We are moving!
As you were informed recently in a separate communication, Anglo Medical Scheme will move its Administration with effect from 1 January 2014 to Discovery Health (Pty) Limited. Your membership, benefits and the Scheme as you know it will NOT change! Some frequently asked questions are included below to provide you with more details.
Frequently Asked Questions: Updated November 2013
WHY ARE WE CHANGING?
Momentum and Metropolitan merged in 2010 and the Scheme had to change to the Metropolitan administration
system by the end of 2013. Due to this change, and in line with good governance, the Scheme's administration
was put out to tender. Discovery was awarded the business.
BUT METROPOLITAN HAS ALWAYS DELIVERED GOOD SERVICE, SO WHY CHANGE?
The decision was not easy; Metropolitan Health has consistently delivered service excellence in difficult times.
After an in-depth assessment of all systems, the Board of Trustees decided that the move would better align the
Scheme to the changing long-term strategy and objectives. The Scheme would also benefit from Discovery's buying power,
risk management and managed care initiatives
WHEN WILL THE ADMINISTRATION CHANGE?
With effect from 1 January 2014.
WHO IS THE SCHEME'S NEW ADMINISTRATOR?
Discovery Health (Pty) Limited will be the new Administrator.
HOW WILL THIS AFFECT ME AS A MEMBER?
From 1 January 2014 all new claims, queries and authorisations will be managed by Discovery. Momentum will manage all 2013 claims as well as 2013 related queries for the first four months of next year. The Scheme will ensure that the transfer is as smooth as possible to minimise disruptions.
WILL I NEED TO REREGISTER ALL MY CHRONIC MEDICATION?
No, the old registrations will automatically rollover to 2014 just as they have done in previous years, unless they have been approved for a six month or limited period.
WHAT WILL HAPPEN TO MY CANCER TREATMENT AUTHORISATIONS?
The 2013 authorisations will automatically be transferred to Discovery in 2014. You will be contacted closer to the end of the year.
WILL I NEED TO REREGISTER WITH OPTIPHARM, CDE OR VITALAIRE?
No, Optipharm, CDE and VitalAire are still contracted by the Scheme and nothing will change.
BUT THE NEWSPAPERS REPORT THAT DISCOVERY IS VERY STRICT AND DOES NOT ALWAYS PAY CLAIMS?
There are two completely separate independent businesses; Discovery Health, the Administrator, and the Discovery Health Medical Scheme.
Discovery Medical Scheme determines its Rules and instructs the Administrator to pay according to their Rules.
Anglo Medical Scheme has contracted the services of Discovery Health, the Administrator, to administer our Scheme according to our Rules. Payment of claims will be made against the same Rules and principles as in the past. You will not receive any different management or increased strictness.
WILL I BE JOINING DISCOVERY?
No, you will not be joining Discovery, you will not become part of Discovery and your medical scheme benefits will not change to Discovery benefits. You will not reach thresholds and have to pay the self- payment gaps nor will you have above threshold benefits.
WILL I BE ABLE TO JOIN VITALITY?
Yes, all members will be able to join Vitality by completing an application form that will be distributed in the near future.
WHAT HAPPENS TO MY MULTIPLY MEMBERSHIP?
If you are a Multiply member because you belong to Anglo Medical Scheme, you will need to terminate your Multiply membership. If you have an automatic debit order, you will need to cancel it before the end of November 2013.
WHAT WILL HAPPEN TO MY SAVINGS ACCOUNT?
By law your savings account belongs to you. For the first four months of 2014 you will effectively have two savings accounts - one at Metropolitan and one at Discovery.
Metropolitan will keep your positive 2013 savings account balance until the final handover at the end of April 2014. This will allow any outstanding 2013 claims to be processes by Metropolitan. You will receive a monthly statement from Metropolitan showing the balance on this portion of your savings account. You will still have access to this money during the four-month period should you need it.
Discovery will start a new account for you on 1 January 2014 and you will have full access to this next year. Discovery will send you a monthly statement that will reflect all contributions and claims paid, including the 2014 portion of the savings account.
Should you spend more than the full 2014 savings allocation before the end of April, upon request, money will be transferred from the Metropolitan 2013 account to Discovery to pay for your 2014 claims.
WHAT WILL CHANGE?
- Contact details: Some telephone numbers and address details.
- Membership card: You will receive a new membership card with a new membership number, which will be valid from 1 January 2014.
- Wellness Programme: Anglo Medical Scheme members who are also members of Multiply will need to terminate
their Multiply membership. If you have other Momentum products, you might be able to keep the Multiply
membership.
You will be entitled to join Vitality. More detailed information on changes from Multiply to Vitality will follow.
WHAT WILL NOT CHANGE?
- your membership
- your Medical Plan/Option
- your benefits
- the Head Office staff
- your Trustees
- the Scheme's philosophy
- the way your claims are handled and processed
- the website, Medibrief and Scheme communication.
HOW DO I FIND OUT MORE?
More information will be provided in the next issues of Medibrief, on the website and, if necessary,
by personalised mail.
A full update will be provided at the Benefit and Pensioner Sessions at the end of this year.
For any further information, you are welcome to contact the Scheme's Head Office on 011 638 5471 or email the Principal Officer, Fiona Robertson.