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					IN THIS ISSUE

• Message from the Principal Officer
• Summary of new benefit options
• Things to consider when making
  your selection
• The seven steps to selecting the
  appropriate benefit option




                                              THE HEART BEAT                                                                  October 2007


        BER
DEAR MEMBER
We introduce "The Heart Beat"; the first edition with the new name allocated to our newsletter that best describes what NIMAS
stands for. In this issue we focus on the new NIMAS 2008 benefits and contributions.

Please ensure that you read this newsletter thoroughly, as it contains all the details that will assist you in selecting your benefit
option for next year and informing you on how to communicate your choice to NIMAS.

Yours in health,
The NIMAS Team



As a result of the strategic revision
                                                                         THE of the Board of Trustees that
                                                           MESSAGE FROM experiencePRINCIPAL OFFICER
                                               Small, Medium and Micro Enterprises
undertaken by NIMAS last year and its          (SMME) sphere and the new structure             the level of membership required is
implementation in stages, the Scheme           affords us the opportunity to provide for       growing. It is our intention for the NIMAS
has made some significant changes to           the needs of all the people making up           member base to expand to around
its benefit options. These changes have        that market. At the same time we have           35 000 members by 2011. This will enable
been made with several goals in mind:          considered the needs of our non-                the Scheme to achieve the critical mass
                                               corporate members.                              required without losing its identity.
•   Simplification of benefits;
•   Differentiation of benefit options;        We are very excited about our new range         Our long-term goal is to be able to offer
•   Cost and pricing accuracy; and             of benefit options and are confident that       our members more benefits for their
•   Ability to offer medical cover to          they will lay the foundation for the growth     Rand and our new 2008 benefit options
    persons from the shop floor to top         we anticipate over the next four years.         provide exactly that.
    management.
                                               It is important to have a substantial
It is the Scheme's intention to position       member base to be taken seriously in
itself for growth as a niche player in the     the medical aid industry, and it is the
                                                                    1
SUMMAR
SUMMARY OF NEW BENEFIT OPTIONS
Now that you know that NIMAS will undergo changes                        •   Improved cover for HIV and oncology patients, subject to
in 2008, let us introduce you to a summary of the                            registration on the respective managed care programmes.
                                                                         •   We introduce an exciting benefit called Preventative health
new benefit options.
                                                                             benefits.
                                                                         •   The existing Internal Prosthesis benefit increases dramatically.
The existing six benefit options will be replaced by four brand
                                                                         •   The Victims of Violence benefit limit increases dramatically.
new benefit options:
                                                                         •   On the Millenium and Supreme benefit options, GPs and
                                                                             specialists (both in- and out-of-hospital) are paid at higher
    Supreme - a more comprehensive traditional benefit option
    with ample benefits.                                                     rates than just the normal recommended medical scheme
    Millenium - a new generation type of benefit option, where               tariff.
    your day-to-day cover is paid from a savings portion. It also
    includes an Above-Threshold benefit.                                 ARE THERE ANY CHANGES THAT WILL INFLUENCE
    Classic - a traditional benefit option, providing cover in the       YOUR CONTRIBUTION FOR 2008?
    form of set limits.
    Primary - a low cost, primary healthcare benefit option, which       There are indeed a number of exciting changes to the way in
    provides entry-level cover.                                          which contributions will be calculated in 2008. Therefore it is
                                                                         difficult to indicate the level of the average contribution increase,
                                                                         as this will depend on various factors. However, contributions
WHAT OTHER BENEFIT ENHANCEMENTS WILL COME                                for the Scheme as a whole would increase at a lower percentage
INTO EFFECT NEXT YEAR?                                                   than the industry norm for 2008.
There are a number of exciting benefit enhancements, so please
ensure that you study the enclosed benefit/contribution schedules        As from 1 January 2008:
for full details. There are a few mentioned here, all of which are       • members on all benefit options, except Primary, will only
aimed at saving you money.                                                   pay for one child dependant (the oldest) in the family;
                                                                         • a child will remain a child dependant (and pay a child
•   On all benefit options, except Primary, there is no annual               dependant rate) up to the end of the year in which the child
    overall limit for hospitalisation.                                       turns 23, irrespective of further studies;
•   You will no longer be liable for any up-front co-payments            • a child that is 23 years or older, and who is a full-time student,
    before hospitalisation.                                                  will be allowed to stay on as an adult dependant (subject to
•   You will no longer be liable for co-payments on specialised              proof of full-time student registration);
    diagnostic procedures (MRI and CT scans).                            • members who select the Primary option, will pay contributions
•   You will no longer be liable for the R40 co-payment per acute            based on their monthly income. Income is defined as the
    medication script.                                                       gross monthly income, before any deductions, and includes
•   On benefit options that provide chronic medication benefits              any allowances. In the case of individual members (members
    for a number of non-Prescribed Minimum Benefit (PMB)                     not part of a registered employer group), the higher income
    conditions, the limits for these conditions have been removed.           of the principal member or the registered spouse or partner
•   The current Post-hospitalisation benefit has been extended               will be taken into account to determine the income bracket
    to include more than just physiotherapy.                                 on which the monthly contribution will be calculated.




