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Medical

Health benefits in South Africa

The health benefits industry is complex and dynamic in a very interesting market that offers members diverse products and services. With current legislation and prospects of change the choice of a medical aid becomes very complex. When evaluating a suitable medical aid, members can use the following guidelines to assist them:

Hospital cover

During hospitalisation, a member is liable for ward and theatre fees that are annually set by the NHRPL and the respective medical aids. If a member is admitted to a private hospital, the hospital groups undertake to charge only the agreed rate for the ward and theatre fees concerned. Specialists and anaesthetists normally charge higher rates than the NHRPL and members may have to make an excess payment. Medical aids offer plans with the cover for service providers in a hospital varying from 100% NHRPL to 300% NHRPL.

Cover for chronic medicine

Legislation provides that all medical aids must cover the 26 prescribed minimum benefits (PMBs). These conditions are adapted annually and include cover for diabetes, epilepsy, asthma, blood pressure, etc. The cover by the respective medical aids mainly includes only generic medicine based on a medicine formula. If the list of PMBs does not apply to a member, the medical aids in most cases offer plans with alternative cover at a higher monthly cost.

Oncology programmes

Like with chronic medicine, medical aids offer cover for cancer and related benefits, with limitations per plan. Most of the medical aids also offer members an oncology programme in which the member receives additional benefits if he were to register for benefits.

Advanced radiology

Advanced radiology (MRI/CT scans) can be a major expense if the medical aid charges the costs as part of the member’s medical savings account or limits the maximum available to the member per year. Medical aids in most cases require members to motivate the use of the services and prior approval is essential.

Out-of-hospital cover

Out-of-hospital cover is funded by a member’s medical savings account (MSA). The maximum contribution to the MSA is limited to 25% of the member’s total monthly contribution. However, certain medical aids have reduced the MSA contribution and vary between 0% and 25%. The money in the MSA remains the property of the member at all times and surplus funds are transferred from one year to the next. KLK not only offers its members the services of health-benefit consultants, namely Verso Health (Pty) Ltd, but there are also two staff members in Upington and Calvinia respectively with whom members can discuss their enquiries about their medical aid daily.

The respective contact persons are:

Charl Holwill Makelaar – Charl Holwill – charl@holwill.co.za Tel: 021 035 0388

KLK Upington – Lize Jooste – medies@klk.co.za Tel: 054 337 6289

KLK Calvinia – Lizette Lambrecht – Email: Lizette@klk.co.za  Tel: 027 341 8219

KLK Calvinia – Elsie Louw – Email: ina@klk.co.za Tel: 027 341 8213

Short term

Make sure you are insured correctly:
  • Make sure that your insured amount is sufficient to make provision for appreciation and depreciation. Insure your items at the current replacement value.
  • Do not insure selectively.
  • Make sure that high-risk items like your cell phone and laptop have all-risk cover.
  • Eager campers, divers or golfers are advised to specify the equipment under the all risk section of a policy.
  • In addition to insurance, it is essential to remain security conscious during holidays.  Make sure that your possessions in the hotel or holiday resort are safe.
  • If you are in doubt, keep your valuables in a safe, which is available at most holiday destinations.
  Evade car thieves like this:
  • Park your car in a garage as far as possible, or in a well-lit area.
  • Make sure your car is locked properly and that all the windows are closed.
  • At all times activate the alarm system or use a steering wheel or gear lock.
  • Do not leave valuable items in the vehicle. Rather lock these in the boot, where they are not visible.
  • Remove all CD players, radios and tape decks if possible.
  • Carry all keys with you.  In this way you can prevent criminals who break in from gaining access to your house or office, for example.
  • Parking lots and business districts remain a target.  Park where there is good supervision and limited entrances and exits.

Be aware and observant, because anybody’s negligence promotes crime.

UPINGTON

Braam de Klerk: – +27 (054) 337 6277 / 082 338 1276 – braam@klk.co.za

Loëla Myburgh: – +27 (054) 337 6236 – versekering@klk.co.za

CALVINIA

Lizette Lamprechts: – +27 (027) 341 8219 – lizette@klk.co.za

Accident assistance

What to do if you have been in an accident:
  • Stop immediately. If someone has died or been injured, do not move the vehicle.
  • Do not drive the vehicle if there could have been mechanical damage.
  • Get the other driver’s particulars – name, address, telephone number, make, model and registration number of their vehicle, the name of their insurer and, if the vehicle belongs to someone else, the name, address and telephone number of the owner.
  • Give your name and other particulars to whoever has reason to ask for them.
  • The most important thing is NOT to ever admit that you could have caused the accident.
  • Try to get hold of witnesses. Write down their names, addresses, telephone numbers and, where possible, their impressions of the accident. Make a note of the number and workstation of the police or traffic officer.
  • Make a note of where the accident occurred – name of road and area, or details of the freeway section (for example between which offramps, distance from nearest town) and the conditions (weather, view, condition of the road).
  • Make a note of the exact time and date of the accident.
  • Sketch the position of the vehicle during the accident.
  • If your vehicle has to be towed, make sure that the operator is SATRA affiliated. Make sure that you know where your vehicle is being taken – you can identify the operator by the SATRA sticker.
  • Report the accident to the South African Police Service within 24 hours, even if it was just a small accident. Show your driver’s licence and provide your full particulars.
Contact your broker if you are not sure what to do.

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