Posts tagged with 'medical aid'

 

Making Sense of Medical Aid Rates and Tariffs

Posted on Leave a comment

The medical aid industry is known for confounding consumers with all sorts of complex terms. Among the most confusing of all are references to medical aid, or medical scheme, rates.

Schemes and plans are quoted as covering the costs of in-hospital procedures up to 100%, 200% or 300% of the scheme rate or tariff. You might reasonably think this means that medical aid will cover all healthcare expenses, up to 100% or more. However, this is far from the case.
In this article, we focus on medical aid rates, how they’re calculated and what impact the different tariff options have on medical aid members.
The truth about medical tariffs
Medical expenses in South Africa are not regulated. Doctors, specialists and hospitals can charge what they want, provided the fees are deemed to offer “fair value” to the consumer.
The Department of Health has, however, published a list of recommended tariffs pertaining to specific treatments and procedures conducted i
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Climbdown on medical aids

Posted on Leave a comment

The Department of Health has done a U-turn on its plan to scrap medical aid schemes, saying they should work with the state when it rolls out National Health Insurance instead.

Department director-general, Precious Matsoso, met leaders of the medical aid plan sector and asked that they work together to reform healthcare in South Africa.

“This is big news,” said Graham Anderson, principal officer of Profmed. The medical aid sector was delighted to be asked to work with the department, because it had been in the dark about NHI for some time, he said.

In the meeting Matsoso made different suggestions on how the government may have to work with the private sector, such as subsidising medical aid options for people who couldn’t afford them.

Finer details of a partnership, however, were not discussed.

Matsoso confirmed the meeting.

She said: “The Department of Health is consulting all stakeholders, private, civil society and labour, to get further inputs [o
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Three things you should know about Three things you should know about rotavirus

Posted on Leave a comment

Rotavirus is highly contagious and a common cause of infectious diarrhoea in developing countries. Since children younger than three are worst affected, a paediatrician sheds light on detection, prevention and treatment.

1. Infection

Nausea, vomiting, watery diarrhoea and fever are the most common symptoms of rotavirus. These symptoms usually start one to three days after exposure to the virus and last for an average of eight days.

‘If your family doctor or paediatrician suspects your child has rotavirus, the infection can be confirmed with a stool sample test,’ says Dr Heidi Ackermann, a paediatrician at Mediclinic George. Adults can also contract the virus, but the symptoms are usually much milder.

‘You can also can get the virus more than once, but you won’t get re-infected with the same strain,’ Dr Ackermann adds. Important to note is that although blood in the stools is not a symptom of the virus, it is a symptom that can’t
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Is your GP contracted in to a medical scheme network?

Posted on Leave a comment

If GPs are contracted in to a medical scheme network, they might be pressurised to recommend cheaper treatment options and medications, say SA health bodies.

The Board of Healthcare Funders (BHF) and the IPA Foundation (IPAF) is extremely concerned at the comments made recently by the Health Professions Council of South Africa concerning Designated Service Providers (DSPs).

The HPCSA recently released a statement to the effect that healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical schemes as the medical schemes attempted to reduce costs by applying pressure on practitioners within a DSP network to prescribe medication or recommend treatment options, when other more appropriate, albeit more expensive, options were medically indicated and readily available.

Pushing healthcare costs down

In the current environment where there are no regulated tariffs for healthcare procedures,
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Most affordable medical aid schemes and hospital plans in South-Africa for 2017

Posted on Leave a comment

The medical aid industry saw a massive shake-up in April as National Treasury introduced new regulations which will see a limit on the amount of gap cover and hospital cash-back policies you can claim, as well as the discontinuation of all primary healthcare policies.

This is was done in an effort to differentiate between “medical scheme products” and “health insurance”, both of which are regulated by separate Acts causing confusion in the medical arena.

The new regulations will now outlaw all primary healthcare policies from 1 April. According to legislation these are not seen as full medical schemes, instead providing limited medical service benefits, such as GP visits, basic dentistry and optometry, and some acute and chronic medication.

The new laws also stipulate that hospital cash-back plans are limited to paying their clients a maximum of R3,000 per day, or a total lump sum of R20,000 per year. Currently there are no limits in place for these pa
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Why opting out for a cheaper medical cover can cost you in the long run

Posted on Leave a comment

Medical cover is expensive, and getting more so every year. Unfortunately this could mean we opt for lower monthly premiums that could mean you aren’t covered in the event of an expensive procedure.

The South African Society of Anaesthesiologists (SASA) is advising South Africans to consider the multiple factors affecting cover when choosing access to medical care.

The SASA understands that healthcare is often hard to comprehend and expensive to access. As a result, the Society believes, many consumers choose their medical plans – including how much cover it offers and whether care is provided at public or private institutions – based on the principle of “what can I afford monthly”.

“The truth is, most people look at cutting their medical costs in an effort to reduce their household spend when they feel an economic pinch. This is a difficult decision, since we’d all like to have access to the best facilities and treatment with the least out of pock
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Manage your medical expenses during winter season to obtain optimal value

Posted on Leave a comment

To obtain optimal value from your medical scheme plan, it’s critical to fully understand the scope of benefits it offers and to manage those prudently.

To obtain optimal value from your medical scheme plan, it’s critical to fully understand the scope of benefits it offers and to manage those prudently. It’s an especially important consideration during the winter months. This is according to Dr James Arens, clinical operations executive at Pro Sano medical scheme.

Minor ailments like a recurrent common cold, for example, may not necessarily require repeated doctor visits that could potentially use up benefits that might be more appropriately used elsewhere.

