Example: biology

Gomomo Care - 2018 - Sizwe

Gomomo Care - 2018pg 2 In the late 1960s, black (African) doctors in the Rand, which consisted of Johannesburg, Pretoria, the Eastrand and Vereeniging formed themselves into The South African Medical Discussion Group (SAMDG). The group discussed matters of interest in respect of black doctors and their patients, as the South African Medical Association (SAMA) was only open to white membership specialists could only work as General Practitioners (GPs) with specialist qualifications, as specialist fees were only affordable to medical aid members. Black specialists who worked in public hospitals were not recognised, but were humiliated as they could not give orders to white juniors and white nurses of all ranks. Many black specialists elected to go into exile and practice in the United States of America (USA) and in SAMDG met once a month on a Sunday afternoon, hosted by members at their homes.

CHILD % of total contribution paid to savings account ADULT PRINCIPAL GOMOMO CARE Income Band Contribution R845 R1 178 R1 681 R2 087 R835 R1 178 R1 623

Tags:

  Contributions

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Gomomo Care - 2018 - Sizwe

1 Gomomo Care - 2018pg 2 In the late 1960s, black (African) doctors in the Rand, which consisted of Johannesburg, Pretoria, the Eastrand and Vereeniging formed themselves into The South African Medical Discussion Group (SAMDG). The group discussed matters of interest in respect of black doctors and their patients, as the South African Medical Association (SAMA) was only open to white membership specialists could only work as General Practitioners (GPs) with specialist qualifications, as specialist fees were only affordable to medical aid members. Black specialists who worked in public hospitals were not recognised, but were humiliated as they could not give orders to white juniors and white nurses of all ranks. Many black specialists elected to go into exile and practice in the United States of America (USA) and in SAMDG met once a month on a Sunday afternoon, hosted by members at their homes.

2 Spouses attended meetings and held their own meeting while members discussed the business of the day. In 1976, the SAMDG which was chaired by Dr. Mzamane of Katlehong in the Eastrand appointed its executive was in 1976 that Dr. Mokgesi who had a practice in Sebokeng, met a white colleague, Dr. Loots at a clinical meeting at the Johannesburg General Hospital. He suggested that it would be good to register a medical aid scheme and a private hospital for blacks. He introduced the matter to some government officials who would make registration of a black company in the urban areas possible, as this was not permissible 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 South African society, assumed leadership of the group.

3 In serving as the chairman of the group, he sold the idea to black doctors to take up shares and negotiated with white business to support the initiative. A Brief history of Sizwe Medical Fund and Sechaba Medical Solutionspg 3 In 1978, the Kwacha Group (Kwacha meaning Day Break in Chewa - a Malawian language) was registered with 38 shareholders. Dr. Loots was the only white shareholder and also served on the board of directors. Sizwe Medical Fund was registered after shareholders had raised R3 million as security to meet medical claims. Lesedi Clinic opened its doors soon after Sizwe Medical Fund started operating. The Kwacha Group was later changed to Sechaba Group Holdings (Pty) motivation for forming the Kwacha Group To provide medical aid cover for Blacks To lead the black population in matters of healthcare To enable black specialists to open private practice To give black private patients and their doctors access to X-rays, other investigations and expensive medications which were out of reach for virtually all who had no medical aid coverAlthough Dr.

4 Motlana tried to persuade the powers that be to allow black civil servants of the day to join Sizwe , the government refused and instead registered other medical schemes to cater for various civil servants races. The first members of Sizwe Medical Fund were drawn from the Barlow Rand Group, Iscor, PUTCO, steel companies and coal mining companies in Witbank and Middleburg as well as motor industry workers from Port Elizabeth and Uitenhage. Forty years later, the initiative by our founding fathers continues to Tlakulapg 4 Gomomo CAREThis is our entry-level option. Gomomo care option provides excellent value for money. GPs, specialists and acute medicines are accessible through a selected network provider dentistry, radiology and pathology are also available from a network provider. No overall limit for hospitalisation at a private hospital. Covers the 27 Chronic Disease List (CDL) 4 2018 Healthcare Offerings - Subject to CMS approvalpg 5 OUT OF HOSPITAL BENEFITSO ption StructureMajor Medical.

