Benefits Guide - 2018 - Sizwe Medical Fund

1 Benefits Guide - 2018 . A Brief Sizwe Medical fund and In the late 1960s, Black (African) doctors in the Rand, which consisted of Johannesburg, Pretoria, the Eastrand, and Vereeniging, formed themselves into The S. A. Medical Discussion Group . (SAMDG) which discussed matters of interest to Black doctors and their patients. The South African Medical Association was only open to white membership then. The SAMDG met once a month on a Sunday afternoon. Meetings were hosted by members at their homes. Spouses attended meetings and held their own meeting whilst members discussed the business of the day. Meetings ended with a social. The executive of the SAMDG was appointed by region to facilitate executive meetings, in 1976, the executive was from the Eastrand, it was chaired by Dr. Mzamane of Katlegong.

2 It was in 1976 that Dr. Mokgesi who had a practice in Sebokeng, met a white colleague, Dr. Loots at a clinical meeting at the Joburg Gen. Dr. Loots suggested that it would be a good thing to register a Medical aid scheme for blacks and a private hospital for blacks, he would introduce the matter to some government officials who would make the registering of a black company in the urban areas possible as this was not permissible then. The matter of a Medical aid scheme and a private hospital for blacks was discussed by the SAMDG and accepted. Dr. Motlana, who was very influential in black circles and highly respected by business leaders and politicians of all sectors of S African society took up leadership of the group, he led the selling of the idea to black doctors to take up shares, negotiated with white business to support the initiative, and served as chairman of the group.

3 At this time, Dr. Motlana also led various committees of the STRUGGLE which took a great deal of his time and resulted in him spending many months under detention. In 1978 The Kwacha Group was registered with 38 shareholders. Dr. Loots was the only white shareholder. He also served on the board of directors. Sizwe Medical fund was registered, the 38. shareholders raised R3 000 000 as security to meet claims. Lesedi Clinic was to open its doors soon after Sizwe started. (Kwacha meaning Day Break' in Chewa was chosen as an appropriate name for the new company). Kwacha was later changed to Sechaba Group Holdings (Pty)Ltd pg 2 Sizwe History Sizwe History 2018 Offerings Hospital Care Gomomo Care history of Sechaba Medical Solutions The motivation for forming the Kwacha Group To provide Medical aid cover for blacks.

4 To enable black specialists to open private practice, black specialists of the day could only work as GPs with specialist qualifications, as specialist fees were only affordable to Medical aid members. Black specialists who worked in public hospitals were not recognised, they were humiliated as they could not give orders to white juniors and to white nurses of all ranks! Many black specialists elected to go into exile and practice in the USA and in Canada. To give black private patients and their doctors access to Xray, other investigations and expensive medications which were out of reach for virtually all who had no Medical aid cover. To lead the black population in matters of healthcare. Although Dr. Motlana tried to persuade the powers that be to allow black civil servants of Primary Care the day to join Sizwe , the government refused, and instead registered Bonitas for black civil servents, Sanitas for Indians, and Prosano for coloured civil servents.

5 All these schemes were to be administered by Medscheme this is certainly the reason for Bonitas being the second largest open scheme in today. The first members of Sizwe were drawn from the Barlow Rand Group, from Iscor, from PUTCO. and from the steel companies and coal mining companies in Witbank and Middleburg as well as motor industry workers from Port Elizabeth and Uitenhage. The initiative by our founding fathers has survived to this day!! Affordable Care Full Benefit Care Dr Tlakula Sizwe Medical fund - Benefits Guide 2018 pg 3. 2018 HEALTHCARE. HOSPITAL CARE GOMOMO CARE PRIMARY CARE. The Hospital Care This is our entry-level Primary Care Option Option offers peace of option. Gomomo Care offers good value for mind knowing that in the Option provides excellent money with unlimited event of hospitalisation, value for money.

6 Hospitalisation at any extensive cover is GPs, specialists and private hospital. available at any private acute medicines are hospital. accessible through a This traditional option selected network provider has generous day-to-day In addition, the Hospital Dentistry, radiology benefitswhich cover acute Care Option provides and pathology are also medicines cover for 27 Chronic available from a network GPs,specialists, Disease List (CDL) provider. radiology, pathology and conditions. more to meet the needs No overall limit for of any family. hospitalisation at any private hospital. Covers the 27 Chronic Disease List (CDL) conditions. pg 4 4 2018 Healthcare Offerings - Subject to CMS approval Sizwe History 2018 Offerings Hospital Care Gomomo Care OFFERINGS. AFFORDABLE CARE FULL BENEFIT CARE.

