Taking control of your medical expenses has become increasingly vital as healthcare costs continue to climb. Finding the right healthcare cover, one that is affordable and aligns with your healthcare needs, is the initial step. We offer insights into how you can save on healthcare costs by leveraging networks, Designated Service Providers (DSPs), opting for virtual care, and choosing generics to maximise your benefits. Utilising Networks One effective method to reduce monthly medical aid contributions without compromising care is opting for a network plan. Generally 15% to 20% cheaper, these plans require members to use network hospitals. Networks negotiate favorable tariffs to minimise out-of-pocket expenses and enhance value. If you choose a network plan, ensure there are doctors and facilities in your area. Be aware of co-payments for not using a DSP or network, but note that network options are waived for emergencies. Co-payments Practitioners and hospitals often charge above medical aid rates, resulting in co-payments, the portion for which you're responsible. These vary among schemes. Tariffs and Payment Rates Each scheme has a rate of payment for services rendered. Understanding this is crucial to avoid surprises. Notably, 100% of the scheme tariff doesn't necessarily cover the entire bill. Virtual Care Technology-driven innovations like virtual integration offer convenient healthcare access while minimising monthly contribution costs. Designated Service Providers (DSPs) By using DSPs, you limit out-of-pocket expenses, co-payments, and maximise annual benefits. Generic Medicines Generics offer cost-effective alternatives to brand-name drugs, often 30% to 80% cheaper, with equivalent efficacy and safety. Benefits Plan benefits vary, so read the fine print to understand coverage. Gap Cover This insurance policy covers the difference between what the medical scheme pays and the provider charges for treatments. Medical Savings Schemes allocate an annual fixed amount for medical savings. Ensure this suits your needs. Managed Care Addressing lifestyle diseases, Managed Care programs help manage chronic conditions like cancer, diabetes, and mental health. By utilising supplementary benefits smartly, you can save significantly on day-to-day expenses such as medication and screenings. Maximise your medical aid benefits wisely to access quality healthcare and extend your coverage effectively.
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All the large open medical schemes in South Africa have announced their contribution increases for 2024. Below is the list. Discovery Health says the average weighted increase across DHMS plans is 7.5% for 2024. Excluding the Medical Savings Accounts, the increase on Risk Contributions is 10.5%.
If you want to review your medical aid plan, please call our Health Department on 011-658-1333, Option 2 or email service@daberistic.com. Are you recently diagnosed with High Blood Pressure? Or Diabetes? Did you know that your Medical aid actually covers your monthly medication? Different medical aid schemes may cover different chronic conditions, but the general 27 conditions are covered by most of the medical aid across all plans. Below we list them:
How to apply for Chronic illness benefit? Discovery:
Once the form has been received and reviewed you will get a confirmation via email whether or not the request has been approved, and/or what medications are approved/declined. The letter of benefit will have details on how you will be covered under the condition. If your script has an end date (such as 3 months or 6 months), to continue with treatment, you must visit the doctor again to get the new script, and send it to Discovery to assess and update the approved medication. If you have any updated new prescription (medication or dosage), you must email the new prescription to Discovery as well so they can update it on their system. Medications that are covered Discovery has its medication formulary. If you are on the Essential Smart plan or Keycare plan, then your medication MUST be from the formulary; if you are on other plans, then medications from the formulary will be paid fully, and medications outside of the formulary will be paid partially. Approved medicine on the Chronic Illness Benefit medicine list (formulary) Bonitas: There are two ways to activate your Chronic Illness Benefits with Bonitas
Follow-up consultation and nominated doctor online Doctors normally advise you to follow up online to save time, normally this is perfect for members who need blood test review. They would send you to the nearest pathology for a blood test. Momentum
For further queries regarding your Chronic Illness Benefit contact Namhla in our Health department tel(011)658-1333, email service@daberistic.com The flu season is here again and with this year’s flu season expected to be more severe, South Africans should seriously consider getting their influenza (flu) vaccine, a local disease expert warns. We are here to remind our Medical Aid Members that use this time to get the flu vaccine, to strengthen immunity, and let you enjoy this winter in the healthiest way possible. Since Covid 19 came into our lives, its very hard distinguish the difference between the two. It is rather important to note that Flu and COVID-19 are very different diseases. Although Flu and COVID-19 may present similar symptoms, the viruses that cause them are not the same. COVID-19 is caused by infection with SARS-CoV-2, and flu is caused by infection with influenza viruses. To gain protection against each, you need to have the vaccine developed against each disease. You don't have to wait between COVID-19 and flu vaccinations. You can have them at the same time and, if you've had COVID-19 and recovered, it's safe to have the flu vaccine. Remember to give the healthcare provider your Medical aid company name and your Medical Aid number. Below we indicate with the different medical aid Providers , you can go about getting the vaccine through your Medical Aid Provider. Discovery Flu shot is paid from savings, or if you are on the Smart Plan, it is paid from your OTC benefit; if you are on the Core Plan, you then will need to pay from your pocket. You may go to: Medirite + Pharmacy (No dispensing and admin fees), ICPA (independent community pharmacy association), Clicks or Dis-chem. Momentum Flu vaccine is paid from Health Platform Benefit, you can either contact Momentum via WhatsApp (+27860117859), Momentum App, access your Momentum profile or call 0860117959 to notify Momentum. Bonitas Bonitas offers all members a free flu vaccine once a year. Simply go to Dis-chem, Clicks, or Pick n Pay Pharmacies. FedHealth FedHealth offers all members a free flu vaccine once a year, you need to pay R36 for admin fee. Fedhealth covers both flu vaccines, namely quadrivalent (QIV) and trivalent (TIV) vaccines. Profmed One flu vaccine per person per year is covered by Profmed Scheme. You must use a Designated Service Provider (DSP). If you want to know more about preventative benefits, please contact Namhla in our Health Department, email service@daberistic.com , Tel (011)658-1333 Due to pandemic, rising costs and high taxes are eroding pensions and retirement savings in South Africa. Many are forced to use the state-funded healthcare services which is already under pressure, causing long queues and even longer waiting lists. There is no doubt that we want the best medical attention for our elderly parents when they fall ill therefore private health care is our solution. It is important to understand what options is best suited for your aging parent’s needs. Where do you start? You would need to sit down and discuss with your parents and obtain the following information:
Once you have answers to the above, the next set of questions you need to discuss is to do a realistic budget to finance the plan.