                                                                     2
           THINGS TO CONSIDER WHEN
           MAKING YOUR BENEFIT OPTION
           SELECTION
           WILL MEMBERS HAVE TO SELECT A NEW BENEFIT OPTION
           FOR 2008?
           Yes, it remains your responsibility to familiarise yourself with the new
           benefit options and to decide which option would best suit your
           healthcare and financial needs.

           WHAT DO YOU NEED TO TAKE INTO ACCOUNT WHEN
           SELECTING A NEW BENEFIT OPTION?
           First decide on the type of medical aid cover you would be comfortable
           with. For example, if you prefer a savings type of benefit option, you
           would have to study the detailed benefits of the Millenium option to
           ascertain whether the level of benefits and cost would meet your
           requirements.

           WHAT OTHER ELEMENTS DO YOU NEED TO CONSIDER?
           There are a number of matters that can guide you in making the best
           possible benefit option selection. Consider the following critical
           elements:

           •   Will all your existing approved chronic conditions still be covered
               on your new benefit option? If not, are you comfortable that the
               cost of such conditions be paid from your normal day-to-day
               benefits, unless it is a PMB condition (a list of conditions to be
               covered unlimited by any medical scheme, as per legislation - refer
               to page 6 for a list of these conditions)?
           •   In the case of Designated Service Providers (DSPs) - a list of
               providers that you have to use to qualify for benefits - ensure that
               you have easy access to these providers. This applies specifically
               to the Primary option.
           •   In the case of members who are currently receiving a subsidy on
               their monthly contributions from their employer, please contact
               your employer to ascertain whether the level of subsidy on the new
               benefit options would remain the same.
           •   In an effort to assist you, we have listed seven steps to guide you
               through the benefit option selection process (see page 6).

           WHO CAN ASSIST YOU TO MAKE AN INFORMED DECISION
           ABOUT THE BEST-SUITED BENEFIT OPTION?
           If you have appointed an accredited healthcare broker upon joining
           NIMAS, you may call on this broker to assist and advise you on the
           selection process. You may contact our Client Services Department
           on 0860 646 272 if you need to confirm who your broker is or to obtain
           their contact details.




Consider
           If you do not make use of a healthcare broker, you are welcome to
           contact our Client Services Department, who will gladly assist in
           answering your questions about the new benefit options. Please note
           however that, due to legislative constraints, our staff is not allowed
           to make any direct recommendations in terms of your new benefit
           option. The option selection has to remain your own choice.

           In trying to assist you even further in selecting the correct benefit
           option, we have enclosed a Summary of your Healthcare Expenditure
           for 2007 to date. This will give you an idea of the level of cover that
           you enjoyed during the current financial year, effective 1 January 2007.
           Please note that this is merely a guide on your existing expenditure
           within your current benefit options and is no indication of expected
           healthcare expenditure going forward, since the state of health of you
           and your family cannot be predicted.

