What is a waiting period?

A medical aid’s waiting period is a time period in which a medical aid beneficiary has to pay the normal monthly contribution but is not yet entitled to make a claim for any of the scheme’s benefits. Medical aids are allowed by law to enforce this waiting period. There are two main types of waiting period:

1. A general waiting period that lasts up to three months. During this time, neither you nor your dependants may claim form the medical aid, aside from the prescribed minimum benefits. When choosing a medical aid scheme, look for one that includes these prescribed benefits.
2. A condition-specific waiting period lasting up to twelve months. If a member has pre-existing medical conditions, the beneficiary is not entitled to medical aid benefits for a condition for care, treatment, advice or diagnosis that was received or recommended within a period of 12 months ending on the date the beneficiary made the application for membership to the medical aid scheme. This condition applies to both you and your dependants.

When can a waiting period be applied?

In accordance with the Medical Aid Schemes Act of South Africa, a medical aid company may impose a waiting period of three months in the following circumstances:

• If the applicant has not been a member of the medical aid scheme for a time period of no less than 90 before that date of the application.
• If the applicant was a previous beneficiary of a medical aid scheme for up to 24 months, ending less than 90 days before the date of the application.
• If the applicant has had previous medical aid coverage for over 24 months but chooses to join another medical aid scheme selectively, on a voluntary basis.

When does a waiting period not apply?

Although there are not many medical aids with no waiting period, there are circumstances in which a waiting period will not apply:

• For a child dependant who is born during the membership period
• For members who change from one benefit option to a different benefit option within the same medical aid scheme. This does not apply if the member is still subject to the waiting period on their current benefit option. If this is the case, the remaining period will apply when the member changes benefit options.
• If an employer chooses to terminate or change to medical aid scheme of its employers, this transfer should take place in the beginning of the financial year, or the medical scheme must be given reasonable notice. In the other word, of the change to a different medical aid is not the choice of the employee (but rather the choice of the employer) the waiting period will not apply.

Tips to avoid a long waiting period

Medical aids impose harsher waiting periods on people who join medical aid schemes with having belonged to another medical aid scheme in the past. Longer waiting period are also given to people who have had a break between memberships. This is to avoid people from only joining a medical aid scheme when they are sick and need the benefits. To avoid incurring these longer waiting periods, join a medical aid as soon as you can afford to do so and ask your employer if they will assist you with medical aid payments. Don’t wait until you fall ill before joining medical aid as it is intended to be used as a preventative measure.

If you change medical aid schemes voluntarily before the waiting period (particularly a condition-specific 12 month waiting period) is up, the new medical aid scheme can impose its new waiting periods as well as adding the remaining amount of time left on the waiting period from your previous scheme.

Where are Life Health Care hospitals situated?

Life Health Care offers a range of healthcare services throughout the country, with hospitals in 7 of the 9 South African provinces. Life Health Care facilities can be found in the most populated metropolitan areas, including Pretoria, Johannesburg, Durban, Cape Town, Port Elizabeth, Bloemfontein and East London. The range of facilities operated by Life Health Care includes multi-disciplinary hospitals with the latest technology, stand-alone facilities and community hospitals. Each facility is adapted to meet the local needs and demands in various regions countrywide.

The Life Health Care Hospitals provide services to the medically insured market. The acute care hospital network includes general hospitals of various sizes with high care units, intensive care units, emergency units, operating theatres, cardiac units and maternity units. There are a number of other specialized facilities that also provide either outpatient or inpatient services, such as:

• Acute rehabilitation
• Mental healthcare services
• Chronic renal dialysis
• Radiation and chemotherapy oncology

Healthcare services

Life Esidimeni is a healthcare service that provides long term chronic and acute hospitalization services to state patients. The Life Occupational Health service also provides occupational and primary healthcare services to employer groups in the sectors of industry, commerce, parastatels, correctional services and mining.

