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NEWSLETTER
NOVEMBER 2005
TIME TO SAY THANK YOU
AND GOODBYE TO 2005
DEAR MEMBER
With just a blink of the eye we find
ourselves at the end of 2005. To POLMED
and its members a year with many
challenges. It seems like yesterday when
I sat in my office, writing to our members
and reflecting on the past year. This time
���������������������������������������� the pace has been somewhat different!
IN THIS ISSUE
The Administrator for POLMED,
with effect from 1 January 2005, was
1 TIME TO SAY THANK YOU AND announced toward the end of 2004. One
GOODBYE TO 2005 of the biggest challenges was to ensure available to enhance those benefits where
2 2006 POLMED BENEFITS a smooth transition period to minimise the need is identified.
any inconvenience to members. I wish
2 POLMED NEW REGIONAL
to thank each member and all other An independent survey was conducted
OFFICES
stakeholders for their patience during in which a sample of our members was
2 POLMED HIV RISK this period. It may not have been without used. The results from the survey will
MANAGEMENT PROGRAMME hiccups, but the commitment from the assist POLMED to address the needs of
3 UPDATES VIA SMS POLMED Board of Trustees, Management the members as reflected in this survey.
and the Administrator, Metropolitan
3 HEALTH ADVICE LINE
Health Group (MHG), ensured the least I want to urge all members to please
3 PRESCRIBED MINIMUM BENEFITS impact on our members. ensure that their address and contact
3 2005 POLMED ANNUAL details are correct and to submit
GENERAL MEETING (AGM) The participation by members in the any changes to MHG’s membership
All SAPS photographs have been supplied by Servamus Annual General Meeting (AGM) process department. Should you have access to
is greatly appreciated. This was yet the internet, these changes can be made
another first for POLMED. Not only did on the POLMED website. This will assist
we experience the election process, but POLMED to improve communication to
we also implemented the rotation of the our members.
AGM to all provinces, with KwaZulu-Natal
being the first to host the AGM. The I want to take the opportunity to thank
meeting was well attended and I want to every person who made a contribution
thank the Provincial Commissioner and his to improve service delivery to POLMED
staff who assisted with the communication members. To families who have lost a
to members in the province to ensure loved one during the year, or who have
participation and attendance of the AGM. a loved one suffering from an incurable
The venue for 2006 will be announced medical condition, I want to express my
soon. sincere condolences.
POLMED managed to increase certain May you enjoy a wonderful festive season
benefit category limits on 1 September and looking forward to a prosperous 2006!
2005. Few Schemes can afford to increase
limits during the year. We can only do this POLMED GREETINGS
due to our members who manage their MBASA MXENGE
benefits well, resulting in funds becoming PRINCIPAL OFFICER
2006 POLMED BENEFITS
The 2006 POLMED Benefit Guide has confusion to members. POLMED is not
been posted to members. The Member the only scheme affected by these tariffs.
Guide contains information that is
important to members. A Z-card has Members are under the impression that
been included in the pack that contains they should be enquiring whether a
the summary of the 2006 benefits. provider (doctor) is “contracted in”. Most
Members should please familiarise providers will say “yes” without rather
themselves with the new limits allocated cautioning the member about the tariff
to each benefit category, as well as charged by the practice.
understand how to access these benefits.
The day-to-day limit has sub-limits for
Benefits are categorised as follows: certain services. The member may
Major Risk (hospital related treatment) have funds left in the day-to-day
benefit, but may have exceeded
Day–to-day – Consultations/services
the sub-limit for a service, the
listed in the guide
claim in that case cannot be paid.
PMBs–No limits (25 conditions listed)
Read your 2006 POLMED
NATIONAL HEALTH REFERENCE Member Guide and Summary of
PRICE LIST (NHRPL) Benefits carefully and use them
Please ensure that you always ask throughout the year for answers
your service provider whether they to any questions you may have.
charge according to the NHRPL tariff. Please do not hesitate to call
If a provider does not charge NHRPL the POLMED Client Service
tariffs, it will mean that the member Centre on 0860 765 633 should
is responsible for the payment of the you require assistance, rather
balance between the NHRPL tariff and than be faced with a rejected claim
rate charged by the Service Provider. or any other problem that may be
This has caused a lot of frustration and encountered.
