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A

Admin checklist for an upcoming procedure

There is a lot to think about before having a procedure done. The following information describes the process with your Scheme prior to a procedure being done.

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Ambulances - Netcare 911, our Designated Service Provider

Netcare 911 is our Designated Service Provider. If you voluntarily choose to use another ambulance service, you will incur a co-payment.

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App of the month

We recently sent you an SMS about the new mySOS app and would like to provide you with more detailed information. Our emergency evacuation partner, Netcare 911, has partnered with mySOS to offer our members fast and easy access to all emergency services in South Africa.

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Authorisations for chronic medicine

As you know from previous years, your registered chronic condition authorisation will have automatically rolled over to the next year. You only have to re-apply if the authorisation for your medication was issued with an expiry date.

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C

Children of adult dependants on your membership

In the January 2019 edition of MediBrief we explained how long, and under which conditions, your child can stay on your membership as an adult dependant after the age of 23. If the conditions are fulfilled and your child remains on the Scheme as an adult dependant and they have children, your grandchildren will be eligible to join the Scheme as well.

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Cancer treatment on AMS and what you need to know for funding

One cannot prepare oneself for a cancer diagnosis, but AMS will try and assist its members with understanding the basics of treatment and the practicalities of funding. Once diagnosed, the doctor will compile a treatment plan for the patient. There are many types of possible treatments.

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Call Centre navigation

Have you ever wondered why your call is answered by a machine and not by a person when calling our Call Centre on 0860 222 633? This ‘machine’ is called Interactive Voice Response (IVR), and we are using it to answer the moment you call, and to ask you basic questions to direct your call to the appropriate agent.

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CDE - The CDE Club App

The Centre for Diabetes and Endocrinology (CDE), AMS’s partner in diabetes management, recently released its CDE Club app to assist members with diabetes by providing valuable information and a tool to track progress and even earn rewards.

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No more cheques

Only current or retired employees of a participating employer can be members of AMS. As a member, you can include your spouse or partner, children and, if approved by special application, a parent, as dependants.

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Cheques - No more cheques for refunds

As announced in the past, the Scheme will only pay claim refunds via EFT to your bank account. The Scheme therefore no longer generates cheques.

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Child dependants - How long can my child stay on the Scheme?

If your registered dependant was 23 years old or younger on 1 January, he/she is eligible to remain on the Scheme as a child dependant on your membership at the child dependant contribution rate for the current year.

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Chronic medication: when and how to refill a prescription from the pharmacy

If you are registered for a chronic condition that requires you to take chronic medication, you need to visit your doctor at least every six months, so he or she can see how you are doing on your chronic medication.

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Claims – how to submit your claims

Our Call Centre team has noticed an increase in the number of questions around the claims submission process. Do you know which information to send and where to send it to?

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Claims - Your assistance is needed for us to pay your claims efficiently

Please always remember to send us proof of payment when you have paid for healthcare services yourself. If you don’t, our administrator will automatically pay the provider.

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Co-payments

Once you are diagnosed with a chronic condition, your pharmacist or doctor should register it with Anglo Medical Scheme. After approval, the treatment for the chronic condition will be paid from a chronic benefit and not from your day-to-day benefits. But, even after approval you might find that certain claims are not paid in full and you cannot understand why you have to make a co-payment.

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Co-payment reminder

In 2017 the Scheme introduced a co-payment structure for endoscopies and cataract procedures if performed in a hospital instead of in a day clinic.

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Complaints – how to lodge a complaint

Anglo Medical Scheme is dedicated to executing good business practises and governance every day. We are lucky to have a membership that participates and communicates with the Scheme, and are pleased that most of the members are very happy with the service that they receive.

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Contribution payments

Contributions for membership of the Anglo Medical Scheme are due monthly in arrears. Some pensioners are responsible for their contribution payments (in part or in full). When Scheme members retire, they will receive a letter from the administrator, asking them to complete the relevant debit order forms to ensure monthly payment of the contributions.

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D

Debt - How to manage debt on your membership

I owe the Scheme money? How did that happen and what are the consequences?
Did you know that there are instances in which you can end up owing the Scheme money?

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Dental network for SCP - Are you looking for a dentist?

To avoid co-payments for dental services, SCP members should use a provider on the Dental Risk Company (DRC) network.

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Dental network - Standard Care Plan (SCP) members to use a dentist on the DRC network

As previously announced, the Scheme has contracted DRC (Dental Risk Company) to provide basic dental services, managed through a network of dentists, for all Standard Care Plan members. Members are required to consult with a DRC Network General Dental Practitioner.

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Different options of submitting your claim

You can post, fax or email your claims to the Scheme. You can now also scan and upload your claim and proof of payment in the member log-in area under the 'submit your claim' tab.

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F

FAQs from the annual member presentations

Anglo Medical Scheme is very fortunate to have members that actively participate in their Scheme. We would like to thank the members who attended our annual employee and pensioner presentations, where we discussed all benefits and contributions for the new benefit year.

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Frail Care cover

Assisting a loved one during the process of ageing and identifying the need for frail care services is very upsetting and can be overwhelming. Their deterioration is also sad to witness. Anglo Medical Scheme can assist you during this very difficult process and funds frail care services against a set criteria.

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Fraud alert

You might be aware that fraud syndicates have managed to illegally deduct small amounts from bank accounts. Known as the "R99 debit order scam", this scam essentially deducts small amounts of money from your account through debit order.

