MEDICAL AID NEWS ALERT

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					     S E P T E M B E R            2 0 0 5                                                                                   n e w s l e t t e r


                                                                  MEDICAL AID NEWS ALERT
1. Managing Absenteeism                        Legislation for medical schemes with options which offer members a choice of
                                               savings has been changed. The Registrar of Medical Schemes has instructed
                                               medical schemes to change their current savings models to ensure that as from
2. DAI Report back                             January 2006, a member is only able to contribute 1 level of savings and will no
                                               longer allow choice as in the past. Please note that Discovery Health will also
3. Discov ery H ealth                          need to comply with this ruling and will be announcing their changes for 2006
                                               shortly. Please be aware of this and carefully read through the communication
                                               which will be sent to you on the changes as well as informing you of the
4. Diab etes                                   dates/times when member sessions will be held for UCT staff.




                                                                        them with regular ‘Operational reports’ which will include
    Please Note:      In preparation for Medical Aid year end           utilisation of sick leave. Sick leave should be used to maximise
                                                                        wellness and therefore performance in accordance with the
    revision, we attach a survey and ask that you please                Organisational Health strategy in achievement of the
    complete it and return by the 19th September to Gina Fraser         University’s goals and mission.
    (Human Resources, Bremner Building) to assist us in setting
                                                                        Below is a graph of statistics which shows the number of sick
    up the necessary processes.                                         days taken by UCT employees who are registered on the
                                                                        HIV/Aids programme (in orange) ie. in a managed environment,
1                                                                       and those employees not registered (in green). This illustrates
       Managing Absenteeism                                             less absenteeism where a health condition is being managed.

    The benefits of managing absenteeism not only results in cost            2.5                                                                                    UCT- SAR
                                                                                                                                                                    DA I -SAR

    savings (see figure 1 below) to the organisation, but is a useful
                                                                              2
    mechanism for early detection of a medical condition.
                                                                             1.5




              Figure 1: Costs of UCT Sick Leave                               1


                         May 2004 - 2005
                                                                             0.5

              Direct costs:
              1.6% of annual payroll = R10.84 million per annum               0
                                                                                   May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05
              Indirect costs:
              Direct costs x 2.5 = R27.11 million per annum
              Estimated costs: R37 million per annum                    HR would like to raise awareness on the importance of
                                                                        capturing sick leave and needing departments to become more
                                                                        responsible in capturing the correct information to assist with
    Traditional health models only interact when people start           this process.
    showing symptoms of a disease, which is reactive and
    expensive. We prefer to focus on prevention and promotion of
    holistic health. This wellness continuum is illustrated in the      DAI Report Back
                                                                                                                                                                                    2
    diagram below:
                                                                        To date 353 employees have taken part in the voluntary testing
                                                                        drive and had an HIV test ie. 13.07% of the total population
                                                                        (2700 active eligible employees). To date there have been 15
                                                                        employees registered on the programme. (Statistics are
                                                                        reported on however confidentiality is strictly maintained).
                                                                        The HIV prevalence of the population tested, is 4.3%.
                                                                        As from 1 January 2005, HIV is a Prescribed Minimum Benefit
                                                                        and therefore covered by all medical schemes. Staff are
                                                                        reminded that Discovery Health also offer an HIV programme.
                                                                        For more information of these benefits please access the UCT
    To achieve this cost saving and early detection, HR is in the
                                                                        HR Website (under Healthcare) or alternately via Discovery
    process of providing Line Management with guidelines on how
                                                                        World (www.discovery.co.za )
    to manage absenteeism in the workplaces, as well as provide