Life Health Care Hospital Division

There are 7665 beds in the Life Health Care network, situated all over South Africa as well as in Botswana. The hospital network also has a support bases consisting of over 2700 specialists and doctors.  Hospitals generally provide inpatient treatments for emergency care and elective care. Within the hospital are a number of specialized departments:

• Life rehabilitation: Life Health Care has 6 adult units and 2 pediatric units dealing with acute rehabilitation services. This is the country’s leading provider of private rehabilitation services, operating almost 50% of South Africa’s private acute rehabilitation beds (229 beds). The units offer cognitive and physical rehabilitation for patients who have been disabled by brain or spinal trauma, strokes, or other disabling injuries and conditions.
• Mental health units: this specialized care is provided in 6 healthcare treatment facilities around the country, with a total of 172 beds. Facilities are bases in Gauteng, the Eastern Cape and Gauteng, either stand-alone or within acute care hospitals.
• Renal division: This service offers 40 dialysis stations through a network of 5 facilities in Gauteng and the Eastern Cape, providing chronic and acute renal dialysis services.

The private hospital facilities are complemented by related health care services:

• Life Esidimeni: Meaning place of dignity, this subsidiary operated 4171 beds under 12 facilities that provide long-term care for chronically ill, indigent patients. Life Esidimeni locations deal with frail care and mental health care patients who require chronic rehabilitation. One district hospital also provided acute care for indigent patients.
• Life Occupational Health: With 289 on-site clinics, Life Occupational Health is South Africa’s leading provider of primary and occupational healthcare services on-site to large employer groups in a range of industries, including government correctional service facilities, parastatals, industry, mining, and commerce.
• Life College of Learning: This higher education institution has over 1350 students enrolled in it. The college was established 12 years ago to offer certified nursing courses and tertiary academic degrees. The Life College of Learning also offers training courses to upgrade service standards and practical nursing as well as courses to improve clinical skills.
• Life Healthcare Foundation: This organization was established in 2007 and is managed as a trust with independent and company trustees. The Life Healthcare Foundation provides different resources in the wellness and health arenas as part of Life Health Care’s social investment contribution. The foundation provides hospital and nursing services as well as other financial sponsorships.

It is for this reason that Absa has come up with a range of services to help the management of businesses effectively bring about workplace productivity through adequate health care and wellness for their employees. This may be the strategic move that your company needs to move you in to the next phase and help you be the best in the market.

If you are now wondering exactly how the Absa Medical Aid Scheme will help you become more productive, then here are a list of some of the services that this scheme offers its customers:

1.  Absenteeism management solutions

This service will not only monitor the amount of absenteeism that an organisation has, but they will analyse why this is occurring and will provide your organisation with planning and training on how to deal with this. This includes training management to review sick notes as well as get the absent staff back up to speed with what happened whilst they were ill.

2. Acturial integrated risk analysis and reporting

There is no point in having a strategy in place for you business if you cannot adequately assess the effectiveness of the strategy. For this reason, Absa will provide you a report that shows you the effectiveness of the planning and strategy, as well as the return o investment which it is providing for your organisation. This is important, especially in small businesses where the initital outlay of funds needs to be proven as a sound investment.

3. Aids management solutions

Unfortunately in South Africa, we have one of the highest HIV/Aids rates out of all of the countries in the world. What is more is that employees are not legally obliged to make their employees aware of their status. This means that many organisations in South Africa regularly have to deal with absenteeism due to HIV/Aids related illnesses.

What is more is that many organisations do not have the proper procedures in place to help their employees with the disease. For this reason, Absa has developed a service which helps management and employees deal with the disease. This includes voluntary counselling and testing programmes, workshops, and surveys in order to tailor programmes for those employees and their specific risk profiles. One of the most common downfalls in businesses is that they do not know how to deal with the stereotypes that surround the disease and how to manage these stereotypes. Absa will provide businesses with the means to do so through their medical aid scheme.

4. Health care and corporate wellness strategy development

One of the biggest things that South African organisations lack in internal communication plans to help develop employee loyalty. It is therefore a service that Absa offers in order to develop an integrated health and wellness programme that will be beneficial to all employees of the organisation and will help improve employee loyalty.

5. Intermediary services

Should your business be looking for a medical aid scheme and are not sure of which scheme is best suited to meet the needs of your business, then Absa will help you find the best medial aid solution for your organisation.

These are merely a few of the great service which this medical scheme has to offer. For more information, you should contact Absa today to help you with your medical aid programme.