POLMED NEW REGIONAL OFFICES
DURBAN – PORT ELIZABETH – PAARL
POLMED and the Administrator, below, should they seek assistance with any
Metropolitan Health Group, are pleased POLMED related queries.
to announce that the Durban and Port
Elizabeth regional offices have been DURBAN:
expanded to meet the needs of our Momentum House, 125 Ordinance Rd,
members. We also now have a client Durban, Tel (031) 335 1500
service agent to assist members in Paarl. PORT ELIZABETH:
236 Cape Road, Port Elizabeth,
Our primary focus for the regional offices Tel (041) 391 6700
is to bring the services of POLMED closer PAARL:
to the members. To enable members to Metropolitan Health Group,
visit our regional offices having to submit 211 Main Road, Paarl, Tel (021) 860 8646
claims, outstanding claims and questions
regarding their benefits. For more information, members who have
access to the internet can also visit our
We encourage our members to visit the website on www.polmed.co.za or call the
new regional offices at the addresses client service line on 0860 765 633.
POLMED HIV RISK AIDS is a disease that is caused by HIV encourages all members to get tested and
MANAGEMENT PROGRAMME that interferes with the body’s ability to know their HIV status. We pledge to support
fight off common infectious diseases. all our HIV-positive members through the
If you are infected with HIV and receive HIV Risk Management Programme offered
TOGETHER the correct treatment, you can still lead a
normal healthy life for many years. POLMED
through Qualsa, a subsidiary of MHG, at no
cost to our members.
WE CAN! For further information about the programme, please refer to the enclosed brochure.
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POLMED NEWSLETTER
UPDATES VIA SMS
POLMED is always striving to improve our
communication to members. One way of
doing this is by SMS to our members’ cell
phones.
The 2006 Member Benefit Guide,
including an Option Selection form has
been posted to all POLMED members.
Provision has been made on the form for
PRESCRIBED
members who may not necessarily be
changing their Option, to update their
contact details.
MINIMUM BENEFITS
WHAT ARE PRESCRIBED MINIMUM BENEFITS (PMBs)? HOW DOES IT AFFECT YOU?
POLMED would like to urge members to Simply put, it means that the 25 chronic treatment of these conditions will not
consider providing us with your cellular diseases on the PMB list of conditions affect your chronic medication limits as it
phone number. This will assist us to will be covered by POLMED. The will be covered by POLMED.
send important notification to members
PMBs CONSIST OF TWO PARTS:
timeously. Members may also select to
be notified by sms of any payments made
to service providers for medical care
TREATMENT PAIRS CHRONIC DISEASES LIST
received.
The treatment pairs include ± 270
SMS communication is immediate and There are 25 chronic diseases for
diagnoses
will keep you up-to-date and informed on which the Scheme has to cover:
Each diagnosis has a broad
important issues. Consultations
outlined treatment plan that has
Special investigations
to be supplied for that diagnosis
Chronic medicine
HEALTH ADVICE LINE in- and out-of-hospital (this means
that each of these diagnoses
Qualsa provides a 24-hour Health Advice NOTE: NOT PAID FROM CHRONIC
must be treated as stipulated by
Line service to Polmed members. You and LIMITS
the Government legislation.)
your dependants may access the service
to discuss your general or specific health
needs with a qualified professional nurse. It is important to note that the includes that which is available in the
Please note that this service is strictly an Government has supplied medical state sector.
advisory service and is not meant to replace schemes with legislated algorithms
the advice or treatment by a doctor. (this is a step-wise approach that has to For further information on PMBs
be followed to treat a certain disease please contact the POLMED Client
To access this service, call the Qualsa medically). The available medicine as Service Centre on 0860 765 633
Call Centre at 0860 104 111 and choose outlined in the algorithms generally
Option 6 to speak to a nurse counsellor
about health related matters.
Wishing you and your 2005 POLMED
family a wonderful
festive season! ANNUAL GENERAL MEETING (AGM)
The rotation of the POLMED AGM to (IEC) at the AGM held on 23 August
other provinces was raised at the meeting 2005. The participation by members of
held on 23 July 2004 in Pretoria. The the Scheme during the election process
Board of Trustees (BOT) undertook to and attendance at the AGM is greatly
look into the matter and KwaZulu-Natal appreciated.
was identified for hosting the AGM in
2005. The BOT and Principal Officer of
POLMED would like to thank the staff of
Another first for POLMED was the Metropolitan Health Group and POLMED,
election of the Board of Trustees who ensured a smooth administrative
members who were announced by the process before and on the day of the
Independent Electoral Commission AGM.
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