                                                                                                                                                                                1
    Reminder: Monthly information and Voluntary Counselling &            ensure payment from the appropriate benefits and more reliable
    Testing sessions are held at Cambria House on the last Friday        statistical data collection.
    of the month from 10h00 – 15h00. For online bookings visit
    http://hr.uct.ac.za/remunbenefits/docs/benefits/index.htm.           Discovery Health must reject claims without ICD-10 codes
    Do the responsible thing and have your test!.
                                                                         Because your attending doctor will usually diagnose your
                                                                         condition and therefore be able to identify the correct, complete
                                                                         and applicable ICD-0 code(s), please ensure your doctor
3                                                                        indicates the relevant ICD-10 code(s) on any accounts,
    Discovery Health
                                                                         referrals, motivations or medical prescriptions.
    Employees who selected either a Priority or Comprehensive
    option (273 employees selected this option) were invited to          Please remember that the ICD-10 code(s) apply when you
    attend information sessions to get a better understanding of         phone to register for hospital admissions, so you need to ask
    their benefits. As only 16 employees attended, we hope that          your doctor for the relevant ICD-10 code(s) in these cases.
    employees are happy and fully understand their benefits.             What about confidentiality?
               Chronic Benefit :                                            All information gathered by using ICD-10 codes will be
                                                                            confidential. You need not be concerned that any information
    In the utilisation reports which Discovery Health provide on the
                                                                            about your medical condition will be given to unauthorised
    UCT group as a whole, it appears that there could be members
                                                                                                            parties.
    who could qualify for chronic benefits
    yet have not registered for the benefit.                                                                How to ensure your health
                                                                   Wellness Week
    As the information is confidential,                         th      th                                  care provider is up-to-date
                                                            12 – 14 October 2005                            with ICD-10 coding
    UCT cannot confirm which members
    these are – please be aware of your              The aim of Wellness Week is to encourage               The health care profession
    benefits and contact Gina Fraser via           employees to look at their health and lifestyles,        has been informed about the
    email: pergds@bremner.uct.ac.za if            assisting and showing various ways of managing            legal requirement for ICD-10.
    you are unsure or need more                                    their stress levels.                     There has been ongoing,
    information.                                                                                            formal communications to all
                                                    Please take time out between the 12th & 14th
                                                  to come an update your Health Passport – more             health care providers. All
               Annual Routine Benefit:                                                                      providers should therefore be
                                                 details will be provided via the Monday newspaper
    Legislation limits the amount which a                                                                   familiar with requirements
                                                                             .
    member can contribute towards their                                                                     and have access to a full list
    Members Savings Account to 25% of                Venue: Graduate School of Humanities
                                                                                                            of ICD-10 codes in their
    the total contribution. In January                                                                      practice.
    2005 Discovery Health introduced the
    Annual Routine Benefit which allows members to contribute
    more than this into their savings account.                              What is VitalityMed?
    As mentioned during the information sessions at the end of
    2004, the Annual Routine Benefit is deemed a “risk” portion          Prevention means anticipating a problem. To prevent disease
    and does not carry over to the following year as does the            and the complications associated with the chronic condition, you
    Savings Account. You will have seen on your member                   have to take the tests that allow you to intervene early.
    statement that the Annual Routine Benefit and Medical                VitalityMed will help you do just that. If you are a Vitality
    Savings Account balance is reflected separately and claims           member, you will also get a double reward. First, you will get the
    are paid from the Routine benefit first. Please be aware of          power of knowing your health status and second, you will earn
    the potential ARB which you will loose if not spent by the end       Vitality points.
    of December 2004.
                                                                         In line with Vitality benefits, Discovery offers VitalityMed to
             ICD-10 Diagnostic Coding:                                   members over the age of 18 years (principal member and
                                                                         spouse only).
    You may be left wondering after being given an account with a        How to join
    set of ‘cryptic codes’ when visiting your doctor, for example
    J03.9. This simply means that you have been diagnosed with           If Discovery has approved or declined your cover on the Chronic
    tonsillitis!                                                         Illness Benefit for one of the following conditions, they will
                                                                         automatically register you for the VitalityMed programme:
    The "International Classification of Diseases and Related Health
    Problems, version 10", or ICD-10 for short, translates the written             Hypertension (high blood pressure)
    description of a medical diagnosis into a coded format. The
                                                                                   Diabetes
    World Health Organisation owns and maintains these codes,
                                                                                   Hyperlipidaemia (high cholesterol)
    which are a standard way of showing the reason for a health
    care interaction.                                                              Asthma
                                                                                   Chronic obstructive pulmonary disease.
    The benefits of coding
    From July 2005, South African law requires all providers to use      You will earn 2 500 Vitality points by filling in a compliance form
    these ICD-10 codes. The benefits of the coding includes              with your doctor. Certain tests are needed specific to your
    speedier payment of claims, clearer definition of medical            chronic condition, if applicable, including an HBA1c, a Pneumo
    benefits, appropriate management of medical services and             vac and a Flow volume loop. The test(s) needed for your
    benefits, correct coding of Prescribed Minimum Benefits to           specific condition are listed on the compliance form.