               3
MAKING YOUR SELECTION
  HOW DO YOU INFORM NIMAS OF YOUR NEW BENEFIT OPTION SELECTION?

  Enclosed you will find an Option Selection Form. You need to complete this form and submit it to NIMAS in any of the following
  ways (members of registered employer groups must please submit their Option Selection Form to their employer):



  TELEPHONIC

  Contact our Client Services Department on 0860 646 272, listen to the voice prompts and follow the instructions carefully.
  (Please note that you would still have to fax or post copies of your proof of income to us should you select the Primary option.)


  POST

  Please use the enclosed self-addressed envelope if you wish to post your completed Option Selection Form to NIMAS.
  (Please note that you have to include copies of your proof of income should you select the Primary option.)


  FAX

  Fax your completed Option Selection Form to 0860 646 273.
  (Please note that you have to include copies of your proof of income should you select the Primary option.)


  WEB / INTERNET

  Update your benefit option selection online at www.NIMAS.co.za
  (Please note that you would still have to fax or post copies of your proof of income to us should you select the Primary option.)


  SMS

  Await our target sms and reply to the sms you received if you wish to select any benefit option other than the Primary option.
  If you decide to select the Primary option, please use an alternative method to submit your form.


  HAND DELIVER

  Hand deliver your completed Option Selection Form to:
  NIMAS Building
  5 The Boulevard
  Westway Office Park
  Westville
  (Please note that you have to include copies of your proof of income should you select the Primary option.)


WHAT SUPPORTING DOCUMENTS DO YOU NEED TO SEND TO NIMAS WITH YOUR OPTION SELECTION FORM?
If you select the Primary option, you have to provide proof of your income (read further for details). If you have a child dependant
older than 23 years who would still be a full-time student in 2008, you will have to provide proof of the student registration as soon
as possible.

IS THERE A DEADLINE FOR THE SUBMISSION OF YOUR OPTION SELECTION?
You have to inform NIMAS of your new option selection by 30 November 2007.

WHAT WILL HAPPEN IF YOU DO NOT SELECT A NEW BENEFIT OPTION FOR 2008?
NIMAS would strongly like to advise members to select a new benefit option, but if we do not receive your Option Selection Form
by 30 November 2007, you will be defaulted to a new benefit option that is the closest to your existing benefit option in terms of
the type and extent of medical aid cover.

WILL NIMAS ALLOW YOU TO CHANGE YOUR BENEFIT OPTION AGAIN?
Members may only change their benefit option once a year, effective on 1 January 2008.

                                                                  4
DO MEMBERS HAVE TO RE-APPLY FOR
APPROVAL FOR THEIR CHRONIC
MEDICATION ON THEIR NEW OPTION FOR
2008?
NIMAS will verify whether your chronic benefits on
your new option requires you to re-apply, in which
instance Qualsa will contact you.

If you however, select the Primary option, your new
PrimeCure provider will prescribe your chronic
medication after 1 January 2008. When we send
you your new membership card in December, we
will enclose a chronic application form that you
have to take to your PrimeCure provider after
1 January 2008 to register your chronic medication.

If a member selects the Primary option, they need
to be aware of the following:

•   Members need to provide proof of income when
    submitting their Option Selection Form. Please
    provide copies of your last payslip or last two
    months' bank statements. In the case of
    individual members (members not part of a
    registered employer group), you need to provide
    proof of your own income and that of your
    spouse or partner, should you register him/her
    as a dependant. Your monthly contribution will
    be calculated based on the higher income of
    the two.
•   PrimeCure will deal with all queries relating to
    benefits and claims. NIMAS will only deal with
    queries relating to your contributions and
    possible changes to your membership details
    (addition or resignation of dependants, change
    of income etc.).
•   The network of providers (hospitals, GPs,
    Dentists and Optometrists) can be viewed at
    www.primecure.co.za or you can contact them
    on 0861 665 665.
•   Members do not have to choose one specific
    provider. They will enjoy benefits at any of the
    listed providers.




