Document Sample
					                                                             FIRST QUARTER 2010 NEWSLETTER

                                                             LETHIMVULA HEALTHCARE INTEGRATES
     Letter from the Principal Officer
                                                             WITH MEDSCHEME

     The 2010 FIFA Soccer World Cup is around the
     corner and keeping healthy and fit this year is not     Since the acquisition of Old Mutual Healthcare by Lethimvula
     only a great new year’s resolution in the spirit of     Investments Limited (Lethimvula) in May 2009, there have been
     our hosting this function, but is also very important
                                                             fundamental upgrades to Lethimvula Healthcare’s systems and
     in ensuring our immune systems are strong. In this
     newsletter we bring you some information on what        processes - including the migration of the administration of Imperial
     health benefits playing soccer can bring you. We        Group Medical Scheme to Lethimvula Healthcare’s Nexus system
     also have a short article on Tuberculosis in light of
     World Tuberculosis day on the 24th of March.            developed by Medscheme.

     We bring you an update on the Lethimvula                Although Lethimvula initially committed itself to maintain its Cape
     Healthcare (LHc) migration, we explain the annual
                                                             Town-based operation, the strategy has not delivered the desired
     medical aid tariff increases and try to shed some
     light on what to expect for 2010.                       results in terms of service delivery to our medical scheme members.

     Winter is around the corner, so start preparing
                                                             Lethimvula has since made a strategic decision to transfer Lethimvula
     your immune system now with lots of vitamin C,
     exercise and regular water intake.                      Healthcare to Medscheme Holdings with effect from 8 March 2010.

     Yours in health                                         This development, which has been sanctioned by the Council for
                                                             Medical Schemes, effectively means that Lethimvula Healthcare will
                                                             now become a separate business unit within Medscheme. The business
                                                             will however continue to operate under the Lethimvula Healthcare
     Johan van der Walt                                      brand until further notice.
     Principal Officer
     Imperial Group Medical Scheme
                                                             In   February   2010,    Medscheme      was   awarded     the    highest
                                                             overall scores for service excellence in a survey conducted by
                                                    and Lethimvula Healthcare is confident that integrating

     In this issue                                           with Medscheme and replicating Medscheme’s best practice processes
     + From the Principal Officer’s desk                     across the business will significantly enhance service levels.
     + LHc Migration Update
     + Tariff Increases Explained                            The integration will not affect your interaction with the Scheme. The

     + Soccer Health Benefits                                Call Centre number, postal address and website address remain
     + World Tuberculosis Day - 24th of March - What         unchanged until further notice.
       is Tuberculosis (TB)?
     + Lethimvula Healthcare Integrates with                 Lethimvula Healthcare has attached the highest priority to rectifying
                                                             any outstanding issues. However, if you are not satisfied with the
                                                             service you are receiving please contact us on 0860 467 374.

                                                                    IMPERIAL GROUP MEDICAL SCHEME NEWSLETTER

     LHC MIGRATION UPDATE                                                  What is the NHRPL?
                                                                           The NHRPL was designed by the Council for Medical Schemes on
     Our Administrator, Lethimvula Healthcare (LHc) has completed the
                                                                           behalf of the Department of Health and first published in 2004.
     migration of IMPERIALMED and the majority of its other Schemes
                                                                           This list is created by gathering submissions of suggestions from
     onto the new Nexus platform. By now you may have received a
                                                                           all disciplines of health service with regards to the actual cost of
     new-look member remittance advice and may have registered on
                                                                           running a practice.
     the new member zone on to be able
     to view your real-time member information online.
                                                                           Hospitals do not yet take part in the classification process and

                                                                           this list therefore does not apply to these rates. In most cases,
     Your member statements and the IMPERIALMED member zone will
                                                                           medical aid providers negotiate with hospitals on an individual
     provide you with information pertaining to your claims and
                                                                           basis to decide on pricing. In 2010, the negotiated increases
     membership. If you have any enquiries, please continue to contact
                                                                           with hospital groups range between 9% and 9.5%.
     the IMPERIALMED Call Centre on 0860 467 374 or send an
     e-mail to
                                                                           It must be understood that the NHRPL is not always reflective of
                                                                           the actual prices that may be charged at medical practices, but
                                                                           its rates are more of a guideline for practitioners and medical
                                                                           aid schemes around which they can calculate tariff structures and
                                                                           design benefit structures so as to minimise additional payments.

