In South Africa, providing adequate healthcare benefits for employees is crucial for small businesses to attract and retain talent. With numerous medical aid options available, selecting the right one can be overwhelming. However, by considering key factors and understanding the needs of your employees, you can make an informed decision that benefits both your business and your staff. How Medical Aid Affects Employee Satisfaction: Employee satisfaction often hinges on the benefits extended by an employer, with medical aid typically ranking among the most crucial offerings. A robust medical aid package not only demonstrates the employer's commitment to their staff's well-being but also fosters a sense of value and support, thereby enhancing job satisfaction. Moreover, such comprehensive medical aid plans provide employees with a sense of security, knowing that they and their families are safeguarded in times of illness or emergencies. This assurance alleviates concerns about healthcare expenses, allowing employees to concentrate fully on their work. Consequently, a workforce free from the burden of healthcare costs tends to be more focused, productive, and engaged, ultimately contributing to a motivated and high-performing team. The Role of Medical Aid in Employee Retention: Research indicates that employees are more inclined to stay with employers that provide comprehensive healthcare benefits. Retaining experienced staff not only mitigates the need for frequent recruitment, thus saving on associated costs, but also fosters a more stable and productive work environment. Here is a comprehensive guide to help you navigate the process of choosing medical aid for your small business in South Africa.
If you need advice and guidance and choosing an option for your workforce, please contact Lebogang in our Health department, email Service@daberistic.com, Tel 011-658 1333, option 2 for Medical Aid.
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Discovery’s additional benefit the WELLTH fund came into effect on 01 January 2023. You and your family will have access to a once-off, additional risk benefit called the WELLTH Fund, offering up to R10 000 per family to empower you and your family members to understand and address your personal healthcare needs. What does the WELLTH Fund cover? The WELLTH Fund covers a comprehensive list of healthcare services to ensure that you are empowered to take specific action according to your individual health needs. This benefit is separate from and additional to the Screening and Prevention Benefit and will be available to all existing and new members of the Scheme. This benefit can be used for appropriate healthcare services up to your WELLTH Fund limit. Cover is subject to the Scheme's clinical entry criteria; treatment guidelines and protocols and qualifying healthcare services are covered up to a maximum of the Discovery Health Rate (DHR). Fund Allocation The WELLTH Fund is a once-per-lifetime benefit available to every beneficiary on Discovery Health Medical Scheme. The value of the benefit is allocated according to size and make-up of each family on a membership. To activate the WELLTH Fund, every person on a membership certificate aged 2+ must first complete their relevant health check at a healthcare provider in Discovery’s Wellness Network. Once the member and all their Dependants have completed their Health Checks, they will have access to WELLTH Fund of up to R10,000, below is a chart of how funds are allocated. The WELLTH FUND is allocated per membership, and therefore once it is activated any person on the membership can make use of any portion of the benefit. Discovery App WELLTH fund tracking On your Discovery APP the WELLTH Fund Dashboard (shown below) will allow members to view all available health checks and recommended next best actions, book consultations and keep track of their use of the WELLTH Fund. For more information on the Wellth Fund contact Jo in our Health Fund on 011 658 1333 or email us on service@daberistic.com
Source: Discovery Discovery’s additional benefit the WELLTH fund came into effect on 01 January 2023. This benefit is a once-off benefit to all medical aid members in which it provides up to R10,000 in additional cover for a family’s healthcare needs. Fund Allocation The WELLTH Fund will be activated in 2023, once members completed their health check in 2022 or 2023 This sets the baseline for a member’s Health Status. To activate the WELLTH Fund, every person on a membership certificate aged 2+ must first complete their relevant health check at a healthcare provider in Discovery’s Wellness Network. Once the member and all their dependents have completed their Health Checks, they will have access to WELLTH Fund of up to R10,000, below is a chart of how funds are allocated. Where to use your WELLTH Fund The WELLTH Fund covers over and above the annual Screening and Prevention Benefit. Discovery App WELLTH fund tracking On your Discovery APP the WELLTH Fund Dashboard (shown below) will allow members to view all available health checks and recommended next best actions, book consultations and keep track of their use of the WELLTH Fund. How tests are covered
