Whilst the year-ahead increases will cause some to question what they are paying for in medical cover, the larger question – one that is much older than the passed few weeks – receives new vitality. That is: What are you paying for?

The financial planning industry (our industry) is currently undergoing some strategically significant changes to bring clarity to that exact question. This change is called the Retail Distribution Review (RDR).

The first phase of RDR is set to arrive on 1 January 2017.

The reason for introducing RDR in South Africa is because the old models for giving advice and selling financial products have created a number of areas that need to be addressed.

RDR is an attempt to focus on the advice rather than the products. One of the key objectives of RDR is to create sustainable business models for financial advice, similar to those of medical and legal advice.

Financial advisors have something far more valuable than just policies or fund wrappers to offer, that is, a financial planning model in which the client is treated more holistically.

“RDR is not about regulation,” said Brian Foster, the co-founder of Beyond RDR. “It’s about business models. We have been running a business model that’s been broken for a long time. Now is the time to change it.”

“You come into the industry by learning to sell policies,” Foster said. “The industry has trained us with this industrial mindset. They build these factories, and send us out to distribute their products. That’s industrial age thinking.”

“I don’t think people buy a financial planner,” Foster said. “But if you ask someone whether they would like you to help them to have the lifestyle you want without running out of money, they will buy that.”

I’m here to help you live the lifestyle that you want – comfortably. Let’s get in touch.

Quotes from MoneyWeb

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Despite the prevalence of the disease and the high price tag associated with cancer treatment, medical aid schemes in South Africa do not automatically cover all treatment costs.

Comprehensive medical aid options that provide cover both in and out of hospital usually have unlimited oncology benefits or limited but with a good overall amount. However, this doesn’t necessarily mean that all expenses will be paid for in full.

Instead, medical aid schemes pay providers at scheme rate, or in some cases 200 or 300 percent of the scheme rate. This rate may be a lot lower than the one healthcare providers actually charge, in which case members have to cover the remaining costs when designated providers are not used.

More affordable medical aid options offer limited oncology cover. Once the limit has been reached, any additional payments have to be taken upon by the member (in most cases). Furthermore, schemes have the right not to cover the costs resulting from non-PMB cancers where it has been stated.

If a cancer is considered a PMB condition (Prescribed Minimum Benefits – defined conditions and treatments which must be provided, by law, to all medical aid scheme members and beneficiaries in full and without co-payment, regardless of the benefit option selected), a medical aid scheme is legally obliged to continue paying for treatment at cost, even if the oncology benefit limit has been reached.

In order to limit PMB expenditure, medical aid schemes can insist that beneficiaries consult specialists and use hospitals in their networks. Low-cost medical aid options may limit members to treatment at state facilities only. In addition, each medical aid scheme covers only medicines listed on a scheme formulary (an official list giving details of prescribable medicines). Entry-level plans typically cover the cost only of generic alternatives, rather than of more expensive branded medicines.

When is cancer considered treatable?

According to the Medical Schemes Act, cancer is considered treatable when:

• only the organ of origin is affected and there is no spread of the disease to contiguous organs, or
• the organ of origin and other life supporting organs and systems have not been irreparably damaged by the cancer

Before you subscribe to a particular medical aid scheme or plan, it’s a good idea to investigate the cover it offers for cancer treatment. Among the issues you should consider are:

1. the monetary value of the oncology benefit per beneficiary per year
2. what specialised treatments or biologics, if any, are covered by the benefit structure
3. whether cover for oncologist and specialist consultations is limited
4. the scheme’s cancer treatment protocols
5. whether the scheme permits plan upgrades at any time during the year.

Need to review your cover? Let’s meet up!

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Adding to this; accidents happen when you least expect them. There is a perception that if you are young, you don’t need medical cover, but that is far from the uncomfortable truth.

Technology has us leading increasingly sedentary lifestyles, which can lead to conditions such as hypertension and diabetes.

If you are without cover, medical costs associated with hospitalisation, surgery, therapy, consultations and medication can entrench you in debt. There are also costly penalties applied if you have been without cover for 90 days or more or if you are over 35 years old and have never belonged to a medical scheme before.

There is a portfolio of products for young South Africans with varying budgets and health care requirements, popular among these are the income-based plans and hospital plans.

Income-Based Plans
An income-based medical plan charges a premium based on your monthly salary. If you are in in the low- to mid-income bracket seeking some basic cover then this is an ideal solution for you, provided that you are willing to use designated service providers only.

As well as being affordable, income-based plans typically offer unlimited benefits in hospital, usually at 100% of the scheme rate. Because tariffs are pre-negotiated, co-payments do not apply in most options, provided you use network providers.

In addition, income-based plans typically provide limited cover for clearly defined out-of-hospital expenses, such as consultations with network GPs, prescribed medicines, and general radiology and pathology. They can also provide limited maternity cover, making them suitable for young South Africans who are planning families.

Hospital plans
These hybrid medical products set aside a percentage of your total annual contributions in a savings account to be used to cover day-to-day expenses. Once you’ve exhausted your annual savings, you have to pay for GP and specialists visits, as well as medication, out of your own pocket.

