OPERATIONAL OVERVIEW TRANSMED MEDICAL FUND 04 October 2007 - PowerPoint PPT Presentation

OPERATIONAL OVERVIEW TRANSMED MEDICAL FUND 04 October 2007 Presented by: Gys Steyn

Index Shareholding Corporate Profile Total number of calls Utilisation per Benefit Quality of Personnel

Shareholding structure Europ Assistance Staff BEE Holding France 4% 35% 61% Europ Assistance South Africa (Pty) Ltd 74% 80% 58% 70% Access Health EA Financial Labour Assist MRI Criticare Africa Services (Pty) ) Ltd 30% 26% 10% 10% 40% 2% Protégé Health EA Benevolent Numsa Investment Sandesh Singh BEE Trust & Simeka Company BEE BEE Group Scientia EA Benevolent Trust BEE

Corporate Profile Access Health Africa • was started in 1995 and is a subsidiary of Europ Assistance South Africa (Pty) Ltd. • has been providing medical services to the healthcare industry for 11 years, while Europ Assistance SA has been a service provider within the industry for the past 22 years. • has state of the art technology and highly trained and skilled medical staff. • has 360 incoming call centre lines. • unlimited network of approved national service providers. • provides services in 9 of South Africa’s 11 official languages.

Services Offered Access Health has been providing benefits to Transmed members for the past 11 years PRODUCTS IMPLEMENTATION DATE Emergency Medical Transportation 01 July 1996 Personal Health Advisor 01 July 1996 Legal, Home & Roadside Assist Access 01 July 2004 International Travel Medical Services 01 July 2004

Total Calls Received- all Benefits Total calls Received 2006 – 2007: 17 032 Calls between July 2006 and June 2007 2000 1500 1000 500 0 6 6 6 7 7 7 7 7 6 6 6 7 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - p v c n b - y n g t r u l c r o e a e a e p a u u O M M J S N D A A J F J

Emergency Medical Assistance Transportations – Road, Fixed Wing and Helicopter Total Transportations over 12 month period 2006 – 2007: 3989 Previous year 12 month period : 4057 (Decrease of 68) Air 0.1% Ambulance Helicopter 0.1% Road Ambulance 99.8%

Emergency Medical Assistance Total number of Emergency Transportation Claims – 12 month period Number of claims plus rand value over 12 month period Total Rand Value Number of Claims 2007 - 3989 R 5 735 427 2006 - 4057 R 4 209 411

Emergency Medical Assistance Emergency Medical Transportation � Access Health Africa manages the transportation of the patient, and advises the Service Provider to transport the patient to the closest, most appropriate hospital depending on the illness or injury sustained. � The patient will be taken to a hospital in accordance with the Medical Scheme’s requirements and benefit options. � In the event that the patient’s condition is stable, the patient will be transferred to an appropriate network hospital. � Access Health Africa makes use of approximately 80 accredited Service Providers in South Africa. � Private ambulance services are accredited and rated according to location, level of service and personnel qualifications. � Access Health Africa is independent and not linked to any hospital group or ambulance service provider.

Emergency Medical Assistance Distribution of admissions by hospital group – 12 month period 0% 0% State 12% Netcare 39% 14% Priv ately O wned Life G roup M ediclinic 14% Clinix G roup 21% Hospice

Emergency Medical Assistance When is an air-ambulance dispatched? � Access Health Africa dispatches air ambulance assistance according to protocols/guidelines designed by the Trauma Department of the University of the Witwatersrand, and in accordance with the medical industry standards. � The decision to dispatch an air ambulance is determined by medical personnel at the scene of the incident, as well as confirmation by an Access Health Africa medical doctor. � Weather conditions may not always permit air ambulance transportation, and in these circumstances a road ambulance is dispatched. � Helicopters are not always ideal for transporting seriously ill patients due to restricted cabin space, vibration and noise levels and therefore are seldom the first option. � Each medical circumstance is unique and Access Health Africa has the expertise to manage the emergency appropriately and according to the situation and the protocols.