Making your
s election
                                                       5
                                    THE SEVEN
                                    STEPS TO
                                    SELECTING THE
                                    APPROPRIATE
                                    BENEFIT
                                    OPTION
                                    1. THINK ABOUT YOU AND YOUR FAMILY'S
                                    HEALTH
                                    What were your medical needs this year? Will they change
                                    next year? Do you have a chronic ailment?

                                    Important points to consider:
                                    • Your claiming history - what were your medical
                                       expenses over the past year?
                                    • Are you planning any medical procedures?
                                    • Are you taking medication every month? If so, is it
                                       for a PMB condition? If not, you need to ensure that
                                       the option you select has sufficient chronic medication
                                       cover for your needs.
                                    • How many dependants do you have? Will this change
                                       next year? If so, this could affect your monthly
                                       contribution.
                                    • What monthly contribution can you afford? Clearly,
                                       this consideration will have a direct impact on your
                                       decision.
                                    • What day-to-day benefits do you need? Carefully
                                       consider the day-to-day benefits (i.e. the out-of-
                                       hospital benefits) provided by each of the four NIMAS
                                       benefit options. Are you satisfied that these benefits
                                       are provided through a designated network of
                                       practitioners on the Primary option for example (i.e.
                                       PrimeCure)?


      Prescribed Minimum Benefits (PMBs) are the minimum benefits a medical
      scheme has to provide for the basic medical management and treatment of 26
      common chronic conditions listed below:

       1.   Addison's Disease                        14. Epilepsy
      2.    Asthma                                   15. Glaucoma
      3.    Bipolar Mood Disorder                    16. Haemophilia
      4.    Bronchiectasis                           17. Hyperlipidaemia
      5.    Cardiac Failure                          18. HIV/AIDS
      6.    Cardiomyopathy Disease                   19. Hypertension
      7.    Chronic Obstructive Pulmonary Disease    20. Hypothyroidism
      8.    Chronic Renal Disease                    21. Multiple Sclerosis
      9.    Coronary Artery Disease                  22. Parkinson's Disease
      10.   Crohn's Disease                          23. Rheumatoid Arthritis
      11.   Diabetes Insipidus                       24. Schizophrenia
      12.   Diabetes Mellitus Type 1 & Type 2        25. Systemic Lupus Erythematosus




the s even steps
      13.   Dysrhythmias                             26. Ulcerative Colitis




                          6
2. CONSIDER THE FOUR OPTIONS
The main factor to consider is the level of day-to-day cover you need, and then
look at the in-hospital cover. Select a benefit option that suits you and your family's
needs and is affordable. A summary of each benefit option:
The Primary Option
This benefit option provides unlimited primary healthcare for day-to-day cover
through a network of PrimeCure providers, whilst hospitalisation is limited to
R500 000 per year for a member or a family in a network of private hospitals -
Netcare, Life Healthcare, certain MediClinic's and NHN (National Hospital
Network). A full list of all providers can be viewed on the PrimeCure website at
www.primecure.co.za
The Classic Option
This benefit option provides day-to-day cover in the form of an out-of-hospital
limit for a list of services, whilst in-hospital cover is unlimited in any private
hospital. Surgeons and anaesthetists are covered at 100% of the NIMAS rate.
The Millenium Option (25% savings plus above-threshold limit)
This benefit option provides day-to-day cover from a compulsory savings portion
(already included in the contribution). It also provides further above-threshold
benefits up to a certain limit. In-hospital cover is unlimited in any private hospital.
Surgeons and anaesthetists are covered at 125% of the NIMAS rate.
The Supreme Option
This benefit option provides comprehensive day-to-day cover in the form of an
out-of-hospital limit for a list of services, whilst in-hospital cover is unlimited in
any private hospital. Surgeons and anaesthetists are covered at 200% of the
NIMAS rate.

