CareChamp works with Medical Aids

MEDSCHEME

• Advanced Serious Illness Benefit (SIB): Alignd Managed Health Care Program - usually 336 hours of cancer care / palliative care covered & bi-weekly RN visits / available to Bonitas and Fedhealth members - see application form here to be filled out by your treating doctor.

• Bonitas: The Hospital Benefit Management (HBM) Programme, Home nursing approved in lieu of hospitalisation up to the available benefit = R18 130.

• Fedhealth: Out of Hospital Benefit of R19 400 for home care / nursing.

• SABC Medical Scheme: Out of Hospital Benefit of R30 150 for home care / nursing.

DISCOVERY

• Advanced Illness Benefit (AIB) specifically for advanced cancer conditions & Compassionate Care Benefit (CCB) for palliative care (other than cancer conditions) between R45 000 - R65 000 benefit per member per lifetime. See application form and ask your doctor to please complete.

• Care Coordination Program /after Hospitalisation (CCP)

  Home-based care authorisation post hospital admission can be requested from dischargeplanning@discovery.co.za Please try request this whilst still in hospital.

• LA Health (AIB program with Discovery)

ANNUAL FRAIL CARE BENEFITS

• Bankmed Frail Care Benefit covers homecare to a max. benefit of R550/day. New Authorisations need to be received yearly.

• Anglo Medical Scheme (AMS) Annual Benefit - Accounts for frail care are paid from the Hospital Benefit up to 100% of the scheme reimbursement rate and is subject to the annual limit of R82 455 per beneficiary with a max. benefit of R293.70/day

• EMBF (Engen Medical Benefit Fund) - paid up to 100% of the Fund rate with a limit of R30 600 per family per year (frail care/end of life care) - preauthorisation required

• Remedi Medical Aid Scheme - paid from and subject to the Overall Annual limit - preauthorisation required:

  • Comprehensive Plan has a sub limit of R46 500 per beneficiary per year

  • Remedi Classic Plan has a sub limit of R44 300 per beneficiary per year

  • Remedi Standard Plan has a sub limit of R16 350 per beneficiary per year

• TFG Health Plus Plan - paid from Overall Annual Limit up to 100% of Scheme rate with a sub-limit of R38 610 per person a year/ R429 per day for 90 days - subject to benefit confirmation

• Wooltru & Profmed also have an annual frail care benefit

There might be various other programs that support frail care benefit - however above mentioned are those we have worked with to date. If your medical aid does not fall within one of the aforementioned ones, we would kindly ask you to first confirm your benefits with your medical aid.

As a medical aid member you are not automatically qualified for care. Medical Aid needs to provide a letter of authorisation that clearly states the level of care covered. Usually in order to do so, the medical aid will require a letter of motivation from the Nursing Agency (Us) after a compulsory initial nursing assessment. Additionally you need a letter of motivation from your Doctor including ICD-10 code(s).

Support paid for OR subsidised by medical aids varies depending on program. The approved funds can be stretched out longer - claiming care on and off / basically creating relief care for families over an extended period of time.

For patients that want to explore their choices of Medical Aid Benefits and programs:

Based on the clinical information received we will evaluate the medical condition and diagnosis and render whether it is covered in terms of the underwriting terms and conditions of the Medical Aids. 

Potential client need to please provide name, address, ID, Medical aid name and number, and dependent code as well as a doctors letter including ICD-10 codes.

Please contact us for assistance and we will get back to you .

Should you require urgent assistance - you can always opt to pay upfront to us directly and try to claim back thereafter.