what is the chronic illness benefit? how do i register for
TRANSCRIPT
What is the Chronic Illness Benefit?The Chronic Illness Benefit (CIB), covers approved medicine for a list of 26 chronic conditions. This list is known as the Chronic Disease List (CDL). You can refer to your member benefit guide for a list of the conditions.
If you choose medicine that is on the medicine list (formulary) we will pay the approved medicine in full up to the Scheme Rate. Where your pharmacy charges more than the Scheme Rate, you will need to pay the difference.
If you choose medicine that is not on the medicine list (formulary) we only will pay up to 80% of the Maximum Medical Aid Price (MMAP) and you will need to pay the difference.
How do I register for the Chronic Illness Benefit?Should you have a chronic illness, you need to complete a Chronic Illness Benefit application form with your doctor and send to us for review, the forms are available on the schemes website: www.glencoremedicalscheme.co.za. Fax the completed application form to 011 539 7000 or email it to [email protected] or post it to Glencore Medical Scheme, CIB Department, PO Box 652919, Benmore, 2010. If your condition is on the Chronic Disease List and we approve your application, the Chronic Illness Benefit will also cover certain tests, procedures and consultations for the diagnosis and ongoing management of your condition.
How we give cover for Additional Disease List (ADL) conditions There are chronic conditions which are not on our Chronic Disease List. We have a further Additional Disease List which covers other conditions. There is no medicine list for these conditions. We will pay for approved medicine for these conditions up to the Maximum Medical Aid Price.
Should you need more information you can call us on 0860 00 21 41 or visit www.glencoremedicalscheme.co.za
Newsletter
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How can you get rewarded?If you have a spouse on your membership, both of you need to do a Vitality Health Check (VHC) to enjoy increased rewards of up to 15% cash back at Clicks or Dischem. The VHC needs to be done annually to qualify for enhanced benefits. The Vitality Health Check is not paid for by your medical scheme.
Get up to 15% cash back on thousands of HealthyLiving items. Enjoy a variety of healthy food choices from Pick n Pay, get personal and family care products at Clicks and sports gear at Totalsports.
Vitality Baby offers new and expecting parents a gift pack filled with useful information, important baby products and exciting gifts. Get up to 10% cash back on nappies and other baby essentials with the HealthyCare benefit at Clicks.
Get active with Virgin Active. The main member and spouse save up to 67% on monthly gym fees at Virgin Active (excluding Classic clubs) health clubs. Adult dependants 18 years and older save 50% on monthly gym fees.
GlencoreFIT funeral cover*
GlencoreFIT funeral cover gives you peace of mind with R20 000 funeral cover for you and your spouse, and R10 000 funeral cover for your children.
Do a VHC to enjoy increased cover for you, your spouse and children.
Remember: GlencoreFIT members must be 18 years and older.
For more information on any of these benefits, contact the Vitality call centre on 0860 99 88 77 or speak to your HR Manager.
* GlencoreFIT funeral cover is offered by Discovery Life Ltd and is only available for beneficiaries (your spouse and children) who are registered on Glencore Medical Scheme.
Understanding your claims statementGlencore Medical Scheme sends out statements on a monthly basis to members who have submitted claims for payments. This statement includes important information about claims submitted, processed and paid as well as how your benefits have been used. This will help you to take control of your spend and manage your Plan benefits.
We have put together an example of how your claims statement works below.
See contact details here
Statement Number 1: 1 July 2016 Your membership details:
Ms T Blackwood Member Tanya Blackwood 155 West Street Membership number 329 705 106 Sunnyside Plan type Glencore Medical Scheme 0002
SUMMARY STATEMENT This section is an overview of your claims statement. It shows the totals from your detailed statement on the next page.
Total claims: 1,607.55 Claims payable: 1,564.46
-‐ To you by the Scheme 0.00 -‐ To healthcare professional 1,564.46
Claims for exclusions not paid by the Scheme: 43.09
-‐ For your own account – please reimburse your healthcare professional
Amounts paid by the Scheme above Scheme Tariff: <active members> -‐ For your own account – to be refunded by you to the Scheme via your
Employer’s payroll
43.09
IMPORTANT INFORMATION
This message and any attachments are confidential and intended solely for the addressee. If you have received this message in error, please notify Glencore Medical Scheme immediately, telephone number 0860 00 21 41. Any unauthorised use; alteration or dissemination of the contents of this email is strictly prohibited. In no event will Glencore Medical Scheme or the sender be liable in any manner whatsoever to any person for any loss or any direct, indirect, special or consequential damages arising from use of this email or any linked website, including, without limitation, from any lost profits, business interruption, loss of programmes or other data that may be stored on any information handling system or otherwise from any assurance that this email is virus free even if Glencore Medical Scheme is expressly advised of the possibility of such damages. Glencore Medical Scheme, registration number 1253.
Glencore Medical Scheme Claim Statement
Delivery details
Statement number
Find your membership details here
Quick summary of claims paid, and amounts owed
GM_45679DIH_24/05/17_V3
Glencore Medical Scheme registration number 1253 is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07. Discovery Health (Pty) Ltd is an authorised financial services provider. Customer service 0860 00 21 41.
Detailed statement
This page provides detailed information about your recent claims.
Member number: 494290380 Statement date: 1 July 2016
<No payment was made directly to you> IF active member then<Please note any amount due to you will be paid via your employer IF pensioner then < Please note any amount due to you will be paid into your bank account>
Portion not payable** = The amount for which neither you nor the Scheme is responsible
Reason Code (RC)
6 Your membership excludes cover for this claim – we have not paid it.
Your claims details Claims payment information
Treatment date
Patient information Procedure code
Claims ref Amount claimed
Scheme Rate
Scheme paid to healthcare professional
Total claim shortfall
Member owes scheme
Refund to member
Portion not payable**
RC
Claims paid in full 1June2016 Jacobus -‐Medxpress 3021
0191 3009 3014
4AtvO 153.00 357.60 135.10 80.90
153.00 357.60 135.10 80.90
153.00 357.60 135.10 80.90
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
1,270.00 1,270.00 0.00 0.00 0.00 Part paid claims 1June2016 Tanya-‐Disc-‐Chem Olympus CHRON 4BB7h 59.46
43.09 0.00 0.00
59.46 0.00
0.00 0.00
0.00 43.09
0.00 0.00
6
102.55 0.00 59.46 0.00 43.09 0.00 Other transactions 0.00 -‐0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total for this statement 1,607.55 1,564.46 0.00 43.09 0.00
Find your membership number and statement
date here
Important note for your information
"Scheme Rate" the amount the scheme pays
This page shows your limits used and available