Dr Arens points out that the economic climate in recent years has seen many South Africans downscaling on their lifestyles.

“This often means ‘buying down’ when it comes to medical scheme cover. It’s understandable that when money is scarce, people wish to pay as little as possible while sti
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

What to consider when deciding on a medical scheme

Posted on Leave a comment

Are your health insurance costs too high? Try decoding your medical aid terms and conditions and associated costs to make sure that it works for you.

“While health insurance is important, it comes at a cost that is rapidly rising. Unfortunately for the consumer, this affects medical scheme membership contribution rates, and the increases of which are sometimes significantly higher than general inflation.

As schemes try to contain their costs in the face of increasing claims, they make changes to their plans and benefits, which can come as a surprise to the consumer,” says Mark Payne, CEO of the Independent Community Pharmacy Association (ICPA).

Annual review of your plan

He recommends that an annual review of your plan is absolutely vital, and will affirm that it is serving your needs rather than the other way around.

The ICPA advises on several important things you should look at when considering a new medical scheme or reviewi
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

The benefits on low blood pressure

Posted on Leave a comment

If you were born with blood pressure on the low side, that’s good news – but there are still a few things worth knowing about this condition.

Having low blood pressure in your genetic make-up means you don’t face the risk of developing heart problems or having a stroke as a result of high blood pressure. However, a sudden drop in blood pressure can indicate something more serious.

What is considered low blood pressure?

Low blood pressure, or hypotension, is a blood pressure measurement of 90/60mm Hg* or below. A normal or ideal blood pressure reading is between 120/80 and 90/60mm Hg. Blood pressure can vary considerably over short periods, depending on:

    • body position
    • stress levels
    • physical conditions
    • medication
    • diet
    • time of day – usually lowest while someone sleeps.

Most people with chronically low blood pressure aren’t even aware of it, and if you have
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Therapy For Breast Cancer Is No Longer Cut And Dried

Posted on Leave a comment

High-profile media campaigns have made most South African women aware that breast cancer poses a very real risk. But the message that really needs to be conveyed is that the disease can affect anyone and that most women who get breast cancer do not have risk factors.

In addition, more and more young women are presenting with breast cancer. “The implication for South African women is important: we should be taking proactive steps for women to be ‘breast aware’ from a young age. The earlier it is detected and treated, the better the prognosis,” says specialist surgeon and breast disease specialist, Professor Carol Ann Benn, who established the Netcare Milpark Breast Care Centre of Excellence.

International accreditation

The facility, which was the first breast care centre of excellence to be established in the private sector in South Africa some 16 years ago, has been granted a three-year, full accreditation by the National Accreditation Programme f
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Why healthcare is so expensive in SA

Posted on Leave a comment

Some of the most significant contributors to soaring healthcare costs are fraud, waste and abuse. These are difficult to detect, monitor and prevent because the perpetrators are at every level of the delivery chain from healthcare providers at the top to policy holders at the bottom with many abusive acts playing out under the radar, for months, even years.

“It is estimated that healthcare fraud costs the sector between 5% and 15% of total pay-outs,” says Lynette Swanepoel, healthcare and insurance forensic specialist at the SA Fraud Prevention Services (SAFPS).

“Fraud is definitely a serious element, but on top of that the healthcare industry also has to contend with waste and abuse of benefits,” she says. One example of healthcare fraud is collusion between the policy holders and healthcare service providers such as doctors and pharmacists, where some doctors or pharmacists will supply non-covered items such as toiletries and baby products, falsely clai
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Pregnant? Which Medical Aid?

Posted on Leave a comment

Pregnant? Which Medical Aid? This is a very good question and it is best to ask a Professional Medical Aid Consultant to get definitive answers as every patient has varying needs.  Know in advance what you will be covered for and what you will not…
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Hospital Plan with no medical tests required or Funeral Plan from R99. Get Free Quotes for Medical-Aid, Hospital or Funeral Plans or Insurance now!

Posted on Leave a comment
Medical-aid

Get a Hospital Plan with Guaranteed acceptance and no medical tests or a Funeral Plan from only R99 per month. Get Free Quotes anytime for Medical-Aid, Hospital or Funeral Plans or any Insurance online now.

Simply email the word “Medical” or “Hospital” or “Funeral” or “Insurance” and your Full Name, age and Cell No. to: [email protected]
Or, SMS/WhatsAPP “Medical” or “Hospital” or “Funeral” or “Insurance” and your Full Name and email address to: 0827385586
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

Is dental healthcare as affordable and accessible as it should be?

Posted on Leave a comment

Oral health is essential to optimal overall health and minimising the probability of developing serious oral health conditions or infections in future. Yet, besides the fear factor, why are so many people reluctant to visit the dentist? “The underlying factors here include resources, socio-economic circumstances, accessibility and education.” “One of the biggest culprits for keeping..
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!

 
 

KPMG-skandaal raak ondersoek na duur medies

Posted on Leave a comment

Private hospitaalgroepe maak beswaar daarteen dat KPMG die Mededingingskommissie met sy navorsing gehelp het. ’n Kompromis is nou bereik wat die hospitale toegang tot die navorsing gee. Die KPMG-skandaal pootjie nou ook die markondersoek na die private gesondheidsorg. Die voorlopige bevindinge van die ondersoek moes die afgelope week bekend gemaak word nadat dit verskeie kere..
Continue reading…

Share with friends on Social Media (if share buttons do not show below, disable your ad blocker temporarily):

Enjoyed this post? Share it!