about your benefits, and includes information on the following topics viz:

1. Hospital Pre-Authorisation2. AGM and Roadshows Queries3. Cancer and Attention Deficit Hyperactivity

Disorder4. COVID-19 and Industry Update

Whilst it seems that we have reached the peak of the 3rd wave, we encourage all of you to keep safe, and wear a mask!

Thabisiwe MlotshwaPrincipal Officer

Dear Members

It seems that this year is going by very quickly, as we head into Spring. Hopefully, the very cold weather that we have all been experiencing will soon be a thing of the past.

As a Board, we are reviewing the benefit offering for 2022, and looking at changes that will provide improved benefits, and continue to provide value for money. The Board’s objective is to ensure that the Scheme remains competitive in benefits and premium offering and covers our members’ healthcare needs.

With the lockdown levels being reduced we are very excited to be getting back on track with the Roadshows, which will resume soon. We will keep you updated as they are scheduled. In this newsletter, the focus is on keeping you informed

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Thabi

From the desk of the Principal OfficerSeptember 2021

Client Services Team and Hospital andPre-authorisation

Tel: 0860 100 078Email: enquiries@medipos.co.zaEmail: preauth@medipos.co.zaWebsite: www.medipos.co.za

Address for the submission of claimsclaims@medipos.co.zaP.O Box 921, Westville, 3629

MEDiPOS CONTACT DETAILSSEND US YOUR SUGGESTIONS!Please send us your suggestions on how you think the Scheme can improve its service delivery and benefits.

Your suggestions may be emailed to fundmanagement@medipos.co.za or posted to MEDiPOS, PO Box 921, Westville, 3629.

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HOSPITAL PRE-AUTHORISATIONWhat is a hospital pre-authorisation? You are required to obtain a Pre-Authorisation by notifying the Scheme that you are going to be admitted into hospital for treatment, whether it is for surgery or for a medical admission, such as being admitted for Pneumonia.This means that you must contact the Scheme for any planned hospitalisation, emergency admission as well as for certain procedures that can be performed in the doctors’ room, such as a gastroscopy, colonoscopy or vasectomy. Only medically necessary hospital treatment and procedures will be pre-authorised.

Why do you need a pre-authorisation?By obtaining an authorisation, we are able to advise you, ahead of time, about what will be covered whilst you are in hospital, and we can also provide you with information about your procedure. It is also to ensure that your hospital claims and your treating doctors’ claims are paid from the Major Medical Expense Benefit. Whilst in a lot of cases, the hospital staff or doctor obtains the pre-authorisation, it is YOUR responsibility to ensure that the pre-authorisation has been obtained, and either your or a family member can contact the Scheme directly for services that require pre-authorisation.

Are there any co-payments that I should be aware off?There are 2 types of co-payments that can be applied to your hospital admission, for all planned procedures. These are:1. A co-payment of R 2 080 which is applied for not obtaining a pre-authorisation prior to admission, and2. A co-payment of R 7 270 which is applied for the use of a non-Designated Service Provider (DSP). In the event of an emergency, the co-payment for the use of a non-DSP will not be applied. However, don’t forget to notify the Scheme within 24 hours, or on the first working day after the admission, if you are admitted over the weekend.

How to obtain a pre-authorisation?To obtain a pre-authorisation we recommend that you contact the Scheme at least three working days prior to you being admitted to hospital. When calling the Scheme please make sure that you have the following information readily available:

» your Scheme membership number and ID number of the main member

» the name and telephone number of the admitting doctor

» the ICD-10 code/s obtained from the admitting doctor

» the proposed treatment or procedure

» the planned date of admission to the hospital

» the name and practice number of the hospital you will be admitted to.

Once we have received the above information, or any additional clinical information that is needed, we will provide you with an authorisation number and you will receive an Authorisation of Benefit letter.

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Why are my COVID-19 claims not being paid?As communicated previously, MEDiPOS does cover COVID-19. There are protocols governing how we cover negative tests. If you were referred by your healthcare worker for a test to a pathologist, this will be paid from the Major Medical Expense benefit, however, should there be no referral from your healthcare worker, negative tests will be paid from your Primary Care Benefit or rejected if you have used up your benefits. Treatment for positive tests are covered by the Scheme. MEDiPOS has recently increased the number of tests from 2 to 4 COVID-19 tests which are payable from your Major Medical Expense benefit, whether negative or positive. This now includes tests that can be conducted at your local pharmacy, however, should you reach your limit of 4 tests, additional tests will only be covered upon referral from a healthcare worker. For more information, refer to the Scheme’s website or contact your Scheme on 0860 100 078 or email enquiries@medipos.co.za.