                                                                                                                                      2
Although you may not need medicine for your potential chronic            Annual ophthalmologic investigations to prevent and
illness and Discovery has not approved your cover from the               screen for diabetes-related eye problem.
Chronic Illness Benefit, you can still join VitalityMed if your          An initial consultation with a dietician followed by annual
doctor confirms the diagnosis of your condition and completes            follow-up consultations
the compliance form. You can fax the form to (011) 539-7005.             A full course in diabetic education
                                                                         A 24-hour telephone help-line, staffed by trained personnel
Once you are registered on the VitalityMed programme, you can
earn additional Vitality points (see below), over and above the          Appropriate laboratory tests to assess diabetic control,
normal Vitality points for these events.                                 kidney function and blood cholesterol
                                                                         Complete cover for costs of all medicine and accessories
       Vitality health risk assessment                                   relating to the member’s diabetes
       Vitality/SASMA physical activity assessment                       All hospitalisation for any acute diabetic emergency.
       Body Mass Index (plus 500 extra points if you are within
       the acceptable range)                                         Member compliance is required
       Cholesterol (plus 500 extra points if you are within the      Diabetic complications need to be detected and treated early to
       acceptable range)                                             prevent long-term diabetes and rising costs and therefore it is
       Blood pressure (plus 500 extra points if you are within       essential to have patient compliance as this is in the member’s
       the acceptable range)                                         best interests.
       Glucose (plus 500 extra points if you are within the
       acceptable range)
       Non-smokers’ declaration
                                                                     Discovery award Vitality points for good diabetic
                                                                     control
       Flu vaccination.

Remember that you will not earn extra Vitality points for            Discovery award a maximum of 4 000 points per year to one
activities done before you have registered!                          family when certain tests are done or procedures followed.

                                                                 4   How does a diabetic member join the CDE
Diabetes
                                                                     programme?
THE mortality rate of children under the age of five has doubled
since 1992 due to HIV/AIDS, gastro-related illnesses and mal-
                                                                     If the member is registered on the Chronic Illness Benefit for
nutrition. Researcher of the Agincourt Health and Population
                                                                     either insulin dependent or non-insulin dependent diabetes
Unit (AHPU), Mark Collinson said that non-communicable
                                                                     mellitus, they can get more information on joining the Diabetes
diseases like hypertension and diabetes were also reducing the
                                                                     Disease Management Programme, or get more information, by
average life expectancy by 16 years. He said 12 years ago the
                                                                     contacting:
average life expectancy would have been 68, but, now it was a
shocking 50 years or less. He said that people needed to be
educated that modern day diets did not need excess salt added        Centre for Diabetes & Endocrinology Disease Management
to their food, as it could increase one's risk of non-               Team – Discovery Health
communicable diseases.
                                                                     Telephone: (011) 712 6000
What is Diabetes?                                                    Telephone: 0860 100 417
Diabetes mellitus (diabetes) is a chronic condition which, if left   Address: 155 West Street, Sandton, Johannesburg.
untreated, may result in serious complications such as
blindness, kidney failure and heart attacks. Most organs are         If the member does not reside in the Gauteng area, Discovery
affected by diabetes and therefore it is essential to treat the      will refer you to your closes Centre for Diabetes &
condition. It is universally accepted that good control of           Endocrinology.
diabetes will reduce the incidence of these complications. It is
essential, therefore, that patients with diabetes are given the
optimum medical care and education necessary not only to                 Option Calculator Hits:
improve their diabetes but also their general state of health.
                                                                     With the changes to the Discovery Health options coming up
Comprehensive Plan members only
                                                                     shortly, employees are once again reminded of the medical
Discovery Health, in association with the Centre for Diabetes        Option Calculator which is situated on the UCT HR webside
and Endocrinology (CDE), has developed the Diabetes Disease          (under Healthcare) – this calculator assists members in
Management Programme. This programme is available to all             selecting a suitable option and will be updated with the changes
Comprehensive plan members and ensures optimum care and              before year end. The following graph gives an indication of the
essential education provided by a specially trained team.            useage of this calculator.
What are the benefits that a member can expect?
It is absolutely essential that members with diabetes are given               60

