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HEALTH BENEFITS IN SA
The health benefits industry is both complex and dynamic – situated in an interesting market which provides its members with diverse products and services. Nowadays legislation and the prospect of change makes the choice of a medical scheme much more difficult. During the evaluation of a suitable medical scheme, members can use the following guidelines:
During hospitalisation, members are subject to ward and theatre costs which are determined annually by the NHRPL and the different medical schemes. If a member should be hospitalised in any private hospital, the hospital group will undertake to only charge tariffs that have been agreed upon by the different wards and theatres. Tariffs for specialists and anaesthetists are normally higher than NHRPL rates and members may therefore experience a shortage. Schemes will provide plans where the coverage of service providers inside hospitals varies from 100% NHRPL to 300% NHRPL.
CHRONIC MEDICATION COVERAGE
Legislation determines that all medical schemes must cover the 26 Prescribed Minimum Benefits.
These conditions are adapted yearly and include coverage for diabetes, epilepsy, asthma, high blood pressure and more. Coverage under these schemes consists of generic medicine.
As with the chronic medicine, the schemes also provide coverage for cancer and relevant benefits, with certain restrictions per plan. Most schemes also provide members with an Oncology Programme where the member receives extra benefits should they register for the benefits.
Advanced Radiology (MRI/CT scans) can be a huge expense if the scheme subtracts the cost as part of the member’s medical savings account or if a restriction is put on the maximum amount of funds available for each member per year. Schemes in most cases require members to motivate the use of services, while approval beforehand is critical.
Out-of-hospital cover is financed by the member’s medical savings account (MSA). The maximum contribution that can be made to the MSA is limited to 25% of the member’s total monthly contribution. Some medical schemes have lowered the MSA contribution and it varies between 0% and 25%. The funds in the MSA remain at all times the property of the member and gets carried over from year to year.
KLK offers its members not only the services of health benefits consultants, Verso Health (pty) Ltd, but the services of two professionals in Upington and Calvinia that help members resolve their medical scheme queries.
The various contact persons are:
ENSURE YOU HAVE THE RIGHT COVER
- Always be sure that your insured amount is sufficient to include both an increase and decrease in value. Also ensure that your items are insured against the current exchange rate.
Do not insure selectively.
- Always make sure that your high-risk items, such as your cell phone and laptop, have all-inclusive coverage.
- If you are an avid camper, diver or golfer, we would advise you to specify all the equipment under the all-inclusive section of your policy.
- Whether you are covered or not, it is also crucial to stay alert during holiday times. Always make sure that your possessions in the hotel or resort are secure.
- If it seems unsafe at all, keep your valuables in the safe that most holiday destinations provide.
TIPS TO STEER CLEAR OF CAR THEFT
- Always try to park your car in a garage or well-lit area.
- Be sure to always lock your car and close your windows.
- Make sure to always activate your car alarm or use a steering or gear lock.
- Never leave valuable items in your car.
- Rather lock your possessions in the boot – out of sight.
- Remove all CD players, radios and tape decks if possible.
- Always carry your keys on your person, to ensure that no one gains access to either your house or office.
- Parking areas and business areas remain a target. Always park in areas that are patrolled and that have limited entrances and exits.
BE ALERT AND ATTENTIVE – NEGLIGENCE PROMOTES CRIME
WHAT TO DO WHEN YOU ARE IN AN ACCIDENT:
- Stop the vehicle immediately.
- If someone is critically injured or in a life-threatening condition, it is imperative that you do not move the vehicle.
- Don’t drive the vehicle if mechanical damage could take place.
- Get the other driver’s details – name, address, telephone number, make, model and registration number of their vehicle, as well as the name of their insurance company.
If the vehicle belongs to someone else, ensure you are supplied the owner’s name, telephone number and address.
Give your name and other details to whomever has a reason to ask you.
MOST IMPORTANT: Never admit that you could have been the cause of the accident.
- Try to identify witnesses. Write down their names, numbers and addresses (and if possible, their impressions of the accident).
- Make a note of the police officer/traffic officer’s number and rank.
- Make a note of where exactly the accident took place – name of the road and area or details of the area of the highway (e.g. between certain exits, distance to the closest town/city) and the conditions (weather conditions as well as the condition of the road).
- Make a note of the exact time and date on which the accident occurred.
- Make a sketch of the exact positioning of the car during the accident.
- If your vehicle needs to be towed, make sure the tow-truck driver is affiliated with SATRA. You can identify the tow-truck driver by the SATRA logo. Make sure you know where your vehicle is being towed to.
- Report the accident to the SA police within 24 hours of the accident happening, even if it was only a small accident. Show them your driver’s license and give them all your details.
CONTACT YOUR BROKER IF YOU’RE NOT SURE WHAT TO DO