Medical aid

[mecheng89]

Profmed,

one of the worst we have to deal with.

have had a number of cases cancelled by the surgeons because they refuse to cover specialist equipment rental.

What's your take on GEMS? 

[Captain Fastbastard Mayhem]

Okay. First, to answer your question re Momentum and whether it's "better"

 

As with everything - it depends. What plan were you on, what plan are you changing to, what are your hospital providers (any / associated / state) and chronic providers (associated / any / state) - and - DO YOU HAVE GAP COVER?!

 

If the answer to Gap is "no", then I'm gonna ask "why the feck not!?" as it is, in my opinion, a required product. Stratum is one of the better ones in my experience. 

 

Now - moving on. Momentum's core benefits aren't any "better" than Discovery's, per se. There are areas where (on a like-for-like basis) one is better than the other in certain area, but not by much. They're both IMMENSELY large schemes (Discovery through their own power, Momentum by managing theirs and many other schemes administration) and they therefore have excellent bargaining power and networks. I'd say they're pretty much equal ito benefit unless there's something you specifically want. 

 

Where Momentum really manages to eke ahead is when you start having a look at mixing and matching their associated / state providers for chronic and hospitalisation, thereby saving you cash. Discovery don't have that option, and it's either all hospitals, or the Delta network, and you can't choose to get your chronic only from the state. That's a major saving on the momentum side of things. 

 

ITO Claims & administration - I'd say Disco has the edge here. They're simply a more polished administrator, which means things get dealt with a bit faster and more smoothly. Yes, there are sometimes hiccups, but when those occur all you have to do is escalate teh query or walk in to one of their client contact centres and they sort it out chop chop. Momentum doesn't have that yet. Momentum certainly isn't BAD, Discovery is just that much better. 

 

ITO Multiply vs Vitality - swings and roundabouts. I'd say they're equal now, but historically Vitality has led the way. For discounts on shopping - Multiply. For discounts on food / gym / hotel & travel - Vitality purely down to the hotel & car hire and international flights. Multiply streaks ahead when paired with the Med Aid without any MSA, as then you can use HealthReturns to give you the same benefit as an MSA would have given you. 

 

Oh - Momentum's day-to-day coverage / screening benefit is great. Even without MSA you get certain screening benefits and docs visits and limited gynae checkups etc. So it's good. 

 

GET GAP COVER!

[Captain Fastbastard Mayhem]

What's your take on GEMS? 

meh. It's okay. 

[Captain Fastbastard Mayhem]

Standard cover on our incentive plan is 200%(I think). If you are on Private club multiply they up that to 300%. That will make a big difference! When my wife was pregnant we had to pay in for every single gynae visit on discovery. In theory that won't happen now with our new momentum plan but haven't tried it out yet.

GET GAP COVER!!!!!!!!

 

Seriously, guys. Gap Cover. R 200 per month (depending on the provider) and gives you cover at up to 500% of the medical aid rate. 

[ShirlsBotha]

Through Vitality at Discovery there are large savings too. Be careful assuming an entire scheme is cheaper because you chose 1 plan that may seem more affordable. Discovery is not more expensive overall and has had lower increases than Momentum. Ensure you know EXACTLY what you are gaining and losing by the move. You will also more than likely get underwriting as it is a voluntary move.

 

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[Escapee..]

medical aid is through work, medscheme.

 

Took out long and short term insurance out through Momentum so keen to find out more about Multyply etc etc

[Long Wheel Base]

I find their service very good. I do have a broker but when you log on to the site there is a new chat option. It's live, You get a response straight away.

[Captain Fastbastard Mayhem]

Which plans from Discovery and Momentum does not a have limit when lying in ICU?

all of them. Some of them have sub-limits for certain procedures though. Generally only on the lower end salary-banded plans (Keycare / Access)

 

You have to delineate between HOSPITAL costs (ie bed & breakfast, surgical implements etc) and SPECIALISTS. 

 

There are % limits on specialists based on the plan you're on. IE if a certain procedure has a "medical aid rate" of R 1,000 then the scheme will cover either 100%, 200%, 300% of that cost. A specialist can charge whatever the hell they want to (based on their own particular expertise, scarcity of skills, period training, self worth etc) but they generally charge between 200% & 500%. If you're on a plan with coverage at 100% and your specialist charges 500% and you don't have GAP cover, then you will have to foot the bill yourself.

