A MESSAGE FROM OUR ACTING PRINCIPAL OFFICER
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WINTER ISSUE 2018
MEDSHIELD QUARTERLY NEWSLETTER
A MESSAGE
FROM OUR ACTING
PRINCIPAL OFFICER
marketing (membership growth & retention) and payroll
(to meet member needs as the Scheme grew); and
• Medshield had an unqualified audit for the year ending
31 December 2017.
On 27 June 2018, the Global Credit Ratings Company (GCR)
released the Scheme’s latest ratings and confirmed that Medshield
maintained an AA- Positive Outlook. Medshield looks forward to
another fifty years of providing quality health care and ensuring that
our members receive the best service.
On that note, Dr Aaron Motsoaledi, Minister of Health, made an
announcement regarding the National Health Insurance (NHI) and
E
the proposed amendments to the Medical Schemes Act, aimed at
very year in June, Medshield Medical Scheme aligning the Act with the introduction of the NHI.
hosts an Annual General Meeting (AGM) in The current phase of NHI sees the alignment of the Medical
accordance with the Scheme Rules. This year’s Schemes Bill with NHI through several amendments. This means
49th AGM took place on Saturday 30 June the way medical schemes operate might change while government
2018. On behalf of the Medshield Board of is determining a way to implement NHI. In his announcement, the
Trustees, I would like to thank all the Medshield members minister said that 12 other Acts would have to be amended before
who submitted their motions prior to the meeting and NHI comes into full effect. The Scheme is cognisant of the impact to
those who took time to attend the AGM. Your participation the industry and some of our stakeholders.
ensured the success of the meeting. Medshield is systematically reviewing both Bills in order to come
up with more substantial comment. The Scheme wil continue to
Here are some of the key points highlighted by the Chairman of the participate in inputs through the relevant industry bodies and will
Medshield Board of Trustees, Mr Charles Akeroyd, in his report at provide our expertise into how private and public healthcare sectors
the AGM: can work together to achieve Universal Healthcare Coverage. We
• The Solvency Ratio for 2017 is 44.6% (2016: 52.1%) – confirming anticipate extensive industry engagement relating to these changes in
that the Scheme is financially sustainable for the foreseeable the interim, and we will continue to keep you informed.
future;
• The Scheme’s strategy of utilising reserves to subsidise member Yours in Health.
contributions and reduce increases to an affordable level; Jerry Molefe – Medshield Medical Scheme
• The Scheme posted a deficit of R90m (the Scheme had budgeted
for a deficit for 2017);
• The membership increased by 7.4% from 73 390 to 78 827 (net
increase of 5 437 members);
• Medshield maintained its credit rating for the 11th consecutive
year, AA- outlook: positive;
• Non-healthcare expenditure as a percentage of gross contribution
income increased marginally from 10.1% to 10.5% - investment in
Page 1
How do I guard against
colds & flu?
B
y far the most effective way to prevent flu is to sure to throw them away immediately after use) and wash your hands
have the annual flu vaccine which is covered afterwards.
under the Medshield Wellness benefit. However, • Try not to touch objects around you when in public places, such as
there are some general measures that can be the rail of the escalator or your coughing colleague’s pen or computer
taken. Colds and flu are spread by viruses which mouse.
can easily spread from surface to person and • With an incubation period of one to four days and a contagious period
person to person. For this reason it’s a good idea to carry an of seven days or longer, it’s best to avoid any person with flu for at
alcohol-based cleanser with you to sterilise any surfaces you least a week.
believe to be putting your health at risk. • Quit smoking. Those who smoke are more vulnerable to respiratory
infections and complications.
Many cold and flu viruses are acquired from people who don’t yet show • Clean surfaces, especially kitchen and bathroom counter tops, with
any symptoms, and it’s always difficult to contain viruses that travel disinfectant soap.
through the air. You can’t really help being exposed to these viruses. • Discourage your child from sharing food, utensils, handkerchiefs,
napkins and towels with classmates.
However, there are some general measures • Teach your children to wash their hands before and after eating, after
you can take to give yourself the best chance of using the bathroom, after touching their faces, after spending time in
avoiding infection: public spaces, and after touching animals.
• Wash your hands frequently and don’t touch your nose, eyes or • Rather keep your toddler at home if a child at the crèche has the
mouth unnecessarily. flu and yours is healthy. Similarly, keep a child at home who shows
• “Contain” sneezes and coughs with disposable tissues (and make symptoms of flu to avoid infecting other children.
