Heritage Health Medical Aid Fund Newsletter 1 for 2019
On behalf of the Board of Trustees we welcome you to your first Newsletter for 2019. In this Newsletter we will address matters which is of importance to you as a member of Heritage Health Medical Aid Fund. To all our new members, welcome on board and we look forward to being of service to you.
Members play a Key Role:
Duties and Responsibilities that all members must apply to ensure effective management of healthcare costs.
Sustainable healthcare relies on the implementation of smarter processes and creating education platforms whereby members become more knowledgeable about chronic conditions, their responsibilities to a healthy lifestyle as healthcare costs have a direct impact on increases to payable monthly contributions by members.
Health Risk Management relies on understanding potential clinical benefits of medical diagnostic and therapeutic care by ensuring that health risk management protocols are applied and that the benefit design is taken on cost effectiveness and affordability ensuring quality healthcare services.
Hospital Admissions, daily case management reporting and out-of- hospital care is a paramount component in managing access to affordable, appropriate, safe and quality healthcare. By educating members on their health, outcomes are expected to improve and reduce the likelihood of re-admissions to hospitals thereby containing unnecessary costs.
Disease Management has been introduced to manage high risk members. The Fund’s clinical team will contact such members to co-ordinate access to appropriate care and to manage available benefits of their chronic condition(s), educating, encouraging and empowering the members to make certain lifestyle changes and taking responsibility of their own health and wellness.
Chronic Medicine Management is applied by using clinical pre-authorisation processes by applying formulary (a set of medication items) and disease specific guidelines. It remains important to always ensure that your chronic condition is registered, and that your prescribed medication is updated every six months.
Did YOU Know?
When you claim for your chronic medication at your pharmacy and you opt for Generic items instead of Branded items then you will not need to pay the 15% co-payment.
Introducing Heritage Health Members to Online Education and Participation
PatientEDonline is a patient-focussed online platform that provides valuable medical information, procedural guidance and educational material to inform members on their medical conditions and guide behaviour towards a healthy lifestyle. The system provides a reliable and controlled environment that consolidates all aspects of preventive care, health promotion and disease or condition specific patient education. By registering at https://patiented.online you will gain access to the specially developed education platform which is available to Heritage Health members only – another first. Members are empowered to actively take part in effectively managing their health and wellness by improving their understanding of a specific medical condition, diagnosis or disease, as well as the methods and means to best manage treatments, medication and associated risks. Heritage Health members are encouraged to participate on the tick list exams and whereby points can be gained, and rewards can be expected.
You will also find various interesting articles providing important information on topics such as Headaches, Sugar as a stumbling block, Bites by spiders, snakes, ticks etc, Sprains and Strains, Burns, Halitosis, Packing a healthy lunch box, Gout, Do we need minerals, Sunshine Vitamins D, Healthy Lifestyle etc. Let us show you how to become an informed Heritage Health member by visiting the newly developed online education platform.
Introducing YOU to Digital Healthcare Platforms
Digital Health is the convergence of digital technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicines more personalised and precise. Digital Health is empowering us to better track, manage, and improve our own and our family's health, live better, more productive lives, and improve our society.
Telemedicine and How YOU will benefit as a member
Telemedicine implies “healing at a distance”. It is the use of technology to overcome geographical barriers and increase access to health care services. Members will have after hours only including Public holidays, access to clinical services by making use of electronic telecommunications technology without being required to go to a doctor’s practice after hours or hospital casualty. In a situation where you require admission to a hospital or casualty division you will be referred to the nearest hospital and which may include EMED.
- Real-time patient consultations;
- Remote monitoring of patients’ vital signs and conditions;
- The storing and forwarding of critical health information for analysis and diagnosis;
- The provision of specialised services over long distances after hours;
- Availability of health information to members
Only after-hours and on Public Holidays
- By using the “doctor.me” icon on your Heritage Health App
- Sending an email to: https://doxy.me/nursekobiecoetzee
Introducing YOU to Biometric Wristbands
Digital-health technologies have the potential to reduce healthcare costs especially when it comes to managing chronic diseases. Heritage Health members will be able to obtain a Biometric Wristband, and which will bring virtual care to their doorstep by enabling non-evasive self-monitoring and disease management and helping members detect patterns and indicators of various health conditions and risks. Vital signs parameters such as blood-pressure trending, blood oxygen, blood glucose, hydration and sleep quality is monitored and stored.
Members are empowered with more control over their healthcare. Members who track their diet, physical activity and weight will achieve better results than those who don’t, and the Heritage Health Biometric Wristbands will provide feedback that reinforces personal accountability for own health and promotes a healthy lifestyle.
We encourage young people who become members as well as the older members to take control of their health by exercising and applying a healthy lifestyle. Physical activity or exercise can improve your health and reduce the risk of developing several diseases like type 2 diabetes, cancer and cardiovascular disease. Physical activity and exercise can have immediate and long-term health benefits. Most importantly, regular activity can improve your quality of life. For more information including the terms and conditions, you may contact the office of the Administrator.
Introducing HERITAGE HEALTH APPLICATION
Interacting Online with your Medical Aid Fund All the Time from any place in the world.
- By logging onto your App store, you can now download, free of charge YOUR Heritage Health App on your smartphone.
- The service is available 24-hours from anywhere in the world allowing members to validate, manage and control their membership under Heritage Health Medical Aid Fund - an applied risk and information tool for Heritage Health members only.
- Use the Namibia pre fix +264 and your number when registering your mobile number.