If you are a public service employee and have never heard of GEMS – Government Medical Health Scheme then I definitely think that you should take a look at their website. Not only does this website provide you with a history of the organisation, but also displays their vision, mission and core values so that you can be reminded that you are in good hands with them. For all prospective members, if you visit www.gems.gov.za, you will able to view or print out a copy of their latest marketing brochure in any language you like. This will help you find the right medical aid solution for you and your family’s needs.  If you still find yourself wondering why you should join, why would you not want to join a medical scheme that understands the exact needs of someone in your industry and who will provide cost effective and comprehensive cover? In addition to this, GEMS has stated that every fortnight they pay out any money owing to any of their members which means that you do not have to wait for months for your repayment should you have over paid, unlike other medical aid providers.

If you are wondering exactly who may join GEMS, then take a read of the list below:

• A National Department listed in Schedule 1 of the Public Service Act;
• A Provincial Department listed in Schedule 2 of the Public Service Act;
• A Provincial Administration listed in Schedule 2 of the Public Service Act;
• Organisational components listed in Schedule 3 of the Public Service Act or
• You belong to any employer group approved by the Scheme.

For those of you who used to work in the public service and are now a pensioner, then there is also an opportunity for you here as they pay for the medical expenses of pensioners. If you are now intrigued, then why not visit www.gems.gov.za and take a look at the quick and easy application process on offer to you. Firstly you can visit one of the GEMS offices and get the forms yourself. But why would you do that when (second point) you can download all of the application forms online and just fax them through their head office. For those of you who are looking to contact them for any reason, you can do so via fax on 0861 000 4367, or email them at enquiries@gems.gov.za. If you prefer to do things the old fashion way or just prefer face to face contact, then why not visit the GEMS Regional Office and drop your application forms off there directly.

There are also a number of options available to public service employees and depending on your needs you can choose from the following options:

1. Sapphire
2. Beryl
3. Ruby
4. Emerald
5. Onyx

Each membership fee is based on the cover that you choose as well as the salary bracket that you fall in to. This means that you will never be charged at a rate that GEMS know you cannot afford. This therefore is one of the better medical aid schemes that are available to public service employees.

What many people get confused with is that the medical aid providers have an exclusion policy for pre-existing chronic diseases which means that in the first year of membership, you will not be covered for chronic illnesses which include thyroid problems such as Hyper or Hypothyroidism, Arthritis, as well as HIV and Aids.  However, this does not mean that you cannot enjoy the full benefits after the exclusion period is up. If you are now wondering why medical aids have these exclusion periods, then you should ask a representative from whichever medical service provider you are joining to explain them in full to you. One source claims that the reason why medical aids do this is because they pool all of their funds in order to provide care for those who need it most at any given time (www.vitacare.co.za). In addition to this, it allows them to safe guard themselves against members who may use up all of their benefits in one year and then leave the medical aid scheme.

For those of you who are looking for medical aid schemes for people with HIV and Aids, then you should contact any of the medical service providers in South Africa, such as Discovery Health, Fed Health or Momentum who can take you through the different policies that they have on offer. This way you will be able to see which medical aid provider has the best scheme for you. Many medical aids additionally have specialised schemes for those people dealing with HIV and Aids and the best thing is that you generally do not have to pay more for these programmes. It is also imperative that you join a medical aid scheme as they will be able to help you manage you the disease by facilitating the continuous monitoring of your CD4 counts and can provide you will all of the anti-retrovirals that you need in the correct dosages. The majority of the medical aid providers will additionally provide you with all the nutritional information and guidance in order to help you along your journey and to ensure that you live a long and healthy life.

If you are concerned that you application for medical insurance will be denied because of the fact that you are HIV positive, then you have no reason to fear as no medical aid provider can deny medical insurance based purely on the basis that you are HIV positive. If you apply for medical insurance and are denied because of the fact that you are HIV positive, this medical aid provider is acting in an unlawful manner and can be taken to court because of it. It is therefore imperative that if you are diagnosed with HIV or Aids that you ensure you know your rights as many people will try to discriminate against you and would be doing so unlawfully.

For more information about how to cope with the disease and the best medical aid providers for people living with HIV or Aids, then you should definitely take a visit to your local clinic or you GP who will be able to provide you with all the help you need. In addition to this, there are specialised HIV and Aids clinics in South Africa that can help you with the emotional and psychological effects of HIV such as The  Well Project (www.thewellproject.org) and Avert (www.avert.org).