Emergency Medical Assistance Summary of Road Ambulance Service Providers used in a 12 month period State 1% ER 24 26% Independent ER 24 44% N etcare In depen den t State Netcare 29%

International Travel Benefit Emergency Evacuation and Medical Expenses up to R1 million per member and a total of R5 million per family The following incidences are covered: � The costs of Emergency Medical Transportation to the nearest appropriate medical facility capable of providing the required treatment, or transportation to a different hospital where necessary, or repatriation to the normal place of residence. This includes medical supervision where necessary. � The costs incurred in a Medical Emergency, while on a journey outside of the borders of South Africa. Included are doctors fees, hospital expenses, medical and surgical treatment given as prescribed by a registered medical practitioner.

International Travel Benefit Number of declarations and claims over 12 month period No. of Declarations Number of Claims Total Value 2007 - 1675 27 R688,000.00 2006 - 1414 6 R63,654.00

International & Local Emergency Incidents 2007 International Travel Evacuation: 69 yr old bi-lateral leg amputee contracts septicemia while in Australia in Sept 2007 R300 000 Estimate While visiting family in Australia, Mr X, contracted septicemia and the doctors did have much hope for his survival. After a few weeks he spent four weeks in ICU, Europ Assistance repatriated him back to South Africa. Local Emergency Transportation: 87 yr old woman with hypertension An elderly lady called the 24 hour emergency number complaining about heart palpitations, difficulty swallowing, speech slurred and face drooping on one side. An ambulance was dispatched immediately and Mrs X is recovering in hospital.

Personal Health Advisor Medical Advice Personal Health Advisor provides professional assistance on how to deal with any health question. Highly experienced nurses will identify the nature of the situation, give advice and information to the caller utilising a sophisticated medical database, in nine official South African languages. The product includes an Audio Health Library – a telephonic information service consisting of an audio text information library of 520 pre-recorded health topics. This service is offered in most of the official South African languages.

Personal Health Advisor Top Ten Calls per Category 1 General medical problems 287 2 Chest pain 170 3 Abdominal pain 158 4 Breathing difficulties 147 5 Neurological deficit 141 6 Depression 110 7 Urinary tract 86 8 Diarrhea 83 9 Dizziness 74 10 Eye problems 73

Personal Health Advisor Personal Health Advisor and Audio Health Library Total Inbound Calls over 12 month period: 10 447 Any call with symptoms TRANSMED - Total Inbound Calls – Health info 01/07/2006 to 30/06/2007 Call for Drs Referral 672 827 Counseling Audio Health Library 4994 Drug info 3758 Benefit information Other (general enquiries, etc) 386 798 23 78 84

Personal Health Advisor Re-direction report – 12 month period REDIRECTION REPORT CALLER INTENT PRIOR NO. OF NO. OF CALLERS % CALLERS TO CALL CALLERS RECEIVED LOWER RECEIVED LOWER ALTERNATIVE ALTERNATIVE Would have called 89 48 70% doctor Contact Pharmacist 71 40 56% Would have visited 772 361 47% doctor Would have gone to 1425 729 51% Emergency Room

Personal Health Advisor PHA – Age / Sex Distribution July 2006 – June 2007 8.74% 76+ 13.93% 4.53% 71-75 4.69% 4.59% 66-70 5.73% 4.05% 61-65 5.26% 3.03% 56-60 5.35% 2.83% 51-55 M ale 3.56% 3.43% 46-50 Fem ale 3.10% 2.44% 41-45 2.66% 1.98% 36-40 4.57% 1.83% 31-35 1.94% 1.52% 26-30 2.03% 1.13% 21-25 1.08% 0.65% 16-20 0.80% 2.74% 0-15 1.82%

Legal Assistance Legal Assistance – Access Advice and guidance is provided on matters such as: � Maintenance agreements � Employment contracts and general working conditions � Domestic workers agreements and conditions of UIF � Instituting a claim against the Road Accident Fund A number of standard legal documents are available and will be provided at the member’s request. The Legal Assist line includes a free, 30-minute consultation and if required, a practicing attorney will draft one letter or make a telephone call to a third party.

Legal Assistance Legal Assistance Calls - TOP TEN CATEGORIES OF ADVICE CATEGORIES OF NO. OF MEMBERS COST SAVING ON ADVICE RECEIVED ADVICE ADVICE GIVEN TOTAL 243 R 145,800.00 Family Law 39 Law of Contract 38 Matrimonial Law 35 Wills and Estates 31 Insurance Law 26 Consumer Rights 23 The Law of Delict 21 Employment 11 Criminal Law & Procedure 10 General Court Procedure 9