Why are COVID-19 tests not covered on Option C?COVID-19 is a prescribed minimum benefit and all positive tests must be covered by the Scheme.COVID-19 tests are covered in the same way on all Options including Option C. Refer to question 1 above for more information on the payment of COVID-19 tests.

Why are vitamins not covered by the Scheme?Vitamins on the Scheme are an exclusion although they can be claimed from your savings benefit for members on Option B. However, we do acknowledge that in this unprecedented time, vitamins are essential for your health in the fight against COVID-19 and should you test positive for COVID-19, the Scheme will cover the vitamins from the benefit allocated to you for COVID-19 according to the Scheme protocols. You may contact the Scheme’s managed care department for benefit information should you test positive for COVID-19.

MEDiPOS ANNUAL GENERAL MEETING AND ROADSHOWS MEDiPOS hosted its 2021 Annual General Meeting (AGM) virtually on 24 June 2021. As you are aware, MEDiPOS also launched the 2021 Roadshows activities in March 2021, and visited certain regions around the country. Due to the COVID-19 third wave, the roadshows were suspended and will resume soon to cover areas not yet visited. We would like to thank all those members that have attended these events and would like to emphasized that we value the feedback , and input that you provided.

Following the roadshows and AGM, we undertook to provide feedback on matters raised, regarding the Scheme’s benefit offering and service delivery, which is highlighted below, viz:

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Can the Scheme administer onsite flu and COVID-19 vaccines at employer sites during working hours?The Scheme can provide that service as it did in 2020. However, due to some logistical challenges, the Scheme did not roll out the flu vaccine programme for 2021. The Scheme will assess and plan for 2022 with the service providers.

Why are roadshows are not communicated to members who are pensioners?Due to COVID-19 all roadshows were suspended; however, roadshows will resume and will include pensioner roadshows at the end of the year for 2022 benefit presentations. This will be dependent on when the Regulator approves the benefits and the COVID-19 lockdown levels. Are there dedicated nurses available to assist members?Our Administrator has dedicated registered nurses for all Disease Management Programmes. Should you be registered on any of the managed care programme such as Oncology, Mental Wellness and Chronic benefit and further be identified as a high-risk patient, a registered nurse will contact you for treatment of your condition. The nurses also visit various regions and you can have a face-to-face engagement with them when they visit your region. You are welcome to contact any of our registered nurses on 0860 100 078 and select prompt 4.

Why are my registered disease management claims being short paid or not paid in full?When you are registered for a chronic condition such as diabetes, hypertension or oncology treatment, as part of your benefits you are allocated a specific treatment plan that consists of a list of tariff codes that your doctor can claim for. These will be paid from your Major Medical Expenses Benefit. However, should your doctor claim for any additional tariff codes, this could result in your claims being rejected or paying from your day to day benefits. Sometimes your doctor might prescribe some medication not covered by the Scheme and this would either be short-paid or rejected. If you have not received your treatment plan, we encourage you to obtain a copy from our Disease Management department so that you know what your doctor can claim for, to avoid any surprise rejections.

Why are there short payments/co-payments on my Over the Counter (OTC) medicine?A co-payment for OTC medication could be as a result of generic or therapeutic medicine pricing being applied. This means that there is a more affordable brand for the same type of medication. Should you be liable for a co-payment for your medication, check with your pharmacist if a generic or therapeutic price is being applied and opt to take the generic product, if possible, to avoid any co-payments.

My claim was submitted more than 5 months ago to the Scheme and was not paid?Should your claims not be paid in 30 days of your treatment date or your submission to the Scheme, we encourage our members to contact the Administrator immediately. We recently identified that not all claims are submitted to the Administrator by service providers on time, which results in your claims being rejected as stale and not being paid. As a member you are responsible to ensure that your claims are received by the Scheme within 4 months of the treatment date, otherwise if received late the Scheme will not be liable to pay your claims and will reject the claims for payment.

However, we also acknowledge that there could be delays in the administration processes due to various issues including clinical investigation of claims and unidentified issues with the claims processing team. Should you encounter such problems, please contact the Administrator and they will investigate and find the root cause of the delay, which eventually will help us improve our service.

I am experiencing poor service delivery by the Administrator.Thank you for bringing this to our attention; however, to ensure an in-depth investigation is conducted, we request our members to provide examples where the service received from the Administrator was unsatisfactory. This will assist us in engaging with the Administrator and identifying gaps for improvement.

