Zurreal are involved because Resolution Health believes that the preservation of our environment has a direct impact on the health of our members.

Care Line Group is a Resolution Health Broker and can assist you in signing up with Resolution Health.

Click Here to full in our on-line medical aid quote form and one of our friendly consultants will contact you as soon as possible.

Source of article information www.resolutionhealth.co.za