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
mechanism for early detection of a medical condition.
Figure 1: Costs of UCT Sick Leave 1
May 2004 - 2005
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
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
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
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,
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
who could qualify for chronic benefits
yet have not registered for the benefit. How to ensure your health
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: firstname.lastname@example.org 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
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
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.
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
Discovery award Vitality points for good diabetic
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
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
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
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
A minimum of two full examinations by the doctor each
A visit to the podiatrist for foot advice and foot-care 0
January February March April May June July
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: email@example.com
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
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
For more Information Organisational
Ottoline Clapham (EAPs) +27 21 6502154 Health
Gina Fraser (Medical Aid) +27 21 6504001
+27 21 650 3028 firstname.lastname@example.org