AMALGAMATION OF AFROX MEDICAL AID SOCIETY WITH DISCOVERY HEALTH MEDICAL SCHEME

 
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AMALGAMATION OF AFROX MEDICAL AID SOCIETY WITH DISCOVERY HEALTH MEDICAL SCHEME
March 2014
Dear member

AMALGAMATION OF AFROX MEDICAL AID SOCIETY
WITH DISCOVERY HEALTH MEDICAL SCHEME

Following the amalgamation road show held in October 2013        What must I do now?
and a majority vote by members in favour of the proposed         You must decide which Discovery benefit plan to join as from
transaction, all members of the Afrox Medical Aid Society        1 May 2014.
(AMAS) will transfer to Discovery Health Medical Scheme
(Discovery) on 1 May 2014.                                       We’ve included a comprehensive Discovery product brochure
                                                                 that describes the benefits and contributions for the 19
Both the Competition Commission and the Registrar of             benefit plans you can choose from. Afrox active and retired
Medical Schemes have approved the transaction in principle       employees can choose to belong to any one of these plans.
and the Registrar’s office has agreed to a transfer date of 1
May 2014. The extension of the transfer date from 1 April        Please note that the Essential Saver Plan has been identified
2014 to 1 May 2014 is to ensure that the data transfer from      by Discovery as the default option for members
Metropolitan Health Group, the current administrator, to         who do not choose a plan before the transfer date.
Discovery Health (Pty) Ltd is done in an orderly manner and
members’ chronic conditions are dealt with appropriately. This   What is the cut-off date for Option Selection?
means that your membership of AMAS will end at midnight          You have to decide by no later than 14 April 2014 to
on 30 April 2014 and you will be automatically enrolled as a     either accept the automatic default Discovery benefit plan,
member of Discovery from 1 May 2014.                             the Essential Saver, or to choose another Discovery benefit
                                                                 plan that better suits your personal needs.
The next step is for you, the member, to choose your Discovery
benefit plan. This communication will help you to make an        I NEED HELP WITH CHOOSING AN
informed choice and answer some important questions related      APPROPRIATE DISCOVERY BENEFIT PLAN
to the transfer process.
                                                                 To help you choose the most appropriate Discovery benefit
Role of Alexander Forbes Health                                  plan to meet your personal needs you can access the
African Oxygen Limited has appointed Alexander Forbes            following:
Health as the broker consultants to AMAS members. Our role
is to assist the employer with the implementation process.       1. Contact Discovery Health Medical Scheme
We will guide and support you in understanding the Discovery
product and to choose the most appropriate benefit plan to       Discovery consultants will provide you with general
meet your individual needs.                                      information on the different benefit plans and contributions.
3. Visit the Alexander Forbes Health website
 Discovery Health Medical Scheme
                                                                 Alexander Forbes Health has designed a website for Afrox:
 Phone: 0860 99 88 77
 (24 hours a day, 7 days a week)                                 http://www.afhealth.co.za/afrox

 Email: healthinfo@discovery.co.za                               All the information you need to help you understand the
                                                                 Discovery product and to choose which benefit plan is best
 Visit any of the following Discovery walk-in centres:           suited to your needs is available on this site.

 Johannesburg                                                    A contribution calculator is also available to help you calculate
 Discovery Health                                                your family’s monthly contribution based on the company
 16 Fredman Drive                                                subsidy and the benefit plan you choose.
 Sandton
                                                                 4. Attend a Presentation and Help Desk Session
 Pretoria
 Discovery Health Building                                       Presentations will be held at all major Afrox sites nationally
 Corner of Oak and Tegel Avenues                                 to explain to members how the Discovery benefit plans work.
 Highveld Techno Park                                            Help desk sessions will also be held during the same day as
 Centurion                                                       the presentations to assist those members who need personal
                                                                 advice on which option is best suited to their needs. Please
 Cape Town                                                       note that help desk sessions will operate on a first come, first
 Discovery Health Building                                       served basis.
 Century City Boulevard
 Century City                                                    It is important to note that you attend a presentation prior to
 Milnerton                                                       attending a help desk session.

 Durban                                                          Please refer to the attached road show schedule for full
 Discovery Health                                                details on the presentations and help desk sessions. You
 41 Imvubupark Place                                             can also contact the Alexander Forbes MSU or access the
 Riverhorse Valley Business Estate                               Alexander Forbes Health website: (www.afhealth.co.za/afrox)
 Durban                                                          to confirm the details.