If you find yourself asking “What’s different about Momentum medical aid?” and the above did not convince you to take a look at what they have to offer then why not consider this – they are the fifth largest medical aid provider in South Africa and service over 90000 families across the country. In addition to this, they offer their members great savings rewards and lower monthly contributions if you use one of their schemes associated providers. If I have now sparked your interest, then why not visit www.momentum.co.za and take a look at the six medical aid options available.

The six medical options available are:

• The Ingwe Option which provides entry-level cover;
• The Access Option which provides cost-effective, unlimited private hospitalisation at a group of network hospitals;
• The Custom Option which was designed for members who require unlimited private hospitalisation;
• The Incentive Option was designed for members who require unlimited private hospitalisation and average day-to-day cover;
• The Extender Option which provides unlimited private hospitalisation, as well as extensive chronic cover and day-to-day benefits;
• The Summit Option which was designed for members who require unlimited private hospitalisation, as well as extensive chronic cover and day-to-day benefits but would prefer to chose their own service providers.

We all know it is wise to have a decent medical health plan, particularly if you are a family with children so finding the right kind of cover at a reasonable monthly cost is important. The Momentum medical aid options are definitely worth considering and the company is worth contacting if you need questions answered on any of the packages.

Bonitas offers 6 key types of medical aid, namely:

• BonComprehensive
• BonEssential
• BonSave
• Standard
• Primary
• BonCap

Bonitas structures their product offerings according to various levels of healthcare needs. This allows members to accurately determine what kind of product they need, based on their level of health and medical aid needs.

The four categories of healthcare needs are:

Major Medical

• Covers in hospital medical expenses and major medical events such as surgery

Chronic medication

• Covers medication for serious and chronic conditions (i.e. conditions that require medication on a continuous ongoing basis)

Supplementary

• Covers medical expenses incurred in or out of hospital

Out of hospital

• Covers out of hospital medical benefits (i.e. doctor’s visits etc)

In terms of Major Medical, being on the BonComprehensive would obviously provide you with the greatest amount of cover.  The reimbursement rate is at 300% Bonitas rate, and your cover is unlimited. The BonSave would reimburse you at 150%, while the BonEssential at 100%. Both of these also provide unlimited cover, and cover you at any hospital (i.e. you do not need to go to a specific Bonitas-affiliated hospital to be covered).

In terms of Chronic Benefits, the more comprehensive your medical aid plan, the more conditions you are covered for. The BonComprehensive covers you for 54 conditions, and provides up to R10 000 per member. The BonEssential and BonSave, on the other hand, only cover you for 26 conditions, and impose stricter rules for your cover.

With regards to Out of Hospital Benefits, BonComprehensive members have the benefit of a medical savings account, which allows them to manage their own medical expenses (for expenses incurred out of hospital). There is the advantage of an insured threshold which provides peace of mind that you are always covered. The BonSave also offers a medical savings account, but without the safety net of the insured threshold.

For Standard and Primary it is recommended that you visit doctors on the Bonitas network, which would ensure that you don’t get charged at above Bonitas rates.

Choosing the right Bonitas healthcare product for you can be tricky – there are so many options across the healthcare needs and the 6 types of medical aid you can join up for. Remember to bear these things in mind when making your decision:

• How many people in your family require healthcare cover?
• Are any of these people chronically ill?
• Do you require top of the range cover to ensure peace of mind, or are you happy with a more basic type of cover, knowing that you can afford day-to-day medical expenses yourself?
• Do you require a medical aid that pays out at doctor’s rates and not at standard medical aid rates?
• How much can you afford to pay in terms of medical aid premiums each month?

Bonitas Healthcare products span across a wide range of needs and budgets – finding the right one for you is simply a matter of identifying what you need!

As you get older, it is a sad fact that your health generally starts to deteriorate. Your health care needs can often increase exponentially at this time in your life, and you need good solid medical aid cover now more than ever.

A key issue for pensioners is that once retired, your monthly income becomes sufficiently squeezed, if it does not dry out completely. Having good retirement plans in place from an early age is essential in ensuring that you have enough money to continue paying for premium medical aid services. This is not always a viable reality, however, and the result is that older people end up paying for hospital plans only, most of which do not provide the kind of medical cover and care required by these aging citizens.