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Fraud – please report!

Fraud is a real 'disease' in the South African healthcare industry. We make it our business to fight fraud in order to protect our members from the consequences, namely increased healthcare costs or contributions.

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Fraud- one of the biggest challenges facing SA healthcare

Based on international studies, fraud in the medical schemes industry costs South Africa between an estimated R8.22 billion and R43.2 billion. Fraud negatively affects healthcare costs and as a result, healthcare costs increase because there is a need to offset the funds lost to fraud. This results in higher premiums and reduced affordability for medical scheme members.

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G

Gap cover insurance

As health care costs increase, members experience higher out-of-pocket expenses. Over the last two years, 68% of surveyed AMS members reported that they had significant out-of-pocket expenses for in-hospital events and 64% experienced shortfalls for out-of-hospital services.

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GP network for Managed Care Plan

In case you missed it in the Benefit Guide: Managed Care plan members can now make use of our administrator‘s GP network. Claims for consultations and selected procedures will be submitted directly to the Scheme and be paid directly from your MSA or by the Scheme if PMB.

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H

Healthcare billing and Scheme reimbursement

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HIV/AIDS - Managing HIV/AIDS for AMS member

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I

ICD 10 codes, and why are they important?

ICD 10 diagnosis codes are used in the healthcare industry to properly note diseases on health records, track epidemiological trends, and assist in medical reimbursement decisions.

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L

Lodge a complaint

Anglo Medical Scheme is dedicated to executing good business practises and governance every day. We are lucky to have a membership that participates and communicates with the Scheme, and are pleased that most of the members are very happy with the service that they receive.

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M

Managed Care Plan – Medical Savings Account

Members who have positive medical savings carried over from 2015 might have, in some instances, noticed that these amounts, and the interest thereof, have not displayed correctly on their 2016 monthly claims statements.

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Membership on the Anglo Medical Scheme

Only current or retired employees of a participating employer can be members of AMS. As a member, you can include your spouse or partner, children and, if approved by special application, a parent, as dependants.

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N

National Health Insurance (NHI) update

In August, following Cabinet approval, the Minister of Health released the NHI Bill for public comment. It would have been difficult to ignore the strong media reaction and you might have noticed the negative stock market response to healthcare businesses.

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O

Out-of-pocket expenses - Managed Care Plan members: how to reduce out-of-pocket expenses when visiting your GP

If you would like to reduce out-of-pocket expenses when consulting your GP, consider selecting a GP on our administrator's GP network.

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P

Personal information your personal and health data online

We are doing everything possible to ensure the protection of your, or your dependant’s personal and health information. Before we share your information with a third party we will ask for your consent. We will also ask you for permission if your dependant requests access on your member login on the Scheme website and limit the amount of information that can be seen by the different parties.

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Personal details – please update!

No banking details – no refund

We are still missing banking details for 10% of our membership. Without your banking details we cannot refund you if anything is due to you.

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Possible co-payments or an increase in co-payments for chronic medicine from 2016

The Scheme annually reviews all medicines approved for the treatment of chronic conditions. This is done to ensure that the most up-to-date and cost-effective medicines are available to members.

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Postal services and your future Scheme communication

There are still a number of members who have only provided the Scheme with a postal address. In the case of postal service failure we cannot reach you at all.

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Protection of Personal Information Act and its impact on the healthcare industry

As you might know, the Protection of Personal Information Act (POPIA) is a reality and compliance by stakeholders in the healthcare industry, as in every industry, is required. Your Scheme, the administrator, managed care organisations and other third-party providers all need to reconsider how to process your personal information and personal health data.

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Post not received? Sign up to receive electronic communication!

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R

Road accident - Claiming for medical expenses after a road accident

If you have been involved in a motor vehicle accident, the Anglo Medical Scheme will pay for your accident-related healthcare expenses in accordance with the Rules of the Scheme and your benefit plan.

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S

Scheme Stakeholders – who plays which role?

We regularly receive questions about the relationship between Anglo Medical Scheme, its participating employers and our administrator Discovery Health. We explain the affiliation with these two stakeholders

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Protection of Personal Information Act and its impact on the healthcare industry

As you might know, the Protection of Personal Information Act (POPIA) is a reality and compliance by stakeholders in the healthcare industry, as in every industry, is required. Your Scheme, the administrator, managed care organisations and other third-party providers all need to reconsider how to process your personal information and personal health data.

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T

Trustee elections - are your contact details up to date?

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Your AMS tax certificate

When the 2019 tax season opens, most likely on 1 June 2019, you may need to submit your income tax return to the South African Revenue Services (SARS). For your annual tax return you will also need your medical scheme tax certificate.

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Tax - Medical tax credit: what it means

Two years ago, the tax treatment of medical scheme contributions changed. Additional tax relief was previously presented as a reduction in taxable income, but it is now applied as a tax credit. This effectively reduces the amount of tax members pay. The medical tax credit system promotes equity across all income groups. Read more on medical tax credits.

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Travel insurance – is it really necessary?

If you are planning to travel overseas, you probably have a long to-do list and might be rushing to finish work, home and travel arrangements. Travel insurance doesn’t always feature and get the necessary attention. Read on, even if you think you are adequately covered.

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V

Value Care Plan Pocket Guide: FAQs

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W

Walk-in Centres - Changes to the walk-in centres

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Y

Year-end presentations

Please diarise and attend the Scheme’s year-end presentations to learn more about your benefits and contributions for the year 2020

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