 Port Elizabeth                                                  CHOOSING A DISCOVERY BENEFIT OPTION
 Discovery Health
 BPO Building                                                    To choose a Discovery benefit plan you need to complete the
 Coega IDZ                                                       enclosed Option Form and return it to Discovery via:
 Zone 4
                                                                 Fax: 011 539 1673

2. Contact the Alexander Forbes Health Member Service Unit       E-mail: updatedetails.afrox@discovery.co.za
   (MSU)
                                                                 You may also hand deliver your forms to your Human Resource
Alexander Forbes consultants will assist you to understand the   representative.
Discovery benefit plans in more detail and will guide you in
choosing the option best suited to your needs.                   Remember that completed Option Forms must reach Discovery
                                                                 by the cut-off of 16:00 on Monday 14 April 2014.
 Alexander Forbes Health
 Member Service Unit (MSU)                                       (Note: We do not recommend using the SA Postal Service
                                                                 due to the irregular deliveries as a result of postal strikes
 Phone: 0860 100 666 or 011 269 2690                             and other delays).
 (office hours from 7h30 to 17h00)

 SMS the words “medical aid” and your contact number to
 31768 (normal sms cell phone rates apply) and a consultant
 will call you back within 24 hours

 Email: hcclientservices@aforbes.co.za
QUESTIONS AND ANSWERS                                                 Principal member          R988
Q: What support can I expect if I have an AMAS claim query            Spouse/ Partner           R778
   after 1 May 2014?                                                  Child (up to 21 years)    R395
A: The AMAS Call Centre at Metropolitan Health Group, the
   administrator, will remain open until 30 August 2014 to
   assist you with claims queries for services rendered              Discovery charges contributions for a maximum of three
   up to and including 30 April 2014.                                child dependants (up to age 21 years). The company
                                                                     will subsidise to a maximum of three children.
    Tel: 0800 003 149 or 011 703 3010
    (office hours 8h00 – 16h30)                                      Discovery charges dependants over the age of 21 at the
                                                                     adult dependant rate. Afrox will subsidise such
   Fax: 011 381 2399                                                 dependants (over 21 years but younger than 25 years)
                                                                     at the Spouse/ Partner rate provided the dependant is in
   Email: afrox@mhg.co.za                                            FULL TIME study at a registered institution of learning
                                                                     AND is fully dependent financially on the member. As is
Q: Will my membership number change with the transfer                the current practice, an annual declaration will be required
   to Discovery?                                                     confirming this.
A: Yes, you will receive a new Discovery membership card
   and membership number which is valid from 1 May 2014.             If the dependant is not in full time study but is fully
   Please inform your doctor and all other healthcare 		             dependent on the principal member, such a dependant
   professionals e.g. dentist, pharmacist, etc. of your              may remain on the medical aid but will NOT receive a
   new membership number as soon as you receive it.                  company subsidy. The member will be responsible for
                                                                     the full cost of the dependant’s contribution (as per the
Q: When will I get my new Discovery membership card?                 current policy).
A: You will receive confirmation of active membership
   and your new membership number via sms and email from          Q: What employer subsidy will apply if I chose a different
   Discovery by 1 May 2014.                                          plan?
                                                                  A: If you chose a plan different to the default option, the
    Membership starter packs will be delivered to Afrox offices      employer subsidy will be the lesser of the total cost of the
    for active employees or couriered to retirees during the         lower plan or the subsidy amount mentioned above.
    month of May 2014. The starter pack will include your
    new membership card and information on the Discovery             For example, if you chose the KeyCare Plus plan and you
    benefit plan you have chosen or the default plan.                earn between R6,651 to R8,800 per month, the total
                                                                     2014 monthly contribution will be R973 pm. The
    It will also provide you with information on how to contact      company subsidy will be limited to R973 pm and your
    the Discovery Call Centre and where to send your claims.         contribution will therefore be covered in full and you will
                                                                     not pay towards the plan.
Q: How do I calculate my new Discovery contribution?
A: A contribution calculator will determine the total 		              KeyCare Plus plan (R6,651 to R8,800)
   contribution for any Discovery benefit plan you choose.            Total Contribution            R 973 pm
   It will also work out your contribution after deducting            Less: Subsidy                 R 973 pm
   the company subsidy. You can access the contribution
   calculator on the Alexander Forbes Health website:                 Member Contribution           R     0 pm