2 Page
How to pre-authorise
a hospital admission or procedure
MEMBERS CAN OBTAIN HOSPITAL PRE-AUTHORISATION VIA TELEPHONE, SMS OR EMAIL:
Telephonically or email
Step 1
Have the following information readily available:
• Membership number
• Patient’s name and date of birth
• Contact details
• Appropriate ICD-10 Code and Tariff Codes
(you can obtain this from your service provider)
• Date and time of admission and procedure
• Name of the admitting Doctor and his/her practice and telephone number
• Name of the hospital, the practice and telephone number
• Length of stay
Step 2
Contact Medshield Hospital Management on 086 000 2121/ +27 11 259 5026
or send an email to medshieldpreauth@mso.co.za
or alternatively send a fax to 086 636 9067.
Do ensure that the information in Step 1 is reflected on your fax/email.
SMS Hospital
Step 1
Obtain the following information from the practitioner:
• Member number
• Patient’s first name
• Hospital name
• Dr’s practice number
• ICD-10 code and tariff codes (you can obtain this from your service provider)
• Procedure name
• Date of admission
Step 2
SMS the information, separated by commas, to 45115.
The turnaround time is 4 working hours: 8:00am to 4:30pm Monday to Friday.
Step 3
Applies to both telephonic and SMS pre-authorisation requests.
Your request will be reviewed in line with the Scheme Rules, benefits covered, and available limits on your current option. You will receive a status text
message (SMS) in relation to the following:
STATUS MESSAGE ACTION
When Your Medshield authorisation request has been approved for • You can now use this hospital authorisation number on admission
approved PATIENT’S NAME from DATE-to-DATE. Your authorisation • The pre-authorisation number is only applicable to that hospital
number is 123 456 789. Kindly note that the Scheme Rules, admission. Any associated claims will be covered according
benefits, protocols, and co-payments apply wherever to your specific Medshield benefit option and according to the
applicable. Automated SMS Scheme Rules.
– Do Not Respond.
When Your Medshield authorisation request for PATIENT’S NAME is • A Medshield Case Manager will contact you to request additional
pending pending due to additional medical information requested as details or information
per standard protocols. Please contact us on 086 000 2121. • Please make sure that the required information is submitted within
Automated SMS three days from the initial pre-authorisation request. An automatic
– Do Not Respond. cancellation will apply if no information is received within three days.
When Dear Medshield member, as per telephonic discussion, your • A Medshield Case Manager would have called you before you
declined authorisation request for PATIENT’S NAME for DATE has been receive this message.
declined. Automated SMS – Do Not Respond.
Page 3
Child immunisation
forms part of your
Medshield Wellness Benefits
A
s a parent, you may not like seeing your baby minimal compared to the pain, discomfort, and trauma of the diseases
or child receiving an injection. However, these vaccines prevent.
vaccination is an important step in protecting Immunisations can save your family time and money. A child with
your child against a range of serious and a vaccine-preventable disease cannot go to school and other childcare
potentially fatal diseases. facilities. Some vaccine-preventable diseases can result in prolonged
disabilities and can take a financial toll because of lost time at work,
Vaccinations are quick, safe and extremely effective. Once your child has medical bills or long-term disability care. Therefore, being vaccinated
been vaccinated against a disease, their body can fight that disease more against these diseases is a good investment and is usually covered by
effectively. If a child is not vaccinated, they will be at increased risk of your Medshield Medical Scheme option.
catching the illness. Immunisation protects future generations. Vaccines have reduced
Immunisations can save your child’s life. Because of advances in and, in some cases, eliminated many diseases that killed or severely
medical science, your child can be protected against more diseases disabled people just a few generations ago. For example, smallpox
than ever before. Some diseases, that once injured or killed thousands of vaccination eradicated that disease worldwide. Your children do not have
children, have been eliminated and others are close to extinction– primarily to get smallpox shots anymore because the disease no longer exists.
due to safe and effective vaccines. By vaccinating children against rubella (German measles), the risk that
Vaccination is very safe and effective. Vaccines are only given to pregnant women will pass this virus on to their fetus or new-born has been
children after a long and careful review by scientists, doctors, and dramatically decreased. If we continue vaccinating now, and vaccinating
healthcare professionals. Vaccines will involve some discomfort and completely, parents in the future may be able to trust that some diseases of
may cause pain, redness or tenderness at the site of injection but this is today will no longer be around to harm their children.