This benefit is available once per beneficiary, per lifetime. Discovery pays the above healthcare services from the WELLTH Fund up to the Scheme Rate and up to your WELLTH Fund limit. Some of these tests and treatments have a rand value limit depending on the number of active dependents you have on your membership. Once you have reached your allocated rand value limit for the tests, Discovery will pay any extra screening and preventive tests and treatments from your available day-to-day benefits, where applicable. The Scheme’s clinical entry criteria, treatment guidelines and protocols apply. The normal claims process applies. Discovery will automatically pay this from your WELLTH Fund. FAQ
Yes, the WELLTH Fund covers the following specific medical devices if they have a registered NAPPI code and are bought from a registered healthcare provider with a valid practice number (such as a pharmacy or doctor):
It depends on which health plan you have. Plan network rules apply for members on Smart and KeyCare plans:
Members on all other plans may use a provider of their choice and do not have to use a network provider to be covered by the WELLTH Fund. 4. The WELLTH Fund tool has recommended a list of check-ups that I should go for, am I only covered for these check-ups? No, the WELLTH Fund Tool is just a guide for which screening check-ups are most suitable for you, based on your age and gender. However, you can go for any of the screening and preventative check-ups covered by the WELLTH Fund - you don't have to go for those recommended by the tool. 5. Can I claim for medication from the WELLTH Fund? No, you cannot claim any medication from the WELLTH Fund. 6. How can I book an appointment to use my WELLTH Fund?
For more information, please contact our Health department on 011 658 1333 or email us on service@daberistic.com Source: Discovery Nowadays most medical schemes have a new-generation option that will typically be a hospital plan with a savings portion. This means the consumer has the peace of mind that he can go to a private hospital for procedures and has a small savings account for day-to-day expenses. What is a medical savings account? The medical savings plan is designed to cover day-to-day expenses while having fewer restrictions on the choice of providers. The consumer gets a total annual amount that is available in advance in his Medical Aid Savings to account for medical expenses. If a consumer joins the medical scheme during the year, this amount will be calculated pro rata. In terms of legislation, this amount may not exceed 25% of his annual premium. Once the savings are exhausted, the consumer will be responsible for any further day-to-day expenses. Any positive balance in the savings account at the end of the year will be carried over to the next year. If the member exhausts his savings component before the end of the year and switches to a new scheme or resigns from the scheme, the scheme may expect the member to repay the difference in savings to the scheme. The amount repayable by the member is the monthly savings multiplied by the number of months left in the year. Here are seven tips to make your medical savings last longer: 1. KNOW YOUR PLAN Understand what you’re covered for, at what rates and with which providers. Does your plan cover you at the medical scheme rate or at a higher rate? Does your plan require you to make use of a hospital or pharmacy network? Refer to the material you receive from your medical scheme, use their website and talk to your financial adviser about what your options are. 2. KNOW YOUR DOCTOR’S RATES Patients are often embarrassed to discuss money with their healthcare provider, but when you make the appointment, ask what rates your doctor charges and whether you’ll be liable for any co-payments. That way, you can make informed decisions about how you’re spending your healthcare funds. If affordability is your greatest concern, it might be better to shop around for a provider who charges scheme rates, but if choice is more important to you and you’re happy to pay more, you’ll know upfront exactly how much. 3. TAP INTO NETWORKS YOUR SCHEME MAY HAVE Some medical schemes have network arrangements in place with healthcare professionals. By using a network, the scheme pays the professional directly, reducing administrative hassle and keeping costs down for you. The Discovery Health Medical Scheme, for example, has an extensive GP network where members are covered in full for doctors’ consultations. We recommend that our members call us or visit our website before they see a healthcare professional, so they know which of these are part of a network. 