3. LOOK AT THE DAY-TO-DAY BENEFITS OF THE OPTIONS
Consider the day-to-day benefits offered by each of the four benefit options so that
you select the option most suited to your day-to-day (out-of-hospital) medical
needs.

4. LOOK AT THE IN-HOSPITAL BENEFITS FOR ALL THE OPTIONS
You also need to consider the hospital benefits offered by each of the four benefit
options to make sure that you select the option most suited to your medical needs.

5. REVIEW THE VALUE-ADDED BENEFITS
Refer to page 2.

6. DETERMINE HOW MUCH YOUR SELECTED OPTION WILL COST
Clearly an important factor to consider in selecting the right option for you and
your family, is the cost and the benefits.
To find out how much the option of your choice will cost (do not forget to refer
to your employer to see if you are subsidised), please refer to the respective
contribution tables.

A: See what income category you fall into (only applies to the Primary option).
B: Write down the cost for the main member.
C: Multiply the number of adult dependants* by the amount in the table for the
   benefit option you are considering.
D: Multiply the number of child dependants** by the amount in the same table
   for the benefit option you are considering (only applies to the Primary 0ption).
   For Supreme, Millenium and Classic you only have to write down the cost for
   one (your oldest) child.
E: Add up b+c+d = total contribution

*   an adult dependant is a spouse, a partner or any immediate family for whom
    the main member is responsible for care and support, or a child 23 years or
    younger who is still a full-time student.

** a child dependant is the main member's natural child, or stepchild, or legally
   adopted child, or any child placed in the custody of the member or his or her
   spouse or partner, who is under the age of 23 years.

                                                                     7
7. MAKE YOUR CHOICE
Now that you have looked through the day-to-day benefits; the in-
hospital and major medical benefits and your calculated contribution
for the benefit option you have in mind, review the actions we set
out at the beginning of this guide:
• Your claiming history - what were your medical expenses over
    the past year? Look at your last claims statement and use this
    information to help you determine what your expenses might
    be in the coming year.
• Are you planning any medical procedures? For example, you
    might be planning to have a baby, or you may need a knee
    replacement, or advanced dentistry. If so, factor this into your
    decision.
• Are you taking medication every month? If so, is it for a PMB
    condition? If not, you need to ensure that the benefit option you
    select has sufficient chronic medication cover for your needs
    that are not covered as a PMB.
• How many dependants do you have? Will this change in the
    coming year? If so, this will affect your contribution rates.
• What monthly contribution can you afford? Clearly, this
    consideration will have a direct impact on your decision.
• What day-to-day benefits do you need? Carefully consider the
    day-to-day benefits (that is the out-of-hospital benefits) of each
    of the four NIMAS benefit options.
• Can these benefits be delivered through a network of practitioners?
    Or do you want the freedom to choose your own doctor, dentist
    and optometrist?

Make sure you are comfortable that the benefit option and the
contribution you have chosen meet your needs. If not, review the
benefits and contribution tables again.



 EXCITING VALUE-ADDED PRODUCT
 NIMAS negotiated an exciting and exclusive value-added product
 for their members through Metropolitan Holdings Ltd. Early in
 2008 members will have access to a debit card facility called
 GoalMed. This card can be used to reserve funds for medical
 expenses not covered by NIMAS. Members who are currently on
 a savings option, and choose a non-savings option in 2008, may
 choose to have their medical savings refunds (due in May 2008)
 paid directly into this card. Please refer to the enclosed brochure
 for more details.


We trust that you are as excited as us here at NIMAS about your
new improved offering. We are looking forward to be of service to
you and your family in 2008.




 WINNERS!
 Congratulations to Mr R Ramsunder who won the R500 voucher
 for suggesting the new name, “The Heart Beat”, for the NIMAS
 newsletter. It was selected out of all the entries as the one that
 best describes the essence of our newsletter as it deals with
 issues that should lie close to your heart, issues relating to your
 health and wellness.

 Congratulations to Ms Y Coertze who won the lucky draw prize
 of a R1 000 voucher for submitting her updated contact details
 to NIMAS.




                                                                   8

				
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