4 Page
How Sugar
effects your teeth
E
veryone knows eating too sugar per day. Considering that the average can
much sugar can lead to of Cola contains 10 teaspoons of sugar we have
tooth decay, but most of us a lot of cutting down to do!
don’t know exactly how that It is easy to look after your teeth if you follow
happens. It is not actually the the directions above! Review your Dental benefits
sugar itself that does the damage, but on your chosen Medshield benefit option and
rather what happens in your mouth after visit your dentist regularly.
you took a sip of that sugary drink or ate
a piece of cake.
Your mouth is filled with bacteria, some good
and some bad. The harmful oral bacteria actually
feed on the sugars you eat to create acids that
destroy the tooth enamel, which is the shiny,
protective outer layer of the tooth. Cavities (holes
in your teeth) are a bacterial infection created
by the acids. Without treatment, cavities can
progress past the enamel and into the deeper
layers of the tooth, causing pain and possible
tooth loss. The World Health Organization says
we should not have more than six teaspoons of
Page 5
Review your
monthly member statement
to be on top of your healthcare expenses!
M
edshield provides all members with a monthly OVERVIEW
membership statement that details every Your monthly membership statement includes a wealth of important
visit to a hospital or your doctor’s office, the information e.g.:
costs thereof and the benefits remaining. • The date of your monthly membership statement
Understanding this membership statement • Your personal address (that Medshield has on record)
helps you to manage your available benefits and healthcare • Medshield’s details
proactively. • Your unique membership details
• A summary of your benefits, the limits as per your chosen plan, how
Medshield continuously aims to make it easy for our members to much you have used to date and how much is left for the year
manage their benefits and the monthly membership statement is a • Details of claims that has been received and processed, or received
critical tool which confirms your current benefit status, at a glance. If and not processed and the reason why it has been declined
you have ever asked yourself, “What do I owe?; Who do I pay?; Why • A tariff code description that describes what product or service
was this denied?; What is the next step?” - then this explanation is where received and claimed for
for you! • Important general information from Medshield.
6 Page
Who qualifies as a
dependant on your
Medshield membership?
A
s a member it is important to ensure that • Grandchild, sibling, niece, nephew or any other person that is
all your dependants belong to a medical dependent on the member for family care and support, may qualify
scheme. But how do you know who for cover and register as a Special Dependant if approved by the
qualifies as a dependant and who doesn’t? Scheme
The term dependant does not only relate • Please note that in certain instances you may be required to
to a minor. Many people are responsible provide proof of their dependency on the Principal member when
for more than just their spouse and young children and it is submitting an application.
therefore essential to know how to make your medical cover • Late joiner penalties will apply if a beneficiary is 35 years and older.
work best for you.
It’s easy - For more information on how to register your dependants
Who qualifies as a dependant of a Principal contact us on 0860 000 2120. The responsibilities of providing for
Member? your family are immense, so it is critical to ensure that all your loved
• Lawful spouse/common law spouse/partner ones have access to medical cover as either members or registered
• Biological/legally adopted children/stepchild/a child who has been dependants.
placed by law in the custody of
• the member or his/her spouse or partner/immediate family Don’t wait until you are faced with massive medical bills for treatments
member in respect of whom the principal with no medical cover to protect your loved ones. Your family is
• member is financially liable depending on you to make a sensible choice and responsible
• Children over the age of 21 years with no proof of mental or decisions.
physical disability or student proof can
• remain on the Scheme, but only as adult dependants Disclosing your and your dependants’, full healthcare status
• Member’s child, who due to mental or physical disability, is including all chronic conditions, previous operations and
dependent on the member for family care and support family medical history, is a critical step in the application for
membership or for dependant registration.