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Can Pap smears be added to the Preventative Care Benefit?We are glad to inform you that this benefit was approved by the Board of Trustees and will be covered from your Preventative Care Benefit.

Can the Scheme provide MEDiPOS Car Stickers?Thank you for your request. This will be part of your 2022 member welcome pack.

Can the Scheme consider enhancing certain benefits? Members have the following suggestions such as, a 24-hour Hospital Pre-authorisation and Maternity Contact Centre, funding for the Pneumococcal vaccine, appliances for Chronic related conditions, expansion of auxiliary benefits to include Chiropractors, Audiometry and Dieticians. A number of members have raised their concern about some of their benefits, during roadshows. The Board will review these benefits as part of the benefit review for 2022. We thank you again for these suggestions. We will provide feedback with the 2022 benefit and contribution communication.

Can the inclusion of extended family members such as Grandchildren be considered as dependants? We are glad to inform you that this recommendation was accepted by the Board and grandchildren, once approved by the Regulator, will be accepted as dependants. The approval will be communicated to all members via our newsflash and newsletter. For more information, contact your Scheme on 0860 100 078 or email enquiries@medipos.co.za.

Can the Scheme consider adding Glucometers to the Chronic Management Programme every 3 years? You already have access to this benefit as the Scheme covers glucometers from the External Medical Appliance benefit for all options. You may refer to your benefit guide for more information on the limits for this benefit.

Can the Scheme consider a benefit for lost or stolen spectacles?Whilst the Scheme empathises with members when they lose their glasses or medication, members can only be covered according to approved benefits. Covering lost or stolen medical products would be expensive for members through high contribution increases and we encourage members to protect their property.

Why are there restrictions to certain hospital facilities?The restrictions are to protect the Scheme from high costs and therefore members from high contributions. Some hospital groups charge very high hospital tariffs for treating members and are not in a position to negotiate with the Scheme. However, MEDiPOS has most of the main hospital groups included on the Designated Service Provider (DSP) list. The only hospital group that is not included on the DSP list is, Netcare. The Board reviews this list every year during the benefit and contribution review for the following year and will do so for 2022. Members will be advised of any changes.

Specialist rates are expensive. Can the Scheme introduce a specialist network?There are some specialists that prefer to charge their own private rates rather than the MEDiPOS Scheme rate. This is a challenge across the industry, however, this recommendation is being reviewed by the Board for 2022.

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Can the General Practitioner Network footprint be expanded?The Administrator works on expanding the MEDiPOS General Practitioner (GP) list at every opportunity with continuous engagements with GPs. In the first quarter of 2021 we reported 3285 GP’s and this increased to 3398 in the second quarter. Should there be a specific area that you would like us to consider or should you want your GP contacted, escalate this to our Administrator to review this area.

Why did the Scheme change its current Auditors?To ensure good corporate governance is met, the rotation of auditors is essential in strengthening the independence of the auditors in relation to the Scheme. It further ensures that objectivity of audit reviews are maintained when audits are being performed on the internal and external controls that may affect the annual financial statements. As part of its governance structure, the Scheme generally reviews its service providers every three years to ensure that the Scheme gets the best from the market, both in terms of fees and service delivery.

What is the Quorum at an AGM and is there a percentage of members who have to vote for a decision to be accepted as passed at the AGM? The quorum at an AGM is 30 members present, excluding proxies. The percentage for a decision to be accepted/resolved is 50%, and a decision is passed by the majority of votes.

Does the Scheme ensure that conflict of interests are declared when appointing Board members? Scheme Rule 20.3 states that “Members of the Board must avoid conflicts of interests, and must declare any interest they may have in any particular matter serving before the Board”. The Scheme enforces this rule and all Trustees are required to complete a declaration form to declare their interests annually as well as at every meeting on any item they have actual or perceived conflict.

The new Administrators have even told me that they don’t read their emails, because there are simply too many emails to go through.It is these kind of examples that both the Scheme and Administrator would like members to provide details on, including dates of their calls so that the Administrator can listen to the calls or read through the emails to ensure that these types of issues can be addressed. Both the Scheme and the ensuring the service provided is exceptional at all times.

When does the term of office of the current members of the Board of Trustee end?The term of office period for each Trustee for the Scheme is 5 years, to a maximum of 2 terms. MEDiPOS has 10 Trustees and the term for 5 Trustees will end at the 2022 AGM.

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24We, the Scheme and the Administrator, exist to serve members and appreciate the feedback that help us improve the service we provide, and to take care of your needs. Please continue to share your concerns and your views, both positive and negative.