optimum medical care and comprehensive education about the                    50

condition.      Members who join the Diabetes Disease                         40
Management Programme have access to the following:                            30

                                                                              20
    A minimum of two full examinations by the doctor each
                                                                              10
    year
    A visit to the podiatrist for foot advice and foot-care                    0
                                                                                   January   February   March   April   May   June   July




                                                                                                                                            3
         Procedure for Trauma Response for UCT Staff                     Useful Discovery Health Contact Numbers:
                                                                   Client Services                            0860 99 88 77
Don't forget that UCT offers a trauma response                     Vitality                                   0860 100 420
procedure/protocol which enables UCT to respond to the
needs of staff following work-related traumatic events.            Claims submission email address: claims@discovery.co.za
                                                                   Claims submission toll-share fax number:   0860 329 252
Contact Campus Protection Services on Extension 2222 for           Direct Medicines                           (011) 456 8000
access to the Trauma Response Support Team.
                                                                   KeyCare                                    0860 102 877
The procedure application will include:                            MediCross                                  0860 10 1151
                                                                   DiscoveryWorld                             0860 100 696
     Traumatic and/or violent events on campus, such as
     employees being the victim of or witnessing incidents         Disease Management                         0860 100 417
     such as rape, shooting incident, suicide, assault, violent    Centre for Diabetes & Endocrinology        (011) 712 6000
     fights, or serious injuries while on duty.                    Fraud Hotline                              0800 00 4500
     Work-related off-campus events, such as hijacking of          International SOS                          0860 347 2683
     staff who are on UCT business when the event occurs.




                                            Ways for Vitality members
                                  To get some more points before the end of 2005
                      Smokenders: Principal member & spouse can earn 5 000 points each either for being
                      a non-smoker or for quitting.
                      Nutrition: Visit the Nutrition Centre at www.discovery.co.za/nutrition and earn 2 500
                      points per principal & spouse.
                      Stress Management: Visit www.discovery.co.za/stress and earn 2 500 points per
                      principal & spouse.
                      Electronic statements: If you register on Discovery world and receive your statements
                      via email, you will receive 500 points per statement (maximum of 6 000 points)
                      Vitality Physical Activity Assessment: Principal member and spouse can earn 7 500
                      points each for fitness assements – both can have 2 assessments per year.
                      Virgin Active / Planet Fitness: earn 150 points per workout – up to a maximum of 15
                      000 points per year.
                      Pedometers (10 000 steps): purchase a pedometer and register at a Vitality check
                      pharmacy and earn 1000 points (need to regularly download your steps at a Vitality
                      check pharmacy).
                        o Walk at least 5 000 steps per day every day on average (earn 500 points per
                            month and 6 000 points per year)
                        o Walk at least 7 500 steps per day every day on average (earn 750 points per
                            month and 9 000 points per year)
                        o Walk at least 10 000 steps per day every day on average (earn 1000 points per
                            month and 12 000 points per year)

                                More information will be available at the Wellness Week




                                                                                             CONTACT
                                                                      For more Information                     Organisational
                                                                      Ottoline Clapham (EAPs)    +27 21 6502154    Health
 4
                                                                      Gina Fraser (Medical Aid) +27 21 6504001
                                                                      Margie Tainton
                                                                         +27 21 650 3028       permt@bremner.uct.ac.za