4. IF YOUR SCHEME OFFERS DIRECT PAYMENTS WITH CERTAIN SPECIALISTS, YOU CAN BENEFIT TOO For example, Discovery Health Medical Scheme has direct payment arrangements in place with most of South Africa’s specialists on most of its plans. If you see one of them, you won’t be liable for any co-payments. If you choose to see another specialist, you may need to pay upfront or pay a portion of the costs yourself – depending on your plan. Find out what your options are. Don’t be afraid to discuss and agreed rates with your specialist. 5. CHECK FOR FULL-COVER ALTERNATIVES In the case of medicine for a chronic illness, schemes often have formularies – lists of medicine that are covered in full by the scheme. Check with your doctor or pharmacist if your prescribed medicine is covered in full and ask about options if not. 6. PAY IN CASH FOR OVER-THE-COUNTER MEDICINES If you have a medical savings account, don’t claim for items not normally covered by medical schemes, for example, over-the-counter headache tablets, cough preparations, etc, from your savings. Paying cash will help the money in your savings account last longer, so you have funds available for more serious, more expensive out-of-hospital treatments. 7. STAY HEALTHY! It seems obvious, but people often overlook the fact that by taking care of their health, they can reduce their healthcare costs in the long term. Make use of your scheme’s preventive screening benefits for regular health checks and live a healthy life. In the case of Discovery Health Medical Scheme, members have access to a range of preventive screenings funded by the scheme. Members can join Vitality, which rewards them for being healthy. Please contact our Health Department, email health@daberistic.com , to find out about different Medical aid options On 21st September 2022, Discovery hosted their virtual workshop with over 10,000 brokers, to announce Discovery's benefits and contribution updates for 2023. Below is a summary what you need to look forward to in 2023 for Discovery Health and Vitality. Discovery Health No increase in contributions until 01 April 2023 Every year, medical schemes increase contributions by medical inflation to meet the expected cost of healthcare claims in the following year. Discovery Health will only increase contributions for 2023 on 1 April 2023. Members will therefore enjoy 2023 benefits at 2022 rates, for the first three months of the year. The increase on 1 April 2023 will be in line with medical inflation, expected to range between CPI plus 3 - 4%, which would be about 10% increase. Discovery will only confirm the exact increase percentage and new premium in February 2023. 2023 Benefit updates
Introducing Essential Dynamic Smart Plan If you are a tech-savvy, then there’s good news! Discovery Health is introducing a new plan called Essential Dynamic Smart Plan in 2023, it only costs R1450 per month and it is personalized. It will connect a member with the most efficient hospital for their admission at a specific point in time. (Deductible/co-payment will occur if choosing other providers) Introducing the WELLTH Fund The WELLTH Fund enables members to better understand their health status. The fund does this by giving risk funding of up to R10,000 per family for a broad range of health screenings and preventive healthcare services – over and above the yearly Screening and Prevention Benefit. It is going to start from 01st January 2023 for 24 months. Simply unlock the benefit by having one health check-up. Vitality Highlights In 2023, Vitality will enhance its benefits to focus on monetizing healthy behaviour and encouraging good clinical outcomes to drive more engagement and better health. The Vitality HealthyWeight programme This new programme uses the latest trends in behaviour change to help members achieve their ideal and healthy weight through a personal nutrition coach, simple meal plans, recipes and shopping lists. Vitality members can access Vitality HealthyWeight at affordable rates, with all at risk Vitality members receiving higher additional discounts. The Easiest Way to Join Gym
If you have Discovery Bank, you can now join the gym with Vitality without any admin with the gym staff, you can simply activate the gym benefit on the App, and skip the gym activation fee! If you like to know more about your cover or review your current Option contact Tammy in our Health department tel (011) 658-1333 email: service@daberistic.com Source: Discovery Every Medical Scheme includes maternity benefits.If you are not already pregnant before applying for your medical aid, you can enjoy maternity benefits when you fall pregnant. This article will focus on Discovery Medical aid company. If your medical insurance is Momentum, Bonitas, Fedhealth or Profmed, please contact us for your maternity benefits. Benefits will be activated when your pregnancy or baby profile is created on the My Pregnancy or My Baby programme on the Discovery app, or on website www.discovery.co.za or when you register your baby onto the Scheme. You can also activate the programmes by calling 0860 99 88 77 and following the voice prompts. These benefits are available per pregnancy per child up to two years after birth. Once these limits are depleted, you will have to pay for out-of-hospital healthcare expenses related to your pregnancy. Benefits Overview During Your Pregnancy For Two Years After Birth Benefits Details