Hospital plans cover the costs of procedures, consultations and medication provided in hospital when you are admitted. They also usually provide benefits for radiology and pathology, oncology, dialysis and internal prostheses, such as pacemakers. (Don’t be fooled into thinking this is only something that old people need)

More expensive hospital plans provide benefits at any private hospital or clinic, while budget options usually cover costs only at state hospitals or specifically designated private facilities.

Upgrading your plan
Regardless of the type of medical plan you choose, you have the choice to upgrade to a more comprehensive product, as and when your circumstances change. For instance, if you’re diagnosed with a dread disease that requires sustained medical intervention out of hospital or you’re ready to start a family, you can level up to a product that offers the higher level of benefits that suits your particular situation.

In most cases though, you may only be allowed to upgrade at certain times of the year, and a pre-existing condition may be temporarily excluded from the cover.

It is extremely important that you understand the terms and conditions of the scheme that you are on as these change from year to year. Even the terminology in this blog may be subject to changes without notice!

If you’re unsure what you are currently covered for or if you are new to medical cover then let’s get in touch!

Source: medicalaid-quotes

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Just as different diets work for different people, we cannot view investments as a cookie-cut, one-solution-fits-all models. And, just as with dieting, creative and tailored solutions often work best! As a financial advisor, it’s my job to be your financial dietician!

A recent popular theme of conversation has been the Tim Noakes diet. For some people it is a radical solution that works wonders, while others see no change at all. If you want to lose weight you need to monitor your food intake, exercise daily and tailor your lifestyle.

The same goes for investments; you need to monitor your income, invest wisely and live the lifestyle that will grant you the financial independance that you desire. If you can turn your determination into habit, you will almost certainly become wealthy!

When it comes to someone that is super fit and exercises every day, it is not the specific exercise that they do but the fact that they are staying active. The same goes for savings. It isn’t about the specific investment that may be lucrative, it is about ‘exercising’ your frugality and making wise decisions for future success.

If you are committed to being financially independent you should steer clear of all debt, rent a small apartment (or share living space) for as long as possible and keep driving that small car that is light on petrol until it gives up the ghost.

Next, there is a large selection of investments to choose from, you can start small with an indexed unit trust that invests in shares. Then, the hard part, putting away between 20-30% of your salary. There will always be excuses that you give yourself as to why you shouldn’t save, but you need to keep your eyes on the prize if you want this plan to work. Remember that there is no magic formula for success, it takes years of dedication to become financially independent. These examples are not specific to any person, but reveal general attitudes to money management.

If you want to make a change the will reap significant results – let’s chat!

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Having come from a generation that largely understood medical cover as a ‘covers all’ policy, I’ve highlighted five more facts about hospital plans that are overlooked until they are needed! Some are comforting to know that they’re in place, others require being armed with the correct information.

1. If you find yourself in a crisis, the hospital will contact your scheme to arrange admittance.

2. Hospital plans can pay for hospitalisation in private hospitals, although some specify the use of network or state hospitals. Usually, schemes have agreed rates with specific hospital groups and your hospital bill and in-hospital medication will most likely be paid in full, depending on the specifics of the plan you have chosen.

3. Private doctors and specialists in private hospitals can charge up to three times the rate that the hospital plan will pay, be prepared to make co-payments (even people on full medical schemes can find themselves in this position). You can always check with your hospital plan administrators for available avenues to reduce costs. Always go with the designated service provider/network hospital if there is one, your bill could be completely covered!

4. Consider taking out gap cover if you want to prevent making co-payments on your hospital bill yourself. It consists of a small monthly payment that could reduce some unnecessary pressure in the future.

5. Hospital plans usually cap the annual maximum hospital bill they will cover per family. Cases that exceed the specified costs will be closely monitored.

Hospital plans generally cost less than half of what full medical insurance would cost you and they are strictly regulated. Always read the small print so that you know exactly what you are covered for. I’d be happy to run through these with you and answer any questions you might have!

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Having come from a generation that largely understood medical cover as a ‘covers all’ policy, it’s important to run through these five facts about hospital plans that are overlooked until they are needed!

1. You usually need to be hospitalised for the hospital cover to kick in. This does not include visits to the trauma unit, unless the doctor decides to admit you to the hospital.

2. Hospital plans are great for people who are fit and healthy and thus need minimal cover. Visits to doctors, dentists and optometrists will have to be paid by you. If your medical needs change, you can always select another option regarding your level of cover (usually in December).

3. Hospital plans need to cover you for 26 prescribed chronic conditions, such as hypertension. This means that the medication for your chronic condition is paid for by the plan. This is done to try and prevent hospitalisation. Prevention is better than cure.

4. Some hospital plans pay for certain procedures that allow for early diagnosis. Colonoscopies, mammograms and pap smears are examples of procedures that can be covered if done in doctors’ surgeries.

5. Designated pharmacies, ambulance and other services recommended by your hospital plan will likely be a lot cheaper.

In order to ensure that your portfolio matures with you, it’s essential that you are kept up to date with your policies and the way in which your portfolio has been designed. If you’d like an update – then let’s hook up!

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What is compression and why is it used?

Who can have a mammogram?

