TRAINING AINING PR PRES ESEN ENTATION TION 20 2017 17 First - PowerPoint PPT Presentation

NAPT PTOS OSA A RONBEL EL HEA EALTH TH PL PLAN TRAINING AINING PR PRES ESEN ENTATION TION 20 2017 17 First family on Naptosa Ronbel Health Plan www.memp.co.za/private/extranet/naptosa This is not a medical scheme and is not a substitute for a medical scheme.

PROGRAM Introduction Benefit Breakdown Administration Process Marketing And Distribution Questions This is not a medical scheme and is not a substitute for a medical scheme.

BENEFIT BREAKDOWN i. Primary Care a. GP Benefits b. Acute Medication c. Basic and Acute Medication d. Chronic Medication e. Basic Radiology & Pathology f. Optometry g. Pre-birth Maternity ii. Hospital Care a. In-patient hospital treatment b. In-patient hospitalisation stabilisation c. Out-patient casualty treatment d. Emergency Evacuation iii. Supplementary Benefits a. C5 HIV Comprehensive Exposure This is not a medical scheme and is not a substitute for a medical scheme.

PRIMARY HEALTH CARE GP BENEFITS Unlimited visits at a Network GP (1500 Network Doctors nationwide) This is not a medical scheme and is not a substitute for a medical scheme.

PRIMARY HEALTH CARE ACUTE MEDICATION Unlimited when dispensed by GP R2500 per person per year at non-dispensing GP This is not a medical scheme and is not a substitute for a medical scheme.

PRIMARY HEALTH CARE BASIC RADIOLOGY & PATHOLOGY Basic list of blood tests and X-rays on referral by Network GP This is not a medical scheme and is not a substitute for a medical scheme.

PRIMARY HEALTH CARE BASIC & EMERGENCY DENTISTRY Up to R1000 per person per incident, Maximum R3000 per family every two years. Double benefit for accidental injury

PRIMARY HEALTH CARE OPTOMETRY 1 Eye test per person per year, a standard frame value R195 and a pair standard clear lenses per person every two years at PPN Network This is not a medical scheme and is not a substitute for a medical scheme.

PRIMARY HEALTH CARE PRE-BIRTH MATERNITY 2 Specialist Visits, 2 Ultrasound scans per year R2500 Overall Annual Limit This is not a medical scheme and is not a substitute for a medical scheme.

CHRONIC MEDICATION CHRONIC MEDICATION Unlimited 27 listed conditions, AIDS / HIV included . According to a medicine list (Addison’s Disease; Asthma; Bi -polar Mood Disorder; Bronchiectasis; Cardiac Failure; Cardiomyopathy Disease; Chronic Renal Disease; Coronary Artery Disease; Crohn's Disease; Chronic Obstructive Pulmonary Disorder; Diabetes Insipidus; Diabetes Type 1&2; Dysrhythmias; Epilepsy; Glaucoma; Haemophilia; HIV/AIDS; Hyperlipidaemia; Hypertension; Hypothyroidism; Multiple Sclerosis; Parkinson's Disease; Rheumatoid Arthritis; Schizophrenia; Systemic Lupus Erythematosus; Tuberculosis; Ulcerative Colitis) This is not a medical scheme and is not a substitute for a medical scheme.

PRIVATE HOSPITALISATION OVERALL MAXIMUM LIMIT The Casualty benefit, Emergency Stabilisation And In-patient Hospital benefit is limited to R1 million per family per year Includes all associated costs This is not a medical scheme and is not a substitute for a medical scheme.

PRIVATE HOSPITALISATION IN-PATIENT HOSPITAL TREATMENT As a result of an ACCIDENT Limited to R1 million per family per year Includes all associated costs This is not a medical scheme and is not a substitute for a medical scheme.

PRIVATE HOSPITALISATION IN-PATIENT HOSPITALISATION STABILISATION ONLY Limited to R16500 per incident Subject to Overall Annual Limit as a result of an unexpected health condition (E.g. stroke/heart attack) before being transferred to a state facility This is not a medical scheme and is not a substitute for a medical scheme.

PRIVATE HOSPITALISATION OUT-PATIENT CASUALTY TREATMENT Treatment in a private hospital casualty unit as a result of an accident Limited to R5000 per incident This is not a medical scheme and is not a substitute for a medical scheme.

