Medical Aid!

Regarding the Gap, did you look at complimed gap? The items that Chris spoke about above were covered in full between the medical aid and the Gap for my wife when she had a procedure done. As long as it's done in hospital, gap covered us.
 
I am a 23 year old male and I need advice on medical aid.

I currently have no medical aid and I am getting older and I feel that it's becoming more and more important and I neglected it for too long.

I am looking for cover mostly for cases like accidents and in case I need a hospital visit or surgery of some kind. I don't really care that much for the day to day stuff like doctor visits because I if I understand correctly it will add a lot to the monthly premium?

What would you recommend in my case?

TIA
 
Cover question

It sucks that private hospitals won't take you if you don't have a medical aid card.

I wonder if HavocXphere's employer has a similar arrangement with CAMAF as my employer (large auditing firm).

I'm seriously pissed with my employer's admin team's disregard for my wellbeing.

I'm going through the following atm and want to know whether HR is right to say I enjoyed cover.

General
- Employer has everyone on CAMAF (except where on spouse's medical aid).
- All employees hand in medical aid application forms before employment begins (also requirement in employment contract).
- Employer tells all first years that they are covered during January despite the medical aid contribution only being made on pay day.

My case
- First salary not processed at end of Jan and I only follow up on this half-way through February due to stress of moving from Jhb to CT
- The payment to me is higher than expected (by R1.2k)
- I am suspicious the amount relates to my medical aid and request my medical aid number from admin
- Admin makes me wait a while with back and forth until owning up to not having my medical aid application form (which I dropped off at reception in person on 06 December)
- Admin promises to arrange a medical aid number for me before end of this week if I resend my application form (which I complete and sign on 11/03/2014)
- Soon thereafter I am informed that I need to retrospectively pay my medical aid contirbutions for January and February due to my employment contract stating that I need to be a member of a medical aid (I quit my previous one on 31/12/2013 so that I could join my employer's medical aid).
- I disagree with the retrospective contributions being deducted from my pay and receive snappy replies from ever higher up the HR chain stating that I enjoyed medical aid benefit and must thus pay (HR can be such bullying cowards, CCing in unrelated parties up to the CEO - WTF...).
- HR also informs me that they are of the opinion that CAMAF would have covered me in case of an emergency (which doesn't make sense as my employer doesn't even have my application form).

As far as I'm concerned my employer's admin people are incompetent and/or pure evil.
I played through the following scenario in my head:

If I had been in an accident this year I would have told my paramedic that I have medical aid.
Ambulance would make haste for private hospital.
Private hospital would want to confirm my membership status before treating me.
Hospital admin would try to get confirmation from CAMAF, who obviously don't have me on their system as my employer's admin team didn't process my application form or effect payments on my behalf.
I would then (hopefully) be taken to a public hospital where I would be lucky to receive adequate and timely treatment.

This can't possibly qualify as being covered. In fact it's even worse, as I would be wasting critical time being ferried from private to public, as well as then receive inferior treatment at a public hospital.

Do I push them to show me policies from CAMAF stating that CAMAF would cover my employer's employees in case of both a missing application form and no payments having been processed?

Do I have a leg to stand on against the HR department? I would be playing with fire due to the power tripping on display by the HR lady who CCed my CEO so I need informed advice.
 
@rudig: We got letters stating that we are covered retrospectively and were told to carry those with us until the med aid cards arrive.

>Do I have a leg to stand on against the HR department?

Not worth it. Just sort out the application and get a med card asap.
 
The letter sounds like a good way for admin to ethically fulfill their responsibilities towards the newcomers until the cards come through. Good on your employer for caring about your wellbeing.
In my case, we never got a letter.
Only oral statement that CAMAF covers us from 01 January (which assumes that the employer sent all applications to CAMAF and didn't lose them).

It grates me that my HR department expects me to pay for their stuff-up which would have meant enjoying the privilege of bad hospital treatment if something had happened.

Surely that can't qualify as medical aid cover?
 
rudig said:
The letter sounds like a good way for admin to ethically fulfill their responsibilities towards the newcomers until the cards come through. Good on your employer for caring about your wellbeing.
In my case, we never got a letter.
Only oral statement that CAMAF covers us from 01 January (which assumes that the employer sent all applications to CAMAF and didn't lose them).

It grates me that my HR department expects me to pay for their stuff-up which would have meant enjoying the privilege of bad hospital treatment if something had happened.

Surely that can't qualify as medical aid cover?
Click to expand...

Unless you were issued with a member number, be it on e-mail or card (the latter you did not receive), you were not allocated onto their system, so should anything have happened, then, i doubt for any better reasoning, you would not have received the private hospitilisation due to you. If anyone i have dealt with Cc's Md's etc in on e-mails, i make sure my argument is sound and reply with all attached. If they open the can of worms, they better be prepared to eat them too. As a sign off at the bottom, you can add "please note that issues of this nature do not befit the time of the "ceo / md / gm". Please endevour to attend to queries of this nature for the CoC they are intended for."

Sorta puts them in place.
 
rudig said:
The letter sounds like a good way for admin to ethically fulfill their responsibilities towards the newcomers until the cards come through. Good on your employer for caring about your wellbeing.
Click to expand...
Yeah - solid employer. It was partly a reaction to the process though...it was made very clear to us that all previous med aid had to stop 31 Dec midnight or else. So the employees made it very clear that they are cool with said precise deadline if come 00h00 1 Jan there is cover. And thus...the letters.