 

Also - you need to delineate planned procedures and PMB's. With PMB's the scheme has to pay the entire cost, BUT they can force you to use their hospital / provider of choice IF you have the capacity to choose. If you're in a car accident and are comatose and can't elect to go to a network hospital / engage with a tied specialist, then they have to cover the full cost regardless of where you go, until you are stable and able to move to a network hospital. 

[Stretch]

Profmed,

one of the worst we have to deal with.

have had a number of cases cancelled by the surgeons because they refuse to cover specialist equipment rental.

 

well not according to my SOB..been with them for over 15 years and not had one problem.

[Captain Fastbastard Mayhem]

medical aid is through work, medscheme.

 

Took out long and short term insurance out through Momentum so keen to find out more about Multyply etc etc

Get multiply, dude. If you get up to Private Club (same as Diamond Vitality, and not difficult) then you get up to 60% off your life premiums. 

 

That is a stupendous benefit. Discovery is the only one that comes close with their 5-yearly payback, but that's a delayed gratification thing vs instant gratification. 

[OneLove]

GET GAP COVER!!!!!!!!

 

Seriously, guys. Gap Cover. R 200 per month (depending on the provider) and gives you cover at up to 500% of the medical aid rate. 

I work in the insurance industry and I say GET GAP COVER!!!!

[Captain Fastbastard Mayhem]

Profmed,

one of the worst we have to deal with.

have had a number of cases cancelled by the surgeons because they refuse to cover specialist equipment rental.

Not to be funny, but that's almost always down to miscommunication of ICD-10 and other codes by the surgeons or the surgeons' admin teams. The amount of times we have to re-request invoices with the correct codes is stupid. But it's always the med aid that is to blame. Always. Because they're not paying...

 

I'm not saying that they don't have their own hiccups, but in my (and my team's) experience it's mostly the incorrect codes being used. 

 

If the correct codes are being used, then it becomes a bit more difficult. Some med aids are just easier to deal with than others. 

[Captain Fastbastard Mayhem]

We also moving off Discovery, but to Bestmed...  Id be very keen to hear the input here.

Don't deal with Bestmed, so I can't really comment here. 

 

We deal with Momentum and Discovery. We've learned to steer clear of the others due to administrative problems in the past, and you can almost always find a fit for a client out of those 2 providers. 

[Escapee..]

Get multiply, dude. If you get up to Private Club (same as Diamond Vitality, and not difficult) then you get up to 60% off your life premiums. 

 

That is a stupendous benefit. Discovery is the only one that comes close with their 5-yearly payback, but that's a delayed gratification thing vs instant gratification. 

 

Ja I got the card last week, just need to activate everything now and get the ball rolling.

[Furbz]

What's your take on GEMS? 

 

Last post then i am done.

 

we rent expensive equipment to hospitals.

the type of equipment that is seldom used - so financially it does not make sense for a hospital to purchase outright. hence the rental.

 

Profmed - they have refused every case we have ever submitted. thats after submitting quotes, Dr motivational letters, ICD 10 code, all nappies. etc

 

GEMS. poor communication. we submit all the above documents multiple times as they tend to loose them. its because of GEMS we started recording all our conversations. that being said, they have authorised all cases after a week or two of back and forth.

 

Discovery. nothing needs to be done. it is listed as a minimum benefit.

 

i suppose one should keep in mind we only really deal with difficult/unusual cases. so 99% of the time other medicals aids will be fine. its the 1% when things really aren't going your way that will make me stay with discovery.

[Captain Fastbastard Mayhem]

I made the change and with some of the money I saved I was able to open a discovery life insurance policy which kept me on Diamond level for Vitality. I now get more discount options, cash back on my Life insurance and I get the R800 health savings per month. 

 

Its only been 6 months but so far so good.

Exactly what I've done. 

 

I'm in the S Subs in CT, and I've moved from Coastal Saver to Custom (Associated hospital / State chronic) and am saving ~ R 1,600 per month in premiums alone. All the hospitals I would use are on the network (Constantiaberg, Kingsbury, Cape Town Mediclinic etc) and none of us are on chronic. Life cover is through Disco, and I'm a Diamond geezer. Best of both worlds. Even with the Multiply discount there wasn't enough differential between the life premiums to warrant a replacement, so it really is case dependent. 

 

Only been on it for ~ 3 weeks though. Was an experiment. If I'm happy with it, I'll be happy to recommend it.