    www.afhealth.co.za/afrox
                                                                     If you remain on the default plan (Essential Saver) which
    Members who do not have internet access can contact              costs R1,570 pm, the company will pay R988 pm and
    the Alexander Forbes Health MSU or attend a help desk            the balance of R582 pm is your contribution.
    session at one of the scheduled information sessions.
                                                                      Essential Saver plan (default option)
Q: How will my new Discovery contribution be deducted?                Total Contribution        R 1,570 pm
A: Your medical scheme contribution deduction process will
                                                                      Less: Subsidy             R       988 pm
   remain exactly the same (eg. via payroll or pensioner
   payroll or direct debit).                                          Member Contribution       R       582 pm

Q: What contributions are charged by Discovery for adult
   dependants?                                                       Alternatively, if you upgrade to the Essential Comprehensive
A: Discovery will charge the adult dependant rate for all adult      plan which costs R2,825 pm, the company will pay
   dependants in the month in which they turn 21 years               R988 pm and you will pay the balance of R1,837 pm.
   old. This applies to all dependents whether or not the
   dependant is in full or part-time study and is financially         Essential Comprehensive plan
   dependent on the principal member.                                 Total Contribution        R 2,825 pm
                                                                      Less: Subsidy             R       988 pm
Q: What will the company subsidy be after amalgamating
   with Discovery?                                                    Member Contribution       R 1,837 pm
A: In order to better align contributions and limit disruption
   to members on amalgamation, Afrox will increase the
   current monthly medical aid subsidy to the following
   amounts from 1 May 2014:
Q: Where do I submit my claims after 1 May 2014?                   Information on the PMB CDL Medicine List is available on
A: AMAS claims with a service or treatment date up to              the Alexander Forbes website: www.afhealth.co.za/afrox
   and including 30 April 2014 must be sent to AMAS                and on the Discovery website: www.discovery.co.za
   in the usual way. You have four months from the date
   of service or treatment to submit a claim for payment.          (Please note that you will only be able to access your
   This means that AMAS claims received up to                      personal portal on the Discovery website once you have
   31 August 2014 will be processed by the previous 		             received your Discovery membership number.)
   Administrator (Metropolitan Health Group).
                                                                   You may also request it from the Alexander Forbes Health
   Discovery claims with a service date from 1 May 2014            Member Service Unit.
   onwards must be submitted to Discovery and must
   include your new Discovery membership number.                   Due to the confidential nature of chronic conditions,
                                                                   Discovery cannot disclose any information, condition
Q: What happens if the chronic condition I am currently            or medication registered for a member to Alexander
   registered for on AMAS is not covered by Discovery’s            Forbes Health. It is therefore important, if you or your
   chronic benefit?                                                dependant(s) are currently registered for chronic
A: On the default Discovery benefit plan, Essential Saver,         medication on AMAS , that you contact Discovery Health’s
   you will have cover for the 27 Prescribed Minimum Benefit       Chronic Care Department on
   (PMB) Chronic Disease List (CDL) conditions.
                                                                   Tel: 0860 400 600
   Approved chronic medication on the Discovery Chronic
   Illness Benefit medicine list will be funded in full while      Email: chronicqueries@discovery.co.za
   approved chronic medication not on the medicine list will
   be funded up to the monthly Chronic Drug Amount                 to confirm whether your condition and medication will be
   (CDA) per condition or medication.                              covered on the default Discovery benefit plan, Essential
                                                                   Saver, or whether it may be necessary for you to upgrade
   Medication for chronic conditions NOT covered by 		             to a higher plan.
   Discovery’s Chronic Illness Benefit will be treated in the
   same way as medication for acute conditions and will be         Please ensure that you have this information before you
   paid from available day-to-day benefits.                        attend a help desk session.

   Members affected by this change will be contacted            Q: Oncology Benefit
   directly by Discovery’s pharmacists before the end of        A: Members registering for the Oncology benefit who choose
   April 2014 and will also receive a personalised chronic         to remain on the default Discovery Essential Saver plan
   benefit letter from Discovery.                                  need to be aware that a 20% co-payment will apply to
                                                                   cancer treatment costs in excess of R200 000 per
   Please bring information on your chronic condition/s to         beneficiary per 12-month treatment cycle. A higher
   a help desk session to ensure appropriate assistance to         limit of R400 000 per beneficiary per 12-month treatment
   any queries you may have.                                       cycle is available on the Comprehensive and Executive
                                                                   plans only.

