With the year speeding by, it s a good time to pause and reflect on how your health journey is going this year. This issue will help you do that.

Transcription

1 Issue 3 May 2017 Chairman s update With the year speeding by, it s a good time to pause and reflect on how your health journey is going this year. This issue will help you do that. It s also time to pause to say goodbye and hello. We say goodbye to our Principal Officer of many years, Belinda Phillips, who left her position at the end of April. On behalf of the Board of Trustees, I would like to thank Belinda for her years of hard work and relentless dedication to excellence. She has helped to build the SAB Medical Aid into a leading medical scheme and your partner in good health. As she turns the page in her life s story, we wish her every success in all future endeavours. We would also like to say hello and offer a warm welcome to Nokukhanya (Khanya) Sibiya, our new Principal Officer who joined us this month. I have no doubt that Khanya will help take the Scheme to even greater heights. Read the short introduction below to get to know your new Principal Officer better. Please remember that our Annual General Meeting (AGM) takes place at SAB Central Office, 65 Park Lane, Sandton, on 15 June We look forward to seeing you there! The AGM communication will be distributed via and post. We encourage you to participate even if you are unable to attend the meeting in person. Yours in good health, Brian Aslett Chairman of the Board of Trustees Meet your new Principal Officer I am Nokukhanya Sibiya, known as Khanya. I have worked in the private healthcare industry for over 20 years in various positions. I find the healthcare industry challenging and forever changing, which is conducive to personal growth. My experience covers a wide range of areas such as governance, compliance management, risk management, stakeholder engagement, research, report writing, negotiations, human resources management, operations, financial management, contract and third-party service provider management, marketing and communication. I hold a Master of Business Administration degree from De Montfort University, Business School in the United Kingdom; a Business Administration Honours in Public Policy and Management from Robert Gordon University, Aberdeen, Scotland; a Diploma in Industrial Relations from Damelin College and other short courses. Khanya Sibiya I learn the most from interacting with people from all walks of life. Every person that I meet has something to share that will continue to contribute to my growth; hopefully in the process, I can share what I know with the other person. I enjoy reading and travelling. Both activities allow me to learn and grow. I am looking forward to the challenge and opportunity to contribute to the solid foundation that has been laid at the SAB Medical Aid. Khanya Sibiya Principal Officer

2 Are you due to receive a salary update and/or promotion in July 2017? This salary increase may push you into the next SAB Medical Aid salary bracket. If this happens, remember that your monthly contribution will increase. Contribution table Basic Monthly Income (R) Main Member ESSENTIAL Total Monthly Contribution Adult Child Main Member COMPREHENSIVE Total Monthly Contribution (includes 10% savings) Adult R911 R911 R272 R2 157 R2 157 R R1 071 R1 071 R320 R2 310 R2 310 R R1 102 R1 102 R329 R2 359 R2 359 R R1 138 R1 138 R341 R2 405 R2 405 R R1 173 R1 173 R351 R2 454 R2 454 R R1 211 R1 211 R364 R2 511 R2 511 R R1 259 R1 259 R377 R2 559 R2 559 R R1 305 R1 305 R393 R2 611 R2 611 R R1 352 R1 352 R409 R2 659 R2 659 R R1 400 R1 400 R421 R2 709 R2 709 R810 Child Giving up smoking is the single most important step any smoker can take to improve the length and quality of their lives. With World No Tobacco Day on 31 May, it s a good time to kick the butt; but why is quitting so tough? One of the reasons is that many smokers are addicted to the nicotine found in tobacco products. Another reason is that, after many years of smoking, it becomes part of our daily routine almost like an old familiar friend. So it takes time, and often a few attempts, to say goodbye for good. But remember, millions have quit completely, and you can be one of them. Since giving up smoking is tough, improve your chances of success by getting help. Join a good programme, like Smokenders or Allen Carr s Easyway. These programmes are not covered by your Scheme benefits but are often supported by wellness and rewards programmes. Enquire directly if you are on one of these programmes. Other support options include Nicotine Replacement Therapies (NRT) and psychological counselling. Calling the ladies! Women who smoke often have a harder time getting pregnant and smoking during pregnancy can harm your unborn baby s development. With International Day of Action for Women s Health on 28 May, this certainly is the right month to take the first steps towards becoming smoke free. Visit the website women.smokefree.gov and click on the Tools tab for great resources and tools specifically designed to help women quit smoking. The Heart and Stroke Foundation South Africa says: Smoking is so NOT cool. Find out why by going to 02

