HealthCare Benefits

HEALTHCARE BENEFITS

MEDICAL AID BENEFITS

We provide an independent advisory service that is member focused, through our experienced and qualified consultants that will help you determine a medical aid scheme most beneficial and suitable to your healthcare needs. Our Health Care Management Solution is member focused to ensure you get maximum benefit out of your medical aid. To do this we conduct:


  • Member Education
  • Actuarial valuation
  • Medical Aid Administration


Mpumelelo Services holds member education sessions where we inform our members about issues that affect their health, with emphasis placed on Prescribed Minimum Benefits (PMB’s), to raise awareness on health and related issues.


GAP COVER




Gap Cover has been designed to reduce your risk of out-of-pocket expenses when you are hospitalised. Typical out of pocket expenses is the shortfall you may experience:

  • Tariff Shortfall - difference between a provider’s fee for in-hospital treatment and your medical scheme benefit.
  • Co-payments or Deductibles – these can range from around R1, 000 up to as much as R11 000 and more depending on your medical scheme plan and in-hospital procedure.
  • Annual Sub-Limits - limitations imposed on certain in-hospital items, e.g., prosthesis used for joint replacements.
  • Oncology Co-payments – 20% of Oncology treatment above a certain threshold.
  • Medical Scheme Contribution Waiver – which continues to pay your medical scheme contributions for the dependants after the death of the principal member, up to a period of 6 months
  • Daily cash benefit for prolonged in hospital care, normally pays after your third

day in hospital. However, this does not pay retrospective to day 1.

Mpumelelo Services prides itself in guiding, educating, and protecting our clients and for this reason we believe you need to be aware of the shortfalls and risks you may be exposed to. It is important to know the rules of your medical scheme to understand the gaps in cover of your medical scheme option and possible out-of-pocket exposure. It is also important to understand what gap does not cover, such as Prescribed Minimum Benefits, procedures declined by your medical scheme and specific exclusions.



PRIMARY HEALTHCARE


Mpumelelo Services offers corporate group and individual primary cover that is affordable and covers both you individually or and your company’s employee’s offering both a peace of mind when it comes to the provision of healthcare benefits. We have some of the industry’s low-cost benefit options that provide economically viable and affordable alternatives to conventional medical aid cover. All employer contributions are tax-deductible Primary healthcare offers unlimited but managed GP consultations through a Network Provider. Corporate group cover plans are efficiently managed, allowing you to focus on what you do best – running your business.


CORPORATE WELLNESS


If your organization has been talking about wellness and doing nothing about it, Mpumelelo Services has a well-structured corporate wellness business that can assist your business. Because we understand that corporate wellness is a vital investment that a company should make to improve its overall productivity and be able to save money on health care expenses. Wellness programmes are about physical wellness, safety, mental health, and taking preventive measures by creating a healthier environment. A study conducted by Discovery Health which sought to benchmark a company’s health and wellness priorities against the survey average, and give insights into how wellness initiatives can change the workplace wellness state for the better, showed:


  • More than 68% of employees do not meet the required physical activity guidelines.
  • 53% of employees did not have all their preventive health checks.
  • 50% of employees have 5 or more risk factors outside of healthy range.
  • 76-100% of employees are inactive at work for at least half their working day.
  • 63% of employees are at an unhealthy weight and a further 25% are obese.
  • 24.3% reported having one or more chronic condition such as diabetes, high blood pressure, lung disease, and high cholesterol.
  • High blood pressure and high cholesterol are the most prevalent chronic conditions

of lifestyle among employees.

According to the Regenesys Business School, South Africa loses over R10 billion per annum and 132 million workdays due to premature employee deaths related to cardio-vascular disease (high blood pressure, stroke, diabetes, and obesity), and over R17 billion is currently lost because of absenteeism and lower productivity related to illness and disability


Interested in our services? We’re here to help!

We want to know your needs exactly so that we can provide the perfect solution. Let us know what you want and we’ll do our best to help. 

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