- Under Info Feed: all invoices, all payments, statements, members’ claim summary, Campaign documents, Certificate of membership etc is reflected.
- Under Interactive Member Card, the membership card is readily available including available benefits, contact details, monthly contribution, level of cover and Authorisations.
- Under Benefits, view the year’s remaining benefits, approved pre-authorisations, chronic medication, view recent claims and underwriting, if any.
- Under Self Service, a query can be logged, request new card, Tariff Calculator, or submit a document by photo.
- Under the Camera, take a photo of the invoice and submit and it reflects directly on the live real-time system - no more scanning, faxes or hand deliveries.
- Under Contact Us all the contact details that may be needed.
- Doctor.me - an only after-hours Telemedicine benefit.
Prudent Benefit Utilisation and YOUR Responsibility as a Member of Your Fund
The prevalence of healthcare fraud, wastage and abuse of medical aid benefits is a serious challenge and has a direct impact on affordable, quality healthcare cover. Did you know that overall it is estimated that between 15% to 20% of your monthly contribution goes towards the funding of this? It is of utmost importance that as a member of Heritage Health you become actively involved with the management of your benefits and that you report any concerns that you may have as ultimately all members are accountable to check their invoices being submitted and the payments undertaken. The prevalence of healthcare fraud, waste and abuse involving collusion between medical aid members and healthcare providers is increasing.
- Know your Benefits, Rules and the Terms and Conditions of your medical aid cover prior to seeing your healthcare provider. Understand your benefits and the sub benefit limits. Make sure the benefit plans you choose will fit your needs.
- When referred to screening/scanning tests it is important that you always ask the costs prior to going for the tests. It is incorrect to assume that because you have medical aid cover the costs will be covered. Different plans have different levels of cover. The referring doctor is not aware of your available benefits for a specific test. Why have duplication of tests, such as a CT scan first, followed by an MRI scan and then followed by colonoscopy and gastroscopy?
- When being sent for pathology tests, know what and why tests are taken and ask the costs as these tests are costly and you may have insufficient benefits. Don’t allow random tests.
- When receiving a prescription understand the contents.
- Always establish whether a less costly test is available and thereby extend your benefits for the year. It is also important for you to know upfront what your out of pocket payment will be where the tests exceed your available benefits.
- Your medical aid fund will not pay for pre- admissions (one day early admission in a hospital prior to the procedure) as the costs are not clinically justified.
- Your medical aid fund will not allow admissions in a hospital for tests to be undertaken. Admissions are based on a clinical diagnosis and a treatment plan.
- Have the right attitude and do not think that because you have medical aid cover you can randomly use it. All costs have a direct impact on the monthly contributions that you pay. Don’t request medical care when it is not required.
- Is it correct to allow children to eat sweets and drink sugar high content cooldrinks as toddlers resulting in costly dental procedures before the age of seven years?
- Members play a key role when it comes to benefit utilisation and the associated costs. It is important that when uncertain, always ask before incurring the costs.
Admissions to a Hospital
All members must always obtain pre-approval prior to being admitted to any hospital or sub-acute facility by contacting Heritage Health.
Why are Pre-authorisations a Necessity?
- The pre-authorisation process alerts the Fund that a member is scheduled for hospitalisation.
- The member, doctor and hospital can be informed beforehand to what extent the treatment/procedure will be covered in terms of the available Benefits and the Rules of the Fund.
- By complying with the process of obtaining a pre-authorisation, you are assisting the Fund in managing these costs and ultimately containing increases to the annual monthly contributions.
- Pre-authorisation is granted based on the validity of your membership, clinical appropriateness, waiting periods, exclusions, length of hospital stay, terms and conditions of the rules and evidence based on clinical guidelines.
What is Pre-authorisation?
For all hospital admissions whether in Namibia or in South Africa a pre-authorisation is required prior to admission for non-emergency treatments. For all non-emergency procedures at least 48 hours prior to obtaining the treatment/procedure you must contact the Fund to obtain the pre-authorisation. For all emergencies or after office hour admissions the hospital will contact the Fund to obtain the necessary pre-authorisation.
What is the definition of an emergency?
Any emergency medical condition is a medical condition which is of sudden and unexpected onset that requires immediate medical or surgical treatment where failure to provide this treatment would result in serious impairment of bodily functions, serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy.
How do I obtain Pre-authorisation?
- To obtain a pre-authorisation number prior to admission you, your attending doctor and/or the hospital must contact the Fund and provide the necessary clinical details as well as:
- Membership number.
- Patient: name and date of birth.
- Treating doctor: name, telephone and practice numbers.
- Hospital: name and practice number.
- Clinical reason for admission/primary diagnosis.
- Codes: Tariff and/or ICD-10 code(s) Date of admission. The Fund does not cover pre-admissions - day prior to procedure.
When your Admission is authorised, you will receive:
- An authorisation number.
- The approved number of days in hospital where stay is necessitated.
- If your hospital stay is extended, the hospital case manager will inform the Fund with the clinical motivation and pending the available benefits.
When Travelling YOU must:
When travelling to South Africa or SADC region, you must inform Heritage Health before you leave to ensure that you are covered. You will be required to submit a copy of your valid passport or permanent residence and an itinerary. You will receive a letter and contact details to be used when in need of cover. When travelling abroad, you must submit a copy of your valid passport or permanent residence and air tickets. You will receive a letter and contact details to be used when in need of cover. Failing to do so will result in no cover.
For all your ENQUIRIES
PLEASE may we request that when contacting our office via email that you ALWAYS only use the following email address: