AMALGAMATION OF AFROX MEDICAL AID SOCIETY WITH DISCOVERY HEALTH MEDICAL SCHEME
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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.zaQUESTIONS 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 POsteoarthiritis 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.You can also read