SUPPLEMENTARY BENEFITS MEDICAL EMERGENCY SERVICES Air & road with ER24, Telephonic Medical Advice, Inter-hospital transfers, Repatriation of mortal remains within borders of SA This is not a medical scheme and is not a substitute for a medical scheme.

SUPPLEMENTARY BENEFITS C5 HIV COMPREHENSIVE EXPOSURE HIV/STD treatment - appropriate treatment within 5 hours of your call anywhere in SA. Immediate HIV/STD Preventative Meds, 28 day anti-retroviral meds, 3 consultations, ER24 transport to nearest doctor network, access to 3 appropriate blood tests This is not a medical scheme and is not a substitute for a medical scheme.

TERMINOLOGY What is an “Emergency”? “Emergency” is an event of a sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person’s life in jeopardy . Examples include heart attacks, strokes. What is an “Accident”? Accident” means bodily injury caused by violent accidental and external physical means. Examples include, motor vehicle accidents, severe burns, exposure to poisons. This is not a medical scheme and is not a substitute for a medical scheme.

TERMINOLOGY The difference between in-patient and out-patient treatment “In - patient” means that the treatment requires the patient to be admitted to hospital, primarily so that he or she can be closely monitored during the treatment and afterwards, during recovery. This is usually in the case of a medical emergency or serious accident. “Out - patient” means that the treatment does not require hospital admission. This is usually in the case of a minor accident. The difference between in-patient and out-patient facilities An in-patient facility is a hospital. An out-patient facility is either an independent facility or part of a hospital designed for the treatment of out-patients. Out-patient facilities offer a wide range of treatment services, diagnostic tests and minor surgical procedures. This is not a medical scheme and is not a substitute for a medical scheme.

TERMINOLOGY What is an acute condition? A short-term condition or illness like a chest infection, sinusitis or the flu. Your doctor can give you acute medication to treat your condition / illness, or write a script for you to get the medication at a pharmacy. What is a formulary? A medicine formulary is a list of approved medicines. Only medications that are on this list will be covered. This ensures that premiums stay affordable. This is not a medical scheme and is not a substitute for a medical scheme.

WHAT DO I DO? What do I do in the event of a medical emergency or serious accident? 1. Call ER24 on 084 124 . The number is also on your Unity Health membership card. 2. ER24 will verify the membership of the person in need of help, whether it be you or your dependant. 3. ER24 will assist you with advice, and emergency transportation to your nearest in-patient hospital facility. 4. ER24 will issue the hospital with a guarantee of payment and you will be admitted for treatment without having to pay a co-payment or deposit 5. Please ensure that you have your Unity Health membership card and ID for verification purposes. 6. Unity Health will then settle the account directly with the Hospital, subject to the benefit limitations. This is not a medical scheme and is not a substitute for a medical scheme.

WHAT DO I DO? What do I do in the event of a minor accident? 1. Call either the Unity Health Call Centre 0861 366 006 (during business hours) or ER24 for a list of the nearest out-patient facilities that accept guarantee of payments, as some out-patient facilities only accept cash. 2. Please ensure that you have your Unity Health membership card and ID for verification purposes. 3. ER24 will arrange the guarantee of payment with the out-patient facility – you do not have to pay anything if a legitimate claim 4. Unity Health will then settle the account directly with the out- patient facility, subject to the benefit limitations. This is not a medical scheme and is not a substitute for a medical scheme.

WHICH MEMBERS NEED THIS 1. Non-government appointed employees 2. Administrative Staff 3. Ground Staff 4. Government appointed educators “not on medical aid” 5. NON-NAPTOSA MEMBERS This is not a medical scheme and is not a substitute for a medical scheme.

MARKETING STRATEGY/SUPPORT 1. Website - www.memp.co.za/private/extranet/naptosa 2. Social media 3. SMS 4. Newsflash 5. Notice board poster 6. Email information from Memp to members 7. Staff Room chatter 8. Meetings 9. Endorsement when member uses their benefits 10. Naptosa Membership Card This is not a medical scheme and is not a substitute for a medical scheme.

MEMBERSHIP CARD This is not a medical scheme and is not a substitute for a medical scheme.

PREMIUMS COMPREHENSIVE PLAN HOSPITAL PLAN Primary Care, Hospital Care + C5 Hospital Care + C5 Principal - R365 Principal - R125 Adult dependant - R255 Adult dependant - R 70 Child dependant - R113 Child dependant - R 25 This is not a medical scheme and is not a substitute for a medical scheme.