                                                                           In the same way that doctors are not bound by the NHRPL,
     Medical aid rates are something that we need to take note of at       medical aid schemes are free to calculate their own MSR, which
     some point in our lives, whether it is deciding which medical         traditionally is done by using the NHRPL as a guideline.
     practitioner to consult or deciding whether to ask for a generic
     medicine. Trying to understand how medical aid tariffs are            IMPERIALMED is unable to predict exactly what a doctor will
     calculated can be difficult, which is why the Department of Health    charge for a specific procedure and will generally provide cover
     (DOH) regulated these tariffs through the National Health             in relation to the IMPERIALMED MSR. If a doctor charges 100%
     Reference Price List (NHRPL).                                         of MSR or less, the patient is covered, subject to the Scheme
                                                                           Rules. If, however, the doctor charges 150% of MSR, the patient
                                                                           is expected to pay the difference from either their Grow Account,
                                                                           Personal Savings Account or from their own funds. It is important
                                                                           for members to get quotes for any procedures or specialist
                                                                           treatments needed and to negotiate with their service providers to
                                                                           ensure that they are getting the best rates possible.

                                                                           For more information on NHPRL and to view the list, please visit
                                                                           the Department of Health Website on and click
                                                                           on “Reference Price List”.

                                                                             Please note: Error in the Member Guide
                                                                             Unfortunately, there was a small error in the Member Guide
                                                                             we sent you.
     This year the DOH announced a 7.9% increase on the NHRPL
                                                                             Please note the following update:
     tariffs across the board. This means that the rate at which we
                                                                             Member Guide - page 26, paragraph 6 d) incorrectly records
     refund your claims, your Medical Scheme Rate (MSR), is also             that the Frames benefit is R600 per family once every two
     adjusted by the increase of 7.9%, and this will mean that your          benefit years.
                                                                             The correct statement should read as follows: R600 per
     Medical Scheme Rates (MSR) will also be adjusted to cover this
                                                                             beneficiary once every two benefit years.

Tuberculosis, also known as TB, is an infectious disease caused         Those who are infected with TB bacteria do not always develop
by a bacterium called Mycobacterium tuberculosis that spreads           active TB and often won’t show any symptoms or infections. This
through the air. It is a global pandemic where 13 out of the 15         is because your immune system controls the infection by forming
countries with the highest infection rate in the world are in Africa.   walls around the bacteria that makes it inactive. Many people can
It affects mostly the lungs, but can also affect other parts of the     live for many years not knowing they have TB, but still develop the
body. If not treated correctly, it could lead to serious illness and    disease later in life if they don’t receive treatment.
even death.

                                                                                                                                       DRAFT 6
                                                                        What are the symptoms?
                                                                        TB usually starts with a dry cough and later becomes a “wet”
                                                                        cough where the individual spits up blood or a thick liquid from
                                                                        inside the lungs. This coughing can go on for over a month and
                                                                        be followed by chest pains; breathing difficulty and shortness of
                                                                        breath; wheezing; hearing loss; diarrhea; excessive sweating
                                                                        (during the day and night); chills and fever; fatigue; loss of weight
                                                                        and loss of appetite.

                                                                        Some people develop active TB within a week of being infected,
                                                                        because their immune systems are weak due to drug abuse,
                                                                        poor nutrition, immune suppression, old age or ill health. Babies,
                                                                        young children, the elderly, those that are HIV positive or who
                                                                        are receiving medical treatments, e.g. chemotherapy are very
                                                                        susceptible. As well as those who have been in close contact
                                                                        with someone who became infected with TB in the last two years.
                                                                        Someone with active TB could infect an average of 10 to 15
                                                                        people in one year. TB is the leading killer of people who are
                                                                        HIV positive.