What if your parents cannot contribute? If your aging parents are financially dependent on you and you happen to be main member of a medical aid policy, you may consider adding them as your dependent as this means they can pay a reduced rate. However, they will be on the same option plan as you, should your option not be sufficient to cover their needs, your option is to upgrade your plan. If you’re on an option that includes savings, they become eligible for using your savings. You will need to be prepared for savings being exhausted due to extensive care required. What happens when parents don’t qualify as your dependent? If you decide to not add parents as Dependants or due to parents not qualifying to be your dependent, they can always choose a medical option according to budget and below are things to consider for when choosing your option. Full medical cover (with savings): On a comprehensive option, most elements are covered for. Such as hospital admission, chronic medication and day to day expenses, medical equipment, and possibly dentistry and optometry. These plans vary widely therefore, read through entire plan before signing up to make sure it qualifies all your parent’s needs. Basic hospital plan: These covers around 90% of hospital procedures, basic prescribed minimum benefit (PMB) condition and cancer benefit. It excludes expenses such as none PMB approved medication, equipment, doctor’s visits, optometry, or dentistry. This may not be a full coverage but highly affordable option. Gap cover is always recommended by Daberistic as this boosts your unforeseen gap payment by 500%. To read more about gap cover click here. What else to keep in mind?
If you would like cover for your parents, please contact Namhla or Tammy in our health department, email Service@daberistic.com, Tel 011-658 1333, option 2 for Medical Aid. Please be reminded that Medical aid upgrades for 2021 will end soon, please make sure you have submitted your change by 30 November. For clients on Discovery KeyCare plan, Momentum Ingwe plan, Bonitas Boncap plan and have been selected to do income verification, please make sure all required documents are submitted to prevent your service provider resulting to default to the highest income band and therefore the highest contribution will apply.
Please note: Members joining Momentum health Ingwe option with effect 01 October 2020 onwards will not be required to submit information for income verification (declaration and proof of income). They will remain on their current income bracket moving into 2021 and the new premium will automatically be applicable from 01 January 2021. For more information on medical aid plans, please see below videos, brochures and links to assist you with change of option decision. Discovery Plan series and videos
Below are Discovery Health Plan Guides Brochures for 2021
To help you stay healthy and informed on the COVID-19 situation, Discovery will continue to provide the most up-to-date information and guidance through COVID-19 Information Hub Below are Momentum Health Plan Guides Brochures for 2021 Below are Bonitas Plan Guides Brochures for 2021 Bonitas, the second-largest open medical scheme in South Africa, has recently released their 2021 updates and increment across all plans. Bonitas recognises that it has been a tough year. It has settled on lowest increase possible to maintain consistent service to the clients for 2021. With the guideline from the Council for Medical Schemes, Bonitas has settled on an average increase of 4.6% across all plans which will range between 0% and 7.1%. The BonFit Select plan has 0% increase. It is to ensure affordability and sustainability for all the members going forth as Bonitas has noted that 7 of its current options are priced between R1500 and R3000 per month, which is where the medical scheme market is experiencing growth currently. "Member behaviour has changed significantly, and demand is for innovation, accessibility and technology. This has the benefit of attracting, a younger, target audience and driving sustainability,” it said. Bonitas has introduced 2 new medical aid plans for 2021, these plans are induced by technology, called Edge.
BonStart and Bonstart Plus, are designed for economically active singles or couples, living in the larger metros, which include access to: • Private hospital network and full cover for emergencies • PMB chronic medicine • Day to day benefits including unlimited GP consultations • Layers of virtual care, dental and optical benefits; preventative care • Wellness screenings • Contraceptives and so much more… The above monthly premium is R1452 and R1731 for principal member respectively. This year has been a challenging year for most due to global pandemic hence personal assurance on safety is where Bonitas will develop and focus their core services like home-based care and day hospitals to reduce risks. Other developments for 2021 include: • Developing its WhatsApp channel and virtual technology platforms • Continuing with the virtual care platform, which provides access to GP consultations and free delivery of chronic medicine • Promoting mental health and mental wellbeing, with screening via the app and providing effective care where necessary • Using the Wellness Extender benefit to pay for up to three months of subscription fees for Run/Walk for life to help members get healthier. To speak to a Medical Aid Consultant, please email service@daberistic.com, Tel 011-658-1333, Option 2 for Medical Aid. |
AuthorKevin Yeh Archives
January 2025
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