Q: Will the medication approved as chronic medication by my        Discovery’s Oncology Case Managers will contact affected
   chosen Discovery benefit plan be subject to a co-payment?       members and advise them telephonically before the end of
A: Cover for PMB CDL conditions:                                   April 2014.
   You have full cover for approved medicine on Discovery’s
   medicine list if your pharmacist charges the Discovery       Q: What will happen to the benefits I have with Multiply?
   Health rate for medicine. For approved medicine that is      A: Membership to Momentum Multiply will terminate upon
   not on the list, Discovery will pay up to a set monthly         amalgamation but AMAS members will have FREE
   Chronic Drug Amount. You will be responsible for a              Discovery Vitality membership for the first four months
   co-payment where the cost of the medicine is more than          following the amalgamation date (i.e. 1 May 2014 to 31
   the Chronic Drug Amount or if the pharmacy charges more         August 2014). In order to qualify for this benefit, you
   than the Discovery Health rate for medicine.                    must complete the enclosed Vitality application form
                                                                   and return to Discovery. From 1 September 2014, if you
   Cover for non CDL conditions on Comprehensive and               choose to remain on Vitality you will pay the normal
   Executive Plans:                                                Vitality premiums. The premium will be deducted by debit
   There is no medicine list for these conditions. Approved        order from your bank account. To opt out, you must
   medicines pay up to a set monthly Chronic Drug Amount.          contact Discovery Vitality directly.
   You will be responsible for a co-payment where the cost
   of the medicine is more than the Chronic Drug Amount or
   if the pharmacy charges more than the Discovery Health
   rate for medicine.
Please refer to the enclosed Discovery brochure for more
   information on Vitality.

   The Vitality gym activation fee for Virgin Active and Planet
   Fitness gyms will be waived for CURRENT AMAS members
   who joined the gym through the Multiply programme prior
   to amalgamation.

Q: Will Gap Cover still be available?
A: Yes, the gap cover currently offered by Guardrisk AdmedGap
   to AMAS members on a voluntary basis will be offered
   to Discovery members. AdmedGap is a short-term
   insurance policy that covers the shortfall between the actual
   fees charged by healthcare service providers (anaesthetists,
   surgeons, other specialists, GPs, etc) and the medical
   scheme tariff for procedures done in-hospital. Depending
   on which Discovery benefit plan you choose, you can
   decide whether or not to keep gap cover.

   Guardrisk will also allow AMAS members not covered
   on AdmedGap at present to join the product free of
   underwriting during the first three months following
   the amalgamation (1 May 2014 to 31 July 2014). The
   monthly premium will be deducted by debit order from your
   bank account.

   For more information, please contact Guardrisk directly:

   Tel: 0860 102 936
   (office hours 8h00 – 16h30)

   Email: admed@guardrisk.co.za

   Website: www.admed.co.za
DISCOVERY HEALTH MEDICAL SCHEME CHRONIC DISEASE LIST 2014