                                                                        Can TB be cured?
                                                                        Yes, TB can be cured if you complete the series of medications or
                                                                        treatments that your doctor will prescribe to fight off the disease.
How is TB spread?
                                                                        You would also need to inform your family, friends and co-
TB is mostly spread through the air by those infected by the            workers (who you interact with daily) that you have active TB and
bacteria when they sneeze, cough, talk, laugh or spit. In extremely     encourage them to also get tested and thereby prevent the spread
rare cases it can be spread through contact with an infected cow        of the disease.
or in drinking contaminated milk that hasn’t been pasteurized.

                                                                        How do I prevent getting TB?
These airborne bacteria can remain active in a house or enclosed
space for weeks. This is why close family, friends and co-workers       Get plenty of rest and fresh air; eat healthy foods and try
of someone with TB (whom they come into contact with on a daily         to maintain a healthy weight and lifestyle. Eating fruits and
basis) are encouraged to also get tested. However, you cannot           vegetables will help build up your immune system. Basic hygiene
get TB from handshakes, sharing eating utensils, clothing, toilet       is also important, so make sure you wash your hands before and
seats or bedding.                                                       after you prepare or eat foods.

                                                                          IMPERIAL GROUP MEDICAL SCHEME NEWSLETTER

                                                                                            Contact us
The 2010 FIFA World Cup is finally here, and in the spirit of this
auspicious occasion why not take your next lunch break to kick
                                                                                            Should you have any queries regarding the Imperial Group
around a ball with your colleagues or friends. From a health
                                                                                            Medical Scheme, please refer these to the Administrator,
aspect, soccer gives you a fantastic cardiovascular workout while
                                                                                            at the following addresses:
working on stamina, strength and endurance. With soccer you
can build team spirit and have fun at the same time. Some of the
benefits of playing soccer include:                                                         IMPERIAL GROUP MEDICAL SCHEME

                                                                                                                                                              DRAFT 6
                                                                                            PO Box 1094
                                                                                            Woodstock 7915

                                                                                            Claims Enquiries, Membership Confirmations &
                                                                                            Tel: 0860 467 374
                                                                                            Fax: 0860 111 788

                                                                                            MANAGED CARE SERVICES
                                                                                            (Hospital pre-certification & Oncology Benefit Management
                                                                                            Tel: 0860 100 081
                                                                                            Fax: 0860 111 895
Physical Health benefits
+    Increased aerobic capacity and cardiovascular health
+    Lower body fat and improved muscle tone
                                                                                            Chronic Benefit Management
+    Strength, flexibility and endurance
                                                                                            (CBM – Chronic Medication and Medical Management)
+    Increased muscle and bone strength
                                                                                            Tel: 0860 100 081
+    Improved health due to shifts between walking, running and
                                                                                            Fax: 0860 111 894

Other benefits
                                                                                            Europ Assistance Emergency Services
+    Teaches co-ordination
                                                                                            Tel: 0861 RESCUE (0861 737 283)
+    Promotes teamwork and sharing
+    Helps to increase skills in concentration, persistence and self-
                                                                                            HIV and AIDS Management Programme
                                                                                            Tel: 0860 467 374
+    Is a great way to meet people and exercise with friends
                                                                                            Fax: 0860 111 892
+    Can provide an opportunity to increase your confidence and


+    Requires very little equipment so it can be played in the
     backyard or park                                                                       Contact your company’s Payroll/HR dept.

+    Is relatively easy to learn

DISCLAIMER: Information and articles in this newsletter do not constitute medical advice or a medical claim for any product of any nature whatsoever on behalf
of the publisher, the Scheme, the Administrator or the distributor. Consult a qualified healthcare practitioner for diagnosis or treatment of any diseases or medical


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