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Vaccines are unsafe and normal safety protocols have been circumvented to fast track their authorisation for use

The vaccine will change my DNA

Vaccines contain a form of microchip that will be used to track and control an individual

Big businesses are pushing vaccines to improve profits

Government is complicit with big businesses in pushing vaccines despite the risks

The Vaccines have the mark of the Beast - 666

The fast development and approval of the COVID-19 vaccines is a great human feat worthy of celebration. No step in the development, testing or ratification of the COVID-19 vaccines has been skipped. The world was able to develop vaccines fast because scientists and governments around the world collaborated in a manner that has never been achieved before and pooled resources and information to ensure that everyone can contribute to the knowledge. The COVID-19, having been identified as a worldwide pandemic that was spreading fast and could be fatal, therefore the world raced to find an effective solution in the form of a vaccine.

Vaccines work by stimulating the body the same way the virus would if someone were infected. That means when you receive the vaccine the body then recognises the virus that resembles that of the coronavirus and then it releases certain chemicals that start a chain reaction to make immune cells that can fight the real virus. The vaccine does not work on the DNA of the body.

There is no vaccine “microchip” and there is no evidence to support claims that such a move is planned. Receiving a vaccine will not allow people to be tracked and personal information would not be entered into a database. Individuals are tracked using the data they voluntarily capture themselves when completing forms or on various social media platforms such as Facebook.

The COVID-19 crisis has caused massive upheaval across the globe and no nation has been spared. A vaccine represents the best hope to save lives and to restore our “normal” way of life; many governments have therefore entered into direct talks with vaccine makers to ensure a timeous supply of vaccines.

Government is committed to saving lives and livelihoods. The fastest way to return to that way of life is through ensuring that a significant majority of the population are protected from the virus. Vaccines are the simplest and most effective way to do this.

Vaccines have no connection with any religious organisations and cannot be infused with spirits, demons or other abstract ingredients. There is no conspiracy to possess, bewitch or control anybody.666

COVID-19 VACCINATION UPDATEAs we have always said, since COVID-19 is from a virus and cannot be treated, but managed through treating symptoms, our most effective weapon in the fight against COVID-19 is an effective and comprehensive vaccination programme. Through close collaboration between the government and the private sector, and with the active support of other social partners, the government is continuing to procure vaccines for all eligible South Africans. This means that after you have registered with the Department of Health, on the Electronic Vaccination Data System (EVDS) system https://vaccine.enroll.health.gov.za/#/ for your vaccine, you can obtain your vaccine from any of the registered vaccination sites. Our Administration partner Medscheme has vaccination sites available as well. Should you wish to book an appointment at one of their registered sites, click on the following link bit.ly/3wULLzS.It is important to understand that there are several myths regarding the COVID-19 Vaccine and the scheme have responded to you with some FACTS.

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ATTENTION DEFICIT HYPERACTIVITY DISORDER ADD/ADHD is a condition affecting both children and adults. Both diseases cause disabling symptoms that impede development and impair social function. ADHD is a mental disorder that interferes with the learning process, impedes social and cognitive development, and can be a precursor to a variety of other conditions.

Don’t wait for a diagnosis start addressing your child's symptoms today

Regularly set up and get moving with your child

Establish structure and consistent daily routines at home

Ensure your child gets enough restful sleep

Learn how your child's diet can affect ADHD symptoms

Seek face-to-face support from family and friends

Talk to your child's teacher about managing symptoms at school

WHAT CAN YOU DO TO HELP YOUR CHILD

Fear of recurrence: Many survivors worry that their cancer will come back at some point. Knowing your own body can help distinguish between normal physical changes and more serious symptoms that need to be reported to your doctor.

Depression: Most cancer survivors experience depression at some point. Know the symptoms of depression and seek treatment as soon as possible.

Body image: Cancer survivors who have experienced amputations, disfigurement or a major change in physical function can suffer from a lack of self-esteem.

Relationships: You may find that friends, co-workers and family members treat you differently after a cancer diagnosis. It can help to seek new relationships with other cancer survivors who know what you’ve been through. Check if your employer has a support group or other resources for cancer survivors.

EMOTIONAL IMPACTS OF CANCERMost cancer survivors will face psychological and emotional issues that can show up many years after treatment. You don’t have to suffer alone in silence. The first step in coping is realising that you have an issue and there are ways that you can reach out for help.

Some of the most common psychosocial issues that cancer survivors may deal with:

MEDiPOS has a dedicated oncology program which includes access to registered nurses and treatment for your condition. To access these benefits, you may contact our Oncology Risk Management contact centre on 0860 100 078.