5 Day to day: RiskProviderNetworkOVERALL DAY-TO-DAY LIMITB enefits100% Sizwe rate, subject to managed care rules, formulary and clinical protocols of the DSP (Designated Service Provider)GENERAL PRACTITIONERSR eimbursement rate100% Sizwe rateLimitsSubject to managed care rules, formulary and clinical protocols of the DSPOut of area visits4 visits per year per beneficiary, within the DSP networkSPECIALISTSR eimbursement rate100% Sizwe rateLimitsSubject to referreal from a GPRADIOLOGY AND PATHOLOGYB asic Radiology and pathologyReimburse-ment rate100% Sizwe rate: subject to managed care rules, formulary and clinical protocolsSpecialised (Advanced) Radiology in and out: Benefit is R 7140 per familyReimburse-ment rateCombined In and Out of HospitalPSYCHIATRIC TREATMENTR eimbursement rate100% Sizwe rateBenefits Only PMBsMEDICATIONA cuteReimburse-ment rate100% Sizwe rate: subject to managed care rules, formulary and clinical protocols of DSPOver the Counter (OTC)LimitsR300 per familyCHRONIC CONDITIONS (subject to pre-authorisation, registration on the chronic disease management programme, formulary and clinical protocols of the DSP)Reimbursement rate100% Sizwe rateBenefitsR7 870 per beneficiaryPMB26 Non-PMBNo benefitDENTISTRY (Subject to Dental Management Programme - 0860 100 871)(Subject to managed care rules, formulary and clinical protocols)Reimbursement rate100% Sizwe rateLimitsM: R2 770 M+1: R3 190 M+2: R3 470 M+3: R3 750 M+4: R4 010 M+5: R4 290 M+6: R4 710 OPTICAL BENEFITS (Subject to managed care rules, formulary and clinical protocols of DSP)Reimbursement rate100% Sizwe rateFramesR490 per beneficiary subject to family limits belowCycle2 yearsLimit per familyM: R1 130 M+1: R1 300 M+2: R1 440 M+3: R2 070 CHRONIC BENEFITS(Subject to.)

6 Subject to registration on the Chronic Disease Management Programme. PMBs subject to pre-authorisation, preferred providers and treatment protocols.)Reimbursement rate100% Sizwe rateNon PMB BenefitsR7 870 per beneficiary. PMBC over for 27 PMB chronic conditions (in-clusive of HIV/ AIDS)HIV/AIDS(Members are encouraged to register with the HIV/AIDS Management Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for monitoring purposes)Reimbursement rate100% Sizwe rateBenefitsSubject to Preferred Provider Disease Man-agement Programme (PPDMP) benefits include counseling, prescription medicine, pathology tests and relevant consultationsIN-HOSPITAL BENEFITS(All hospital admissions must be authorised. A co-payment of R1 500 will be applied if pre-authorisation was not obtained)Overall annual limit UnlimitedProvider NetworkContracted networkBENEFITSAMBULANCE SERVICESC ontracted EUROP ASSISTSA (Telephone number:0860 11 77 99100% Sizwe ratePRIVATE HOSPITALS AND NURSING HOMES(Subject to treatment, case management protocols and PMBs.)