Antenatal consultations You are covered for up to 8 consultations at your gynaecologist, GP or midwife covered from the Maternity Benefit at the Discovery Health Rate. Pre- and postnatal care You have cover for up to five pre- or postnatal classes (including online classes) or post-birth consultations with a registered nurse, up until two years after birth. Once these have been used, we pay antenatal classes from the available funds allocated to your Medical Savings Account. Prenatal screening You are covered for one non-invasive prenatal testing (NIPT) or one T21 chromosome test subject to clinical entry criteria and/or amniocentesis or chorionic villis sampling (CVS) from the Maternity Benefit at the Discovery Health Rate. Blood tests Cover for a defined basket of blood tests per pregnancy from the Maternity Benefit at the Discovery Health Rate. Ultrasound scans You are covered for up to two 2D ultrasound scans including one nuchal translucency test from the Maternity Benefit at the Discovery Health Rate. 3D and 4D scans are paid up to the rate we pay for 2D scans. Medicines for morning sickness, iron supplements and folic acid (Medical Savings required) Discovery pays for medicines and supplements that are taken during your pregnancy from the available funds allocated to your Medical Savings Account. If these accounts are more than the money you have available in your Medical Savings Account, you will have to pay these costs. GP and specialist care after birth Your baby under the age of two years is covered for two visits to a GP, paediatrician or an ear, nose and throat specialist from the Maternity Benefit at the Discovery Health Rate. Other healthcare services You are covered for one flu vaccination during your pregnancy. You also have access to postnatal care which includes a postnatal consultation within six-weeks post-birth for complications postdelivery, a nutritional assessment with a dietitian and two mental healthcare consultations with a counsellor or psychologist. You are also covered for one breastfeeding consultation with a registered nurse or breastfeeding specialist from the Maternity Benefit at the Discovery Health Rate (DHR). Point-of-care devices (Medical Savings required) If you are registered on the My Pregnancy or My Baby Programmes, you also have access to the latest remote monitoring medical examination device called TytoHome until your youngest child turns six. Discovery pays up to 75% of the Discovery Health Rate for one device per family every five years. You will need to pay 25% of the cost of the device. For more information, refer to the Connected Care for healthcare at home guide available on www.discovery.co.za under Medical Aid > Manage your health plan > Find important documents and certificates. Discovery covers normal deliveries or home births or birthing home delivery with a registered midwife If you choose to have a water birth or normal delivery at home or birthing home, Discovery will pay for care from a midwife for your approved delivery from your Hospital Benefit. The midwife must be registered with a valid practice number. For a water birth at home, Discovery will pay for the cost of the hire of a birthing pool from your Hospital Benefit at the Discovery Health Rate. This must be hired from a registered provider who has a valid practice number. If you use a midwife within our network, the birthing pool is included in the amount we pay. Hospitalisation for your delivery You have cover for hospitalisation for your delivery from the Hospital Benefit, if approved. We pay the hospital account from your Hospital Benefit up to the Discovery Health Rate. You have cover for a water birth in hospital. The midwife must be registered with a valid practice number. Treatment for neonatal jaundice If your baby needs phototherapy due to neonatal jaundice, Discovery will pay for the phototherapy lights from the Hospital Benefit as long as you call for authorization. Please consult the treating doctor for the treatment codes so that we can provide you with the authorization number of the treatment. Is Baby Immunization Covered? Baby immunization is paid from your available Medical Aid Savings, if you are on a hospital plan (Core Plan) then you need to pay for it from your own pocket. The suggestion we would provide, whether you have Medical Aid Savings, is that you should call the Dischem near you, ask them if they have stock for government/public immunization shots, this would not only save your time from queuing at a Public Clinic, but also save you money, as the price difference between the private and public immunization shots can be huge. If you would like to know more about your Maternity Benefits, please contact Jo or 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. |
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January 2025
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