For many people in South Africa, their medical aid premiums are either fully or partly subsidized by their employers. This of course also comes to an end at retirement age (which for most people is 65). Some companies do offer options for post-retirement medical aid funding, so ensure you speak to your employers in advance to find out what your options are. It may be worth paying a higher contribution while you are still employed, to ensure you are covered for a number of years post your employment.

Sadly, there are no medical aids that offer you a “pensioner’s discount”, due to the fact that you become a greater risk as you get older. The other sad fact is that most, if not all medical aids do not willingly accept senior citizens to join their schemes if these people have not been a member from earlier on in their lives.

Whilst this may seem harsh and unfair, the reason for this is logical – medical aids do not want to take on members for whom it seems likely that they will need to frequently pay out for, when these members have not contributed much in terms of premiums. These situations would represent a loss for the medical aid providers, and the fact remains that these providers are running a business at the end of the day, and need to ensure they are able to run at a profit.

While some will accept pensioners with no prior medical aid history, the conditions and joining restrictions will most likely be strict. For example, harsh “late-joiner” fees are usually applied to these applicants. Further, cover restrictions are usually applied for a much longer period than they would be for a younger person. A person in their late 60’s, for instance, may be restricted from claiming for a particular condition for a full year after joining, whereas a person in their 20’s would only be restricted from claiming for the same condition for only 3 months.

The best thing for pensioners and senior citizens in terms of medical aid, is to ensure they join a scheme long before they retire, ensuring they will be able to continue on this scheme as they get older.

If you are looking for a medical that is right for you, you should let Bonitas take care of your family’s health, because they know how important your health is to them and also to yourself. Bonitas medical aid covers hospital and medical expenses and you will also find that all hospital medical rates are paid in full, as long as it is within the rates negotiated with them. The other great thing is that Bonitas medical cover does not only cover you in hospital but also out of hospital. If you are looking for healthcare plans and medical aids, and it does not matter whether those needs are basic or comprehensive, this trusted medical aid company has the right product for you.

This is definitely a cover suitable for everyone and hospital plans and their medical aids are welcome in most hospitals and medical practices around the country. This is medical cover that is customizable and it covers most, maybe even all your requirements. If this is what you are looking for then this is definitely the right medical insurance plan for you.

Medical aids usually do not cover any procedure or treatment for a pre-existing condition within the first year of joining a scheme.

This applies to pregnancy as well. While it is clear that pregnancy is not a disease or illness, and should this not be lumped in the same bucket from a medical aid point of view, the fact remains that medical aid providers need to weigh up the costs to them relative to what the member has contributed towards her medical care.

Medical aid is not cheap, and many young mothers (especially those without stable partners or husbands) are unable to afford the monthly premiums. Due to the high cost of being on a medical aid, there has been a trend in South Africa whereby pregnant woman join the scheme, stay on it during pregnancy, and then cancel their contracts shortly after the baby is born. (www.vitacare.co.za).

Most South African medical aid providers have now stopped accepting new members if they are pregnant, to protect themselves against what was becoming a burgeoning trend. While there are still one or two that do, these usually have very strict criteria for the women who can join. For example, they may have to be for university lecturers only, or be wives of men in a particular industry.

It is understandable for young women to want to join medical aids when they are pregnant, especially given the cost of giving birth. Giving birth in a private hospital can cost between R7 000 – R12 000, depending on the type of birth. Should your baby have complications and need to be hospitalised or kept in an incubator, the costs can quickly and easily elevate to over R30 000.

However, is it fair to expect a medical aid to cover these costs for a member who has paid no premiums up until this point? The reality is that for medical aids who do accept pregnant women, it is ultimately the long-standing members who are paying for this medical care through their own exorbitant fees.

It is difficult o judge women who suddenly seek out this option – in South Africa the prevalence of rape and sexual violence is frighteningly high, and often women don’t have a choice as to when they are impregnated, not to mention how or by whom.

However, women in stable, loving relationships should be advised not to join a medical aid scheme only when they get pregnant, but rather years before they contemplate having children. This protects them against all eventualities, and also protects the schemes and its long-standing members against having to pay more for their premiums to cover other peoples’ “unexpected events”.