Myths about mammograms

• That the machines increase the size of your breasts
• That your breasts are pressed flat
• That by having a mammogram, you will get breast cancer
• That compression is very painful. Compression should not hurt you but it will naturally be uncomfortable.

Further investigations if mammogram report was not normal

• In the case of a call back, make an appointment as soon as you can and ask a loved one or friend to come with you. This will make you feel a little more comfortable and you will have someone to talk to while you wait for your results.
• The first step would be to assess the mammogram images.
• Thereafter if something was suspicious, a biopsy would be preformed, whereby a needle is inserted into the area, cells removed and sent to a laboratory to be checked.
• The results from the laboratory could take between two days and a week to become available.
• According to those results, you could then be referred to a specialist for surgery.
• It is your right as a patient to get a second opinion if you are not satisfied with the feedback.
• Most breast diseases grow very slowly, so there is no need to act immediately. Go home, do some research and discuss matters with your family. Once you are completely informed, only then make your decision.

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The current SA stats for breast cancer reveal that one in thirty-six women has breast cancer. My blog last week spoke about the general costs and overall statistics of cancer, but today I’d like to get a little more specific as to the expected ‘realistic’ impact that breast cancer will have on those who may be diagnosed this month.

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Last year I shared an article on my blog that spoke to the stark reality of the tragic impact that cancer has had (and continues to have) on almost every family in South Africa. It’s very rare, in fact, to meet someone who hasn’t either had cancer themselves, or has a close family member who has been diagnosed with some form of cancer.

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E-cigarettes are becoming increasingly popular, but they’re no stranger to controversy. The latest news on the topic highlights the increasing number of governmental regulations kicking in across the world to restrict or limit the distribution and use of electronic nicotine delivery systems (ENDS).

The Cancer Society of South Africa (CANSA) is one of many organisations voicing its dismay with the popularity of e-cigarettes, emphasising that the use and distribution of e-cigarettes is regulated under the Medicines and Related Substance Act, which classifies nicotine as a schedule 3 drug and requires it to be sold only at pharmacies and with a doctor’s script.

The device itself also falls under the Act, as it is considered a delivery device for a scheduled drug.

In spite of this, the Act does not seem to be enforced, with many shopping mall kiosks selling e-cigarettes across South Africa.

E-cigarettes are believed to be less harmful than tobacco cigarettes, but the long-term effects of the use of e-cigarettes (commonly referred to as ‘vaping’) remain uncertain. Many health organisations argue that these devices have the potential to create a whole new generation of nicotine addicts.

A recent report by reinsurer Gen Re placed the life insurance industry’s stance on these products in the spotlight, emphasising that all users of nicotine must be treated as smokers, regardless of the nicotine source.

Last month, the World Health Organisation added its voice to the fight against the use and distribution of e-cigarettes, calling for tougher restrictions on these devices. These should include restrictions against advertising of e-cigarettes, their indoor use and the use of flavours such as fruit and candy.

Over 59 countries are already said to regulate the use of e-cigarettes, with 39 countries enforcing advertising and sponsorship bans, and 30 countries prohibiting vaping in public spaces.

According to the WHO, e-cigarettes represent a $3 billion industry. The reason vaping is perceived as less harmful than smoking speaks for itself: Tobacco cigarettes release nicotine in smoke containing 7 000 harmful chemicals (of which 70 of these chemicals cause cancer). E-cigarettes, on the other hand, deliver only one potentially harmful chemical, known as propylene-glycol (PG).

Gen Re reports that PG is approved for use in food, tobacco, cosmetics and pharmaceutical products such as asthma inhalers. Even hospital air is disinfected using it, which means many of us could have been exposed to this chemical without knowing it.

But why take issue with a substance like PG if it’s in such common use? Because the long-term risks of inhaling it remain unknown, argues Gen Re.

And, it adds, scientific evidence to support the view that vaping aids in quitting smoking is inconclusive. In fact, many smokers don’t stop smoking, but instead become dual-users of tobacco and e-cigarettes.

“Much effort has been made to de-normalise smoking in recent years, yet the design and advertising of many mainstream e-cigarettes mimic their tobacco counterparts,” Gen Re claims.

“Many fear their popularity could re-glamorise smoking, enticing new smokers or discouraging others from stopping. ‘Celebrity vapers’ and new ‘fun flavoured’ e-cigarettes are drawing particular criticism from health campaigners due to their influence on teenagers.”

They argue more and larger long-term trials are urgently needed to establish whether vaping can be an effective aid to smoking cessation. In the meantime, all users of nicotine should be treated as smokers regardless of the source. In line with international insurance industry practice, underwriters apply smoker rates to users of e-cigarettes.

The reason for this — as summarised by Gen Re — is threefold:

1. Cotinine screening (the routine test for applicants who claim to be non-smokers) cannot identify the method of nicotine intake;
2. Individuals who remain addicted to nicotine are in danger of using tobacco;
3. It is highly likely that users of e-cigarettes will revert to smoking or become dual users.

Lighting up or switching on will have the same impact on your risk profile – and could have unknown future complications with your health. Either way – e-ciggies will cost you more.

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