Wasp_21 said:
Unless you were issued with a member number, be it on e-mail or card (the latter you did not receive), you were not allocated onto their system, so should anything have happened, then, I doubt for any better reasoning, you would not have received the private hospitilisation due to you.
Click to expand...
In truth I would not want to have test the soundness of said letter in an emergency either. Purely from a practical point of view - I've battle to get an immediate response from emergency departments even when suitably armed with med aid car & credit card.
 
Last edited:
Hi All

Anyone on Profmed medical aid. Doing some research on it and want to join their hospital plan. How is their service etc and are they good generally?
 
I am trying to ascertain what my hospital plan covers and what it does not

I recently went in for a foot op and obtained pre-authorisation from the company

After a week, the first statement appeared. All the claims had been rejected, reason "no pre-authorisation"
Submitted them again. This time rejected since description of injury differed from hospital to surgeon (tripped on flat surface as opposed to fell off ladder)
Corrected this again and resubmitted
Next statement shows that, of the 6 items on the surgeon's invoice, they only paid 25% of two items and ignored the rest
Submitted this again
Next statement shows "no benefit under scheme rules"
Spoke to surgeon and he says there most definitely is cover for these items
Submitted this again, and they paid 85% of the rest of the items

Spoke to medical ombudsman and they can only assist if there is a dispute

What I want to find out is what is the scope of the cover? Upon asking medical scheme, am sent a 16 page list of procedures. I thought a hospital plan covers you whilst you are in hospital, but apparently some items are not covered. All medical scheme will say is that each case is assessed individually

When you attend a hospital for an operation, there is usually

The hospital stay itself
The surgeon
An anaesthetist
A pathology service
X-rays or radiology during the operation

When you leave, there are sometimes more x-rays

If the x-rays taken after being discharged relate to the procedure which was done in the hospital, should they be covered or not? The scheme will not answer this, emails are ignored
 
Good day,

I'm new here and see that there are many questions about m/aid and short term m/aid products.

This is my field of expertise and I'll gladly answer any questions.

Feel free to pm me concerning more personal things.

The worst that could happen is I'll broker note you...

Regards
L3hav
 
L3hav said:
Good day,

I'm new here and see that there are many questions about m/aid and short term m/aid products.

This is my field of expertise and I'll gladly answer any questions.

Feel free to pm me concerning more personal things.

The worst that could happen is I'll broker note you...

Regards
L3hav
Click to expand...
Have a shot at chris's question above.
 
I am on Discovery Essential Saver barely visit maybe once a year mostly optometry which exhausts MSA easily.. after visiting ER and having to pay R170 upfront and now another for R480 that was not paid by med aid propably due to MSA exhausted... would have thought hospital visits are covered...
 
BigBear said:
I am on Discovery Essential Saver barely visit maybe once a year mostly optometry which exhausts MSA easily.. after visiting ER and having to pay R170 upfront and now another for R480 that was not paid by med aid propably due to MSA exhausted... would have thought hospital visits are covered...
Click to expand...

Hospital cover usually only kicks in if you are admitted. I believe a visit to the ER (without hospital admission) is considered out-patient and is not covered by hospital cover
 
chrisc4290 said:
When you leave, there are sometimes more x-rays

If the x-rays taken after being discharged relate to the procedure which was done in the hospital, should they be covered or not? The scheme will not answer this, emails are ignored
Click to expand...

What medical aid/plan are you on? I had a similar situation on discovery and managed to find out how it works. Are you on discovery?
 
Do you know what you are covered for??

For example:

1. Are you a member of Discovery Medical Aid and if so, did its Broker or anyone else on its behalf ever tell you, that the only medical care you and your dependents are unconditionally entitled to as of right is that arising out of illness. Were you told that medical care due to the act of another –e.g. Road Accidents, workplace Injuries, dog bites, assaults and so on are excluded unless you agree in writing, under threat of immediate termination of medical care and a further threat that you have to refund the cost of care already provided to your or your dependants, to claim from the wrongdoer at your own risk and cost and to thereafter reimburse Discovery in full any medical costs paid by it.
Click to expand...

Read the rest here: http://www.bobroff.co.za/116-a-shoking-discovery-for-discovery-medical-aid-members.html
 
A shocking discovery for Discovery medical aid members

http://www.bobroff.co.za/116-a-shoking-discovery-for-discovery-medical-aid-members.html

THE*REAL REASON FOR DISCOVERY’S VENDETTA AGAINST RONALD BOBROFF and RONALD BOBROFF & PARTNERS INC. EXPOSED

DISCOVERY’S WILFUL NON-DISCLOSURE OF HIDDEN RULES AND EXCLUSIONS, AND NON-COMPLIANCE WITH THE MEDICAL SCHEMES ACT NO. 131 OF 1998
Click to expand...

Very long read. My wife just sent me the link.
We moved from Discovery because of their reluctance to medial costs because my son was born 4 days earlier than had been estimated.
We eventually got refunded though - 7 months later and lots of fighting.
 
Last edited:
The Law Society of the Northern Provinces (LSNP) labelled Darren Bobroff, director of personal injury law firm Ronald Bobroff & Partners (RBP), “a disgrace to this society (LSNP)” during a disciplinary hearing for his defamatory postings on social media.
Click to expand...
the bobroffs seem more like clowns than lawyers
 
You must log in or register to reply here.
Back
Top
Sign up to the MyBroadband newsletter
X