                                                    Condition covered on Discovery
                                                                                        Condition covered on Discovery
Conditions covered on AMAS Base plan                Priority, Saver, Core and KeyCare
                                                                                        Comprehensive and Executive plans
                                                    plans
Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL)
Addison’s disease                                                     P                                 P
Asthma                                                                P                                 P
Bipolar mood disorder                                                 P                                 P
Bronchiectasis                                                        P                                 P
Cardiac failure                                                       P                                 P
Cardiomyopathy                                                        P                                 P
Chronic obstructive pulmonary disorder                                P                                 P
Chronic renal disease                                                 P                                 P
Coronary artery disease                                               P                                 P
Crohn’s disease                                                       P                                 P
Diabetes insipidus                                                    P                                 P
Diabetes mellitus type I                                              P                                 P
Diabetes mellitus type II                                             P                                 P
Dysrhythmias                                                          P                                 P
Epilepsy                                                              P                                 P
Glaucoma                                                              P                                 P
Haemophilia                                                           P                                 P
HIV/ AIDS                                                             P                                 P
Hyperlipidaemia                                                       P                                 P
Hypertension                                                          P                                 P
Hypothyriodism                                                        P                                 P
Multiple sclerosis                                                    P                                 P
Parkinson’s disease                                                   P                                 P
Rheumatoid arthritis                                                  P                                 P
Schizophrenia                                                         P                                 P
Systemic lupus erythematosus                                          P                                 P
Ulcerative colitis                                                    P                                 P
Additional chronic conditions covered by AMAS
Acid Peptic Disorders                                                 x                                 x
ADHD                                                                  x                                 x
Allergic Rhinitis                                                     x                                 x
Alzheimer’s Disease                                                   x                                 x
Anaemia                                                               x                                 x
Ankylosing Spondylitis                                                x                                 P
Benign Prostatic Hypertrophy                                          x                                 x
Biliary Tract Disorders                                               x                                 x
Cardiac Dysrythmias Non-PMB                                           x                                 x
Cerebrovascular Disease including stroke                              x                                 x
Coagulation Defects                                                   x                                 x
Cystic Fibrosis                                                       x                                 x
Endometriosis                                                         x                                 x
Hyperthyroidism                                                       x                                 x
Hypoparathyroidism                                                    x                                 P
Kyphosis and Scoliosis                                                x                                 x
Major Depressive Disorders                                            x                                 P
Meniere’s Disease                                                     x                                 x
Menopause                                                             x                                 x
Myasthenia Gravis                                                     x                                 P
Osteoarthiritis                                                                         x                                                x
 Osteoporosis                                                                            x                                                P
 Pancreatic Disorders                                                                    x                                                x
 Spinal Cord Injuries                                                                    x                                                P
 Pituitary Gland Disorders                                                               x                                                x
 Psoriasis                                                                               x                                                x
 Tuberculosis                                                                            x                                                x
 Additional chronic conditions NOT covered by AMAS
 Behcet’s disease                                                                        x                                                P
 Connective tissue disorder (mixed)                                                      x                                                P
 Cushing’s syndrome                                                                      x                                                P
 Delusional disorder                                                                     x                                                P
 Dermatopolymyositis                                                                     x                                                P
 Generalised anxiety disorder                                                            x                                                P
 Huntington’s disease                                                                    x                                                P
 Motor neuron disease                                                                    x                                                P
 Muscular dystrophy                                                                      x                                                P
 Obsessive compuslive disorder                                                           x                                                P
 Paget’s disease                                                                         x                                                P
 Panic disorder                                                                          x                                                P
 Phempigus                                                                               x                                                P
 Peripheral athero-sclerotic disorder                                                    x                                                P
 Post traumatic stress disorder                                                          x                                                P
 Pulmonary interstitial fibrosis                                                         x                                                P
 Systemic sclerosis                                                                      x                                                P
 Thrombocytopaeniapurpura                                                                x                                                P
 Valvular heart disease                                                                  x                                                P
 Wegener’s granulo-matosis                                                               x                                                P

Please note that cover for the above mentioned conditions is subject to Discovery’s benefit option treatment guidelines/ protocols.
Members must make sure that they know and understand these guidelines.

CONTACT DEATILS

       Discovery Health                      Alexander Forbes Health
                                                                                                    Vitality                      Guardrisk (AdmedGap)
       Medical Scheme                          Member Service Unit

          Tel: 0860 99 88 77                Tel: 011 269 2690 or 0860 100 666                   Tel: 0860 102 877                        Tel: 0860 102 936
  Email: healthinfo@discovery.co.za        Email: hcclientservices@aforbes.co.za        Email: vitalityinfo@discovery.co.za       Email: admed@guardrisk.co.za
   Website: www.discovery.co.za             Website: www.afhealth.co.za/afrox            Website: www.discovery.co.za              Website: www.admed.co.za

Alexander Forbes Health is committed to making sure that the transfer of members from the Afrox Medical Aid Society to
Discovery Health Medical Scheme is a success. We aim to equip all members with the knowledge to choose the right benefit
option for their needs. We encourage members to attend the information sessions where possible.

Kind Regards,

Alexander Forbes Health

              Disclaimer: Information contained in this letter on the proposed amalgamation of Afrox Medical Aid Society and Discovery Health Medical
             Scheme is subject to the Council for Medical Schemes confirmation of the transaction.While all reasonable care has been taken by Alexander
             Forbes Health in compiling this communication, we have relied upon the accuracy and completeness of the information made available to us
                 and subsequently cannot accept any liability or any errors or omissions that may arise as a result of the reliance of such information.
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