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
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3. Good nutrition isn't all about what you don't eat, it's often just as important to add in more nourishing nutrients. This ensures you get enough vitamins and minerals.
Try slicing up raw veggies and keeping them bagged in the fridge as snacks, far easier to grab when they're already bite sized. 4. Another simple, festive trick to up your fruit and Veggie intake. Eat as much of the rainbow as you can. At each meal, see if you can introduce one more colour to your main or side dish. 5. Some call them nature's candy - for good reason. Fruits make excellent desserts, and they are also a key part of a healthy diet, filled with disease-fighting nutrients. 6. Skipping breakfast will likely make you hungrier later in the day, and more prone to overeating unhealthy foods. Morning meal represents a prime opportunity to boost your diet with produce. 7. A good night's rest can also go a long way in keeping you on track. When you are sleep deprived, you are more likely to eat mindlessly and crave high-fat, high-sugar foods. 8. Walking is a good way to fit more activity into your day. Breathing fresh air and seeing different scenery is good for metal health and depression. Getting your blood circulating will assist in reducing your risk for chronic health conditions. Sirago is one of the leading medical gap cover providers in South Africa. If you have medical aid, then Sirago gap cover is an essential supplement to your medical aid, to cover payment shortfalls. Sirago offers some of the premium, benefit-rich products. Overall, the premium increase will be 8.6%. It has some great updates and additions in 2021. These are:
Continuing with their focus on specific niche markets, they will be launching the following products:
2021 Sirago Gap Cover Premium Momentum Medical Scheme focuses more than ever on keeping benefit design stable and ensuring that their members continue to enjoy comprehensive and affordable benefits. The 3rd largest open medical aid scheme in South Africa, Momentum Medical Scheme has announced an average annual contribution increase of 3.9% for 2021. This is substantially lower that the weighted average annual contribution increase of 8.2% for 2020.
If you have any queries or are interested in joining Momentum Medical Scheme, please contact us on 011-658-1333, 076-200-5488 or email service@daberistic.com. Discovery continues to lead the industry by rolling out exciting benefits and offerings: Mental wellbeing Shari'ah compliance arrangement Infertility and assisted reproductive therapy benefit Hospital network and day surgery updates New clinic and other services for employers Diabetes care programme Chronic Illness Benefits Co-payments and deductibles To find out more, please click on each tab below.
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Mental wellbeing Statistics according to WHO shows one in four people in the world will be affected by mental disorders at some point in their lives, this positions mental disorder amongst one of the leading causes of ill-health worldwide. Mental ill-ness often left undiagnosed and with 84% of adults never receiving treatment and this impacts society and WHO estimates cost to global economy may exceed $16 trillion by 2030. Discovery’s approach to alleviate this disorder, they have introduced management in mental wellbeing. Below programs offered are:
Shari’ah compliant arrangement From 2021 members from our Muslim community can appoint to have their contribution and claims across all plans to conform with Shari’ah principles through the Shari’ah compliant arrangement. • Model is compliant and is based on Takaful principles • Process flow happens in an acceptable manner • No interest earned or paid at any stage • No ambiguity in contracts • Members’ interests are protected • Investments are managed in Shari’ah Compliant manner • No interest earned or paid on Shari’ah Compliant arrangement. Funds will be invested in a compliant manner allowing members opportunity to earn profit on Medical Savings Account balances. • Members that partake in this arrangement attain affirmation on their contribution and balances remaining after settlement of claims and other expenditure will be invested in Shari’ah compliant investments. Infertility and assisted reproductive Therapy benefit When a couple is looking forward to building a family and the incapability to fall pregnant is aggravating. It affects many families and takes a emotional toll, however, many infertility cases can be remedied through treatment such as drug, surgical repair and assisted reproductive techniques including intra-urine insemination (IUI) and in vitro fertilisation (IVF). Taking a leap of faith on possibility to become a parent can come with a price tag, an average of R65000.00 – R85000.00 for a single IVF treatment cycle, this may be a hefty cost for many families in which will hinder and or have reservations from taking on this treatment. Discovery would like to support couples/ families distressed from infertility with introducing cover for Assisted Reproductive Technologies (ART) and the benefit will include cover for: • Up to two cycles of ART if Scheme’s benefit and clinical entry criteria are met. • This includes a series of care for the progress of the full duration: consultations, ultrasounds, oocyte retrieval, embryo transfers, admission costs including lab fees, medication and embryo and sperm storage. • The total limit of R110 000.00 per person per year at Discovery health rate applies. • Members will be subject to 25% of the costs and any excess above the Discovery Health Rate. • This benefit will be attainable at Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) accredited centres only and subject to clinical pathways and protocols. • Lastly, the benefit is only available to female members that has been on Executive and Comprehensive Plans for at least 2 years and the age between 25-42 years old.
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Chronic Illness Benefits
Diabetes Care Programme 2021 Premier Plus GP network will become the Designated service provider for members with Diabetes on the comprehensive plans. It is supported by the extensive coverage offered by the Premier Plus GP network and the clinical outcomes achieved by the diabetes care programme. The chosen GP will be member’s DSP for the ongoing management of diabetes as well as cardiovascular conditions. Statistics has shown in improvement when member’s care is coordinated by a single doctor. Hospital Network Updates and Day Surgery New hospitals will be added, and some existing hospitals will be replaced with region specific substitutions for 2021 to ensure continued optimisation of the Delta, Smart and KeyCare hospital networks In the Day Surgery, they will extend this offer to Comprehensive plans given focus on provider and patient safety because of COVID-19. The 2021 new hospital network and day surgery lists will be published by the end of October 2020.
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Limits, Co-payments, deductible and Thresholds
Next: Vitality 2021 - To Help members stay motivated Co-payments For Endoscopic Procedures
New Clinic and Other Services for Employers Daily monitoring of COVID-19 exposure, prevalence, and disease progression:
Did you know! That you can request extended chronic or acute medication when you are travelling out of South Africa for more than a month or up to 6 Months. Discovery Health will review the request only when you need the extra supply of chronic or acute medication because you will be outside the borders of South Africa. The request will be declined if its longer than 6 Months. If you change Medical aid plan, cancel membership or if the membership is suspended during the period for which the extended medication is approved, member will be liable to pay the cost themselves. How to activate this benefit or what you need to do!
Please contact Namhla or Tammy in our Health Department, email health@daberistic.com , for more information regarding chronic benefit. Source: Discovery Did you know,that you can request extended chronic or acute medication when you are travelling out of South Africa for more than a month or up to 6 Months. This benefit is only available if you will be travelling more than a month or up to 6 months. Discovery will review the request only when you need the extra supply of chronic or acute medication because you will be outside the borders of South Africa for longer than one month or up to and no longer than six months. Please note the maximum period for extended supply of medicines Discovery will consider Months. The request will be declined if its longer than Months If you change Medical aid plan, cancel membership or if the membership is suspended during the period for which the extended medication is approved, member will be liable to pay the cost themselves. How to activate this benefit or what you need to do!
Source: Discovery |
AuthorKevin Yeh Archives
January 2025
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