Healthcare Articles

PMB dispute a blessing in disguise for schemes

by Mark Arnold
Published: January 1st, 2011 in Cover
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The legal dispute over Prescribed Minimum Benefits (PMBs) could be just the revitalising shake up the industry needs says Mark Arnold, Principal Officer of Resolution Health Medical Scheme. While the current Council for Medical Schemes’ (CMS) interpretation of the regulations regarding PMBs is problematic, that is, that schemes must pay out at whatever rate healthcare …. »

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Anti-Retro-Viral compliance in HIV products

by Dr Pamela Chetty - regular
Published: January 1st, 2011
Dr Pamela Chetty

We publish the first of a two part series by Dr Pamela Chetty, Life Business Unit, MRoA, on compliance in HIV products which assists life companies in underwriting HIV positive individuals. Part II will follow in our April issue. The Life Assurance Industry in South Africa (SA) has made progress in leaps and bounds since …. »

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A sustainable future for dental cover?

by Dr Gareth Hayton
Published: December 1st, 2010 in Cover

Worldwide, insuring dental treatment is a complex and somewhat enigmatic issue.  The reason for this is that the science of dentistry has blurred the lines between health-related treatments and lifestyle related treatments. Consequently, determining dental risk is no longer a purely actuarial matter.  The clinical element of dentistry is critical in this process in order …. »

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Calcium scans of the heart: Why the controversy?

by DR PAMELA CHETTY
Published: December 1st, 2010 in Cover
Dr Pamela Chetty

Historically, there have been various medical tools that served as risk stratification tools for coronary artery disease. These included non-invasive investigations such as the electrocardiograph (ECG), the blood tests for cholesterol and scoring systems such as the Framingham Score. Now, at the centre of much debate and controversy are the Coronary Artery Calcium (CAC) scores …. »

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Avoid a polarised debate and find a solution for National Health Insurance

by Andre Jacobs
Published: December 1st, 2010 in Cover
André Jacobs

The debate and plans to provide healthcare cover to all the citizens of South Africa are unfortunately often simultaneously overshadowed by specific theoretical terminology with arguments either promoting ideological viewpoints or protecting existing delivery models. The problem with this is that, while both arguments have merit, they often detract from the real issue at hand …. »

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How dependent eligibility audits can reveal significant savings in healthcare benefits

by Andre Jacobs
Published: November 1st, 2010 in Cover
André Jacobs

In response to current economic conditions, many organisations are paying increased attention to carefully managing balance sheets in an effort to remain competitive, or, in some cases, viable. Companies are taking steps to free up capital and cut costs while also trying to keep their work forces engaged and productive. In this climate, many employers …. »

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POPI and healthcare organisations

by Ashleigh Theophanides
Published: November 1st, 2010 in Cover
Ashleigh Theophanides

The Protection of Personal Information Bill (POPI) is expected to be promulgated in December 2010.  It is the product of the Law Commission’s finding that privacy law is lacking in South Africa, even though the Right to Privacy is enshrined in the Constitution.  POPI will give effect to the constitutional right to privacy; it will …. »

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Critical illness feature

by COVER
Published: October 1st, 2010

Severe Illness cover is critical to your customer’s financial health Ferdi Booysen, Risk Product Manager at Old Mutual There is a very good chance that your customer will contract and survive a major illness, such as heart disease or cancer, before they die. While medical schemes provide help in meeting the medical costs associated with …. »

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Medical practitioners must be insured

by Donald Dinnie
Published: October 1st, 2010 in Cover
Donald Dinnie

Regulations published on 30 August 2010 under the Health Professions Act require health practitioners, which include doctors, specialists, dentists and psychologists practising for their own account, whether in partnership, association or by way of a company allowed for in the Act, to obtain professional indemnity insurance.  The insurance must be obtained from an insurer registered …. »

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PMBs can save you money but you need to know the facts

by Marcel du Toit
Published: September 1st, 2010

Can a lack of knowledge regarding Prescribed Medical Benefits mean that you end up paying for bills that your medical scheme should cover? As per the Council for Medical Schemes (CMS), PMBs are a set of defined benefits to ensure all medical scheme members have access to certain minimum health services, regardless of the benefit …. »

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