3 Understanding the appliance benefit This benefit covers a medical and/or surgical appliance required for recovery or treatment of a medical condition. Examples are a hypertensive member who needs a blood pressure monitor, an asthmatic member who requires a nebuliser or someone who needs a wheelchair. Remember: Appliance benefits are subject to pre-authorisation. Call Members with chronic conditions who wish to receive this benefit need to make sure they are registered on the relevant chronic disease programme. Members with acute medical conditions wishing to receive this benefit need to show evidence of some form of treatment. The member s treating practitioner also needs to provide a letter of motivation for the particular appliance. For hearing aids, the audiologist reports and quotations must be submitted for review. Once authorised, you can submit an account for the appliance and the benefit will be paid up to the available benefit limit. Limits differ depending on which benefit option you ve chosen. Time frame Essential Comprehensive Appliance limit Annual benefit R5 990 per family R per family Hearings aids Once every three years Forms part of the appliance benefit Forms part of the appliance benefit Hearing aid repairs Once every two years R2 500 per beneficiary R2 500 per beneficiary If your benefit is not enough to cover your appliance, you could request an ex gratia benefit. This is a goodwill payment which the Scheme may consider paying after reviewing the situation. All documentation should be submitted via to auths@sabmas.co.za. Explaining the ex gratia benefit Ex gratia benefits are benefits that the Scheme legally does not need to pay, but still pays following careful review. The benefit may be awarded to cover clinically appropriate treatment where benefits have run out. The Ex Gratia Committee, which consists of two Trustees, the Principal Officer, two medical practitioners and a medical scheme specialist, reviews all ex gratia applications. The following information is key for an ex gratia payment to be considered: A completed ex gratia application form. Please visit and click on the information tab, member forms and ex gratia application form. information/documentation to support your case. This could include a letter of motivation or clinical report from your treating practitioner, or recent scans/test results. Quotations from relevant service providers. Make sure the service providers have valid practice numbers. Three quotations are required from three different providers if the request for funding is greater than the benefit limit for an appliance or prosthesis. In deciding whether or not an ex gratia payment will be granted, the following is considered: The type of treatment required: routine treatment versus treatment for a chronic or life-threatening illness. Whether the treatment is clinically appropriate. How cost effective the treatment is. Alternative treatment. There is no guarantee that the application for an ex gratia benefit will be approved. If a fully-completed application form is not submitted along with all the required documentation, the process can be delayed. 03

4 SAB MEDICAL AID? The following people can be registered as dependants: biological child(ren) adopted child(ren), or a child in the process of being adopted your spouse or partner grandchildren, if you are the legal guardian or if the parent is registered as your dependant on the Scheme financially dependent parents and parents-in-law. To register a dependant on the SAB Medical Aid, please go to click on the information tab, click on member form and then download and complete the dependant application form. Remember to provide any supporting documentation required, such as a certificate of membership from a previous medical scheme with an end date. This is important to avoid overlapping scheme membership, which is illegal. The completed form should be sent to your People Department. Application forms sent directly to the Scheme are re-routed through your People Department who coordinate this process. Underwriting may apply if: You register a dependant later than 90 days from when they become eligible through either marriage, birth or adoption; or If you add a financially dependent parent/parent-inlaw on a voluntary basis, such as where they were not your dependants on your previous medical scheme and do not join SAB Medical Aid at the same time as you. Underwriting may include: a 3-month general waiting period a 12-month condition-specific waiting period for pre-existing conditions a late joiner penalty, depending on the period the dependant was not on a previous medical scheme. Dependants who can t stay on the Scheme include: ex-spouses or partners, even if payment for medical scheme cover is stipulated in the divorce agreement the parents of an ex-spouse or ex-partner a grandchild who is no longer in your legal custody or whose parent is no longer registered as your dependant on SAB Medical Aid. Check the numbers on the back of your membership card. If a dependant s identity document number (ID) is incorrect or incomplete, please a copy of the ID to membership@sabmas.co.za. Remember to write your membership number on the ID copy. Keep your personal information up-to-date. Make sure we have your latest postal and address, banking and contact details. 04

5 Say good-bye to the flu bug and hello to good health this winter. It s not too late to vaccinate! Getting a flu vaccination is especially important for the elderly, young children, pregnant women and people with chronic medical conditions. The vaccination continues to offer benefits when given at any time during the flu season, but the earlier you get vaccinated, the better. A flu vaccination PLUS the correct vitamins EQUALS a healthy productive winter, with little time off sick. The flu vaccination may also make your illness milder if you do get the flu. Your annual flu vaccination is covered by your wellness benefit a range of additional benefits, over and above your routine (day-to-day) benefits and/or savings. Wellness benefits are available to all members. Don t delay. Get your flu shot today. Oncology claims If you or one your dependants is registered on the oncology programme, and anything related to your treatment changes, please let us know immediately so that we can adjust your authorisation accordingly. This will ensure that your treatment costs (claims) are funded correctly and do not eat into your routine benefits and/or savings. Send any updated prescriptions and/or medical motivations for additional radiology and pathology tests by to oncology@sabmas.co.za or by fax to for approval. 05

6 Have you heard about stale claims? Have you ever had a claim rejected because it was stale? A stale claim is a claim that the Scheme receives for the first time more than four months after the health service was delivered. According to Scheme rules, the Scheme can refuse to pay these very late claims. To avoid claims from becoming stale, make sure that you, or the healthcare provider, submits the claim on time, well before the four month period is up. All accounts for payment (claims) should be sent to claims@sabmas.co.za. For speedy payment, the following information should be clearly reflected on the claim: practice name and number member s details and membership number patient s details date of service ICD-10 code (diagnosis codes) tariff code (what type of treatment rendered) amount due for payment. If you have already paid the service provider in full and you need to be reimbursed, please attach a copy of the receipt so that we know to pay you directly. Keep an eye out for your tax information sheets, which will be mailed around mid-june The tax season runs from 1 July to 30 November The information on your tax information sheet is shared with the South African Revenue Services and should be included with your tax return. BENEFIT EXCLUSIONS Like most medical schemes, we don t cover costs related to treating obesity, self-inflicted injuries, injuries resulting from professional sport and holidays for healing purposes. While we cover dental procedures, we don t cover dental treatment under general anaesthetic or conscious sedation once the patient is older than eight years. We also don t cover cosmetic procedures like certain plastic, reconstructive surgeries and dental implants. Please call the Customer Care Centre on for a list of exclusions. 06