Page 7
DIRECTORY of Medshield Partners
SERVICE PARTNER CONTACT DETAILS
Ambulance and Emergency Netcare 911 Contact number: 086 100 6337 (+27 10 209 8011)
Services for members outside of the borders of South Africa
Chronic Medicines Management Medscheme Health Risk Solutions (MHRS) Contact number: 086 000 2120 (+27 10 597 4701)
for members outside the borders of South Africa
Facsimile: +27 10 597 4706
email: medshieldcmm@medscheme.co.za
Dental Authorisations Denis Contact number: 086 000 2121 (+27 10 597 4701)
for members outside of the borders of South Africa
- Crowns/Bridges and Dental Implant Authorisations
email: crowns@denis.co.za
- Periodontic Applications email: perio@denis.co.za
- Orthodontic Applications email: ortho@denis.co.za
In-Hospital Dental Authorisations email: hospitalenq@denis.co.za
HIV and AIDS Management LifeSense Disease Management Contact number: 24 Hour Help Line 086 050 6080 (+27 11 912 1000)
for members outside of the borders of South Africa
Facsimile: 086 080 4960 email: medshield@lifesense.co.za
HIV Medication Designated Pharmacy Direct Contact number: 086 002 7800 (Mon to Fri: 07h30 to 17h00)
Service Provider (DSP) Facsimile: 086 611 4000/1/2/3
email: care@pharmacydirect.co.za
Hospital Authorisations Medical Service Organisation (MSO) Contact number: 086 000 2121 (+27 10 597 4701)
for members outside of the borders of South Africa
Facsimile: 086 636 9067 email: medshieldpreauth@mso.co.za
Oncology Disease Management Medical Service Organisation (MSO) Contact number: 086 000 2121 (+27 10 597 4701)
Programme (for Cancer for members outside of the borders of South Africa
treatment) Facsimile: 086 634 0460 email: oncology@mso.co.za
Medshield has partnered with the Independent Clinical Oncology Network
(ICON) for the delivery of Oncology services. Go to the ICON
website: www.cancernet.co.za for a list of ICON oncologists
Optical Services Iso Leso Optics Contact number: 086 000 2120 or (+27 10 597 4701)
for members outside of the borders of South Africa
Facsimile: +27 11 782 5601 email: member@isoleso.co.za
DIRECTORY of Medshield MediPhila Partners
SERVICE PARTNER CONTACT DETAILS
Ambulance and Emergency Netcare 911 Contact number: 086 100 6337 (+27 10 209 8011)
Services for members outside the borders of South Africa
Chronic Medication Courier Clicks Direct Medicines Contact number: +27 10 210 3300
Services Customer Service number: 086 144 4405
Facsimile: 086 144 4414
Chronic Medication Courier Pharmacy Direct Contact number: 086 002 7800 (Mon to Fri: 07h30 to 17h00)
Services Facsimile: 086 611 4000/1/2/3
email: care@pharmacydirect.co.za
Chronic Medicines Management Medscheme Health Risk Solutions Contact number: 086 000 0376 (+27 10 597 4703)
(MHRS) for members outside the borders of South Africa
Facsimile: +27 10 597 4706
email: medshieldcmm@medscheme.co.za
Dental Authorisations Denis Contact number: 086 000 0376 (+27 10 597 4703)
for members outside the borders of South Africa
Wisdom teeth and In-Hospital Dental Authorisations
email: hospitalenq@denis.co.za
HIV and AIDS Management LifeSense Disease Management Contact number: 24 Hour Help Line 086 050 6080
(+27 11 912 1000) for members outside the borders of South Africa
Facsimile: 086 080 4960 email: medshield@lifesense.co.za
HIV Medication Courier Services Pharmacy Direct Contact number: 086 002 7800 (Mon to Fri: 07h30 to 17h00)
(DSP) Facsimile: 086 611 4000/1/2/3
email: care@pharmacydirect.co.za
Hospital Authorisations Medical Service Organisation (MSO) Contact number: 086 000 0376 (+27 10 597 4703)
for members outside the borders of South Africa
Facsimile: 086 636 9067
email: medshieldpreauth@mso.co.za
Oncology Disease Management Medical Service Organisation Contact number: 086 000 0376 (+27 10 597 4703)
Programme (for Cancer (MSO) for members outside the borders of South Africa
treatment) Facsimile: 086 634 0460 email: oncology@mso.co.za
Medshield has partnered with the Independent Clinical Oncology Network
(ICON) for the delivery of Oncology services. Go to the ICON website:
www.cancernet.co.za for a list of ICON oncologists
Optical Services Iso Leso Optics Contact number: 086 000 0376 (+27 10 597 4703)
for members outside the borders of South Africa
Facsimile: +27 11 782 5601
email: member@isoleso.co.za
Medshield Head Office MediPhila Contact Centre Medshield Contact Centre
288 Kent Avenue, cnr of Kent Avenue Contact number: 086 000 0376 (+27 10 597 4703) Contact number: 086 000 2120 (+27 10 597 4701)
and Harley Street, Ferndale for members outside the borders of South Africa. for members outside the borders of South Africa.
email: member@medshield.co.za Facsimile: +27 10 597 4706 Facsimile: +27 10 597 4706
Postal Address: PO Box 4346, Randburg, 2125 email: member@medshield.co.za email: member@medshield.co.za
Medshield Medical Scheme Contact Centre Operating Hours
Monday – Thursday 8:15am to 17:00pm
Friday 8:30am to 17:00pm
16 Page
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