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

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

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.

Introduction Benefit Breakdown Administration Process Marketing And Distribution Questions

PROGRAM

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

BENEFIT BREAKDOWN

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

• rgan 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,

• r 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

• nly 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 Primary Care, Hospital Care + C5 Principal

• R365

Adult dependant

• R255

Child dependant

• R113

HOSPITAL PLAN Hospital Care + C5 Principal

• R125

Adult dependant

• R 70

Child dependant

• R 25

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

No underwriting restrictions shall apply to members or their dependants under the following conditions: Existing members: If they join within a 3 month window period from the commencement date of the group. New members: If they join within a 3 month window period from their membership commencement. Family changes: If new dependants, e.g. marriages, new born, join within a 3 month window period from date of the family change. The following underwriting restrictions shall apply to members and dependants joining outside of the 3 month window period: 1 month general waiting period shall apply; 12 month waiting period shall apply to chronic medication benefits; 12 month waiting period shall apply to optometry benefits; 9 month waiting period shall apply to pre-birth maternity benefits.

UNDERWRITING & WINDOW PERIOD

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

1. Complete the Naptosa Ronbel Application Form (Refer Addendum) 2. Email to napadmin@memp.co.za or fax to 086 723 4635 3. Form to be completed fully a. Personal details – the underwriters/ER24 need to identify the members b. Dependant details – if not listed dependants will not be treated c. ID numbers – used for identification purposes d. Contact details – member pack will be mailed to your physical address (preferably school) e. Contact numbers – members will be kept up to date of any changes/benefits f. Current medical practitioner – if the GP is not on the network Unity Health will contact the GP to sign them up g. Bank details – payment is only by way of debit order h. Preferred debit order date – premiums are paid in advance and if premium is not received benefits will be suspended i. Debit order date is either 25th or last working day of the month j. Member to read, understand and sign the disclosure and declaration page k. ID Documents for each dependant to be submitted together with the form

APPLICATION PROCESS

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

• No “pre-authorisation” for hospital benefits
• Benefits managed by ER24 at the scene of an accident
• No maximum on the number of legal child dependants
• No co-payments, claims settled directly with network providers
• No pre-existing condition exclusions
• No cover cessation age

DISTINGUISHING FACTORS

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

• A child dependant is covered until they reach the age of 21
• Can be extended to age 25 in respect of full time unmarried students
• Members do not need to nominate a network provider, they may visit any

provider on the Unity Health Network

• Members may go to any private hospital managed by Unity Health/ER24
• Unlimited emergency and evacuation services through ER24
• Unity Health call centre, for any claims/membership related queries

DISTINGUISHING FACTORS

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

 Not covered:  Planned procedures  Investigative procedures  Any treatment not a result of an accident or emergency

EXCLUSIONS/EXCEPTIONS

THIS IS NOT A MEDICAL AID

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

 Naptosa Ronbel Health Plan is only available to actively employed paid up Naptosa members  Immediate Family only (Partner/biological and legal children)  This is primary basic health care  Coming soon – a rate for retired Naptosa members

IMPORTANT TO NOTE

THIS IS NOT A MEDICAL AID

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

1. Naptosa Ronbel Health Plan 1-pager 2. Naptosa Ronbel Health Plan Debit Order Application 3. Naptosa Ronbel Health Plan Table of Benefits 4. Naptosa Ronbel Health Plan FAQ 5. Naptosa Ronbel Health Plan – Unity Health Banking details 6. Naptosa Ronbel Health Plan – Notice Board posters 7. Social media examples

ADDENDUMS

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

QUESTIONS? TIONS?

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

TH THANK NK YOU

Disclaimer: This document is a summary for information purposes

• nly and does not supersede the terms and conditions as outlined

in the Policy document. In the event of any discrepancy, the Policy document will prevail.

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

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