7 Pre-authorisation required unless it is a medical emergency)AccommodationUnlimited at a private hospitalReimbursement rate100% Sizwe rateClinical limitationsAdvanced laparoscopic, reconstructive surgery, joint replacements, cardiac surgery including cardiac stents, spinal surgery, breast reconstructive surgeryExclusionsRefractive surgery including radial keratot-omy, breast reduction, breast augmentation, keloids, frail careOTHER SERVICES(Physiotherapists, Speech Therapists, Clinical Psychologists, Podiatrists, Equipment and External Prostheses)Reimbursement rate100% Sizwe rateBenefitsR2 530 per family: subject to PMBsOUT OF HOSPITAL BENEFITSMATERNITY (ANTENATAL CARE)(subject to managed care rules, formulary and clinical proto-cols of DSP)Reimbursement rate100% Sizwe ratePregnancy scans and blood tests2X2D scansBlood tests:2 Haemoglobin Measurement tests, 1 Blood Grouping test, 1 VDRL test for Syphilis and 1 HIV blood testDENTAL HOSPITALISATIONR eimbursement rateLimited to PMB level of careConscious sedation in roomsSubject to pre-authorisa-tion and limited to PMB level of careGENERAL PRACTITIONER AND SPECIALISTR eimbursement rate100% Sizwe rate for consultations and visits in-hospital AUXILIARY SERVICESR eimbursement rate100% Sizwe rateDietician, speech therapy, occu-pational therapySubject to clinical protocols and pre-au-thorisationPHYSIOTHERAPYR eimbursement rate100% Sizwe rateMATERNITY(Hospitalisation [public or private hospitals] delivery, post-natal services and midwifery)Reimbursement rate100% Sizwe rateBLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTSR eimbursement rate100% Sizwe rate.

8 Subject to PMBsPROSTHESIS(Pre-authorisation and managed care protocols apply)Reimbursement rate100% Sizwe rateBenefitsR28 090 per beneficiaryONCOLOGY(subject to pre-authorisation, treatment protocols and PMBs)Reimbursement rate100% Sizwe rateRADIOLOGY AND RADIOGRAPHY(Subject to Hospital Benefit Management Programme and Dis-ease Management Programme. Limited to PMB level of care)Reimbursement rate100% Sizwe ratePATHOLOGY(Subject to Hospital Benefit Management Programme and Disease Management Programme)Reimbursement rate100% Sizwe rateMENTAL HEALTH(Subject to pre-authorisation and managed care rules)Psychiatry hospitalisationLimited to 21 days per beneficiary including psychiatrist consulta-tions and 6 in-hospital clinical psychologists subject to PMBsAlcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package3 days withdrawal treat-ment and up to 21 days rehabilitation ORGAN TRANSPLANT AND RENAL DIALYSISR eimbursement rate100% Sizwe rateBenefitsSubject to Prescribed Minimum Benefit at DSPREFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMYB enefitsNo BenefitIN HOSPITAL BENEFITSCHILD% of total contribution paid to savings account ADULTPRINCIPAL Gomomo CAREI ncome BandContributionR845R1 178R1 681R2 087R835R1 178R1 623R1 704R352R427R467R4990%2018 ContributionsR0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +R0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +R0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +pg 7 CHRONIC MEDICATION PROGRAMME:Tel: 0860 103 455 | 011 353 0030 Fax: 011 353 0352/0076 Email: PRE-AUTHORISATION, HOSPITAL BENEFIT MANAGEMENT PROGRAMME:Tel: 0860 101 176 DENTAL BENEFIT MANAGEMENT:Tel: 0860 109 556 | Fax.

9 0866 770 336 Email: PROGRAMME HELPLINE FOR ASTHMA, CARDIOVASCULAR DISEASE, DIABETES AND MENTAL HEALTH:Tel: 0860 103 455 | Fax: 011 221 5238 Email: MANAGEMENT PROGRAMME:Tel: 0860 103 454 | Fax: 011 221 5235/56 EUROP ASSISTANCE SA, MEDICAL EMERGENCIES, 24-HOUR AMBULANCE SERVICES AND MEDICAL ADVICE:Tel: 0860 117 799 Sizwe BABY PROGRAMME:Fax: 011 221 5218 Email: ANONYMOUS FRAUD LINE:Tel: 0800 204 702 | Fax: 0800 007 788 Email: MEDICATION PROGRAMME:Tel: 0860 103 455 | 011 353 0030 Fax: 011 353 0352/0076 Email: CONTACT 100 871


Related search queries