7 Our Affordable Care Our Full Benefit Care Option Option offers generous offers comprehensive cover comprehensive cover with and generous Benefits to unlimited hospitalisation cover families and individuals in any private hospital. who need access to unlimited hospitalisation at any private Primary Care It also covers additional hospital. chronic conditions with specialised dentistry and This option also offers additional preventative chronic conditions, specialised Benefits . dentistry, GPs, specialists, acute medication, preventative care This option is suitable Benefits and more rich Benefits . for young and healthy This is the only option which families. offers Top-up cover when in hospital up to 200% of the Sizwe rate. Affordable Care Full Benefit Care Sizwe SizweMedical MedicalFund fund -- Benefits Guide 2018 .

8 Benefits Guide 2018 pg5. pg 5. HOSPITAL CARE. Offers peace of mind knowing that in the event of hospitalisation, extensive cover is available at any private hospital. pg 8 Hospital Care Sizwe History 2018 Offerings Hospital OUT OF HOSPITAL Benefits CHRONIC Benefits IN-HOSPITAL Benefits . Major Medical ; Subject to : (All hospital admissions must be authorised. Option Structure Day to day: Risk subject to registration on the Chronic A co-payment of R1 500 will be applied if pre- OVERALL DAY-TO-DAY LIMIT Medicine Programme. PMBs subject to authorisation was not obtained). pre-authorisation, preferred providers and MATERNITY. Benefit No benefit treatment protocols). GENERAL PRACTITIONERS Reimbursement Rate HIV/AIDS Hospitalisation (public or private 100% Sizwe Rate Reimbursement rate No benefit (Members are encouraged to register with the HIV/AIDS hospitals) delivery, post-natal Programme.

9 This benefit includes relevant consultations, services and midwifery SPECIALISTS counselling, medication and the cost of blood tests for (excluding psychiatrists), Acute Medicine, monitoring purposes) BLOOD TRANSFUSIONS AND BLOOD. Pathologists,Radiologists And Physiotherapists REPLACEMENT PRODUCTS. Reimbursement rate 100% Sizwe rate Reimbursement rate No benefit 100% Sizwe rate, No limits but subject subject to PMBs and Benefits Only PMBs Benefit to treatment protocols Reimbursement rate annual limit of R79 490. and PMB's at a DSB. ACUTE MEDICINES AND PHARMACY ADVISED THERAPY per family Hospital Care (PAT) - FALLS WITHIN DAY-TO-DAY BENEFIT WITH THE. FOLLOWING SUB-LIMITS. IN-HOSPITAL Benefits PROSTHESIS. (All hospital admissions must be authorised. Reimbursement rate No benefit 100% Sizwe rate, A co-payment of R1 500 will be applied if pre- subject to an annual RADIOLOGY AND RADIOGRAPHY authorisation was not obtained) Reimbursement rate: pre-au- limit of Care Gomomo Care R37 930 per family.

10 Reimburse- Overall annual limit Unlimited thorisation and managed care General No benefit maximum of 3 cardiac ment rate protocols apply stents and 2 vascular Provider Network Any stents per family per Reimburse- Specialist No benefit Benefits annum ment rate PHYSIOTHERAPY Top-up cover No benefit ONCOLOGY. Reimbursement rate No benefit General Reimbursement rate 100% Sizwe rate R1 300. scopes PATHOLOGY Overall limit of R320 000. Co Payments Endoscopic Benefit per family Reimbursement rate No benefit (Laparoscopic R3 000. surgery). BASIC DENTISTRY investigations RADIOLOGY AND RADIOGRAPHY. Reimbursement rate No benefit AMBULANCE SERVICES Reimbursement rate 100% Sizwe rate SPECIALISED DENTISTRY Contracted EUROP ASSIST. 100% Sizwe rate Specialised Radiology (MRI/. SA (Telephone number: Reimbursement rate No benefit 0860 11 77 99 CAT scan/ Anglogram) Pre- Limited to R25 270 per Primary Care authorisation and managed care family OPTICAL Benefits ACCESSED THROUGH PPN PRIVATE HOSPITALS AND NURSING HOMES protocols (Subject to treatment and case management protocols Reimbursement rate No benefit and PMBs.))