29
MEMBER GUIDE
Important contact details
Libcare Customer Care 0800-12-CARE (2273)
Libcare e-mail queries [email protected]
To submit your claims, drop them in the box at the
Libcare Desk or on the bridge between Liberty Life Centre
and Libridge, or post them to:
Libcare
P.O Box 44850
Claremont 7735
Hospital and casualty authorisation Libcare Hospital Approvals
0800-12-CARE (2273)
(08:00-17:00 Mon-Fri)
Fax: 021-657-7521
Chronic Medicine Management 0800-12-CARE (2273)
Cancer Management Programme 0800-12-CARE (2273)
Centre for Diabetes and Endocrinology (011) 712-6000
LIFEWORKS 0860-50-55-55
Libcare Fraud Hotline 0800-21-26-38
Netcare 911 for emergencies within South Africa 082 911
Netcare 911 for emergencies in neighbouring countries +27 11 254-1443
Authorisation for overseas medical cover (Netcare) +27 11 254-1443
Use the area below to record your healthcare providers’ details
Your healthcare provider Address Phone or fax
This guide will explain:
n What you are covered for
n How to use your
medical aid
The fold-out at the back of the
guide summarises your benefits
and limits for 2008.
If you have any questions, please:
n visit the Libcare Desk at
Liberty Life Centre, or
n call Libcare Customer Care
on 0800 12 CARE (2273)
Use this pocket to store important papers
M e M B e r G U I d e
INTRODUCTION
Table of contents1. Letter from the Trustees 22. A definition of the Libcare Rate, and other useful information 33. What Libcare covers 4
3.1 Cover for preventative care 43.2 Cover for day-to-day expenses 63.3 Cover for chronic conditions 83.3.1 Special cover for members with cancer, diabetes or HIV/AIDS 103.4 Cover for major medical expenses, including hospitalisation 12
4. Cover for emergency transport 145. Cover when travelling overseas 156. What Libcare doesn’t cover 167. Who can belong to Libcare 178. How to claim 199. How much you pay for Libcare: 2008 contribution rates 2110. How Libcare pays your day-to-day medical expenses 2211. 2008 Benefits: Out-of-Hospital Expenses Benefit, Medical Savings Facility and Threshold level 2312. 2008 Benefit Table and notes 2413. Member support and important numbers Back flap
1
The following benefits and services have been added to Libcare for 2008:n From 1 January, you may use the 0800-12-CARE (2273) number to access all scheme
services and programmes, such as pre-authorisation for hospitalisation and authorisations for and updates to chronic medicine, in addition to customer service. A voice prompt will help you choose the right option.
n Tuberculosis (TB) has been added to the list of conditions covered by the Chronic Benefit. This will provide TB patients with the medication they need to treat the disease. See page 8.
n Certain biological drugs used to treat cancer, such as Herceptin, will now be covered under their own benefit limit. See the Benefit Table on the back flap.
n Libcare now offers unlimited cover for treating HIV/AIDS, as long as the patient is registered with the LIFEWORKS HIV/AIDS management programme. See page 24.
n The value of all benefits has been increased to keep up with inflation (the consumer price index, or CPIX). See the Benefit Table on page 24 and the back flap.
New for 2008
The 2008 Libcare Trustees
2
1. Letter from the TrusteesDear Libcare member,
Welcome to your 2008 Libcare member guide. You may notice that the format is much like last year’s – that’s because we got nice feedback from members on the way we made the guide easier to read and navigate. We hope you find this guide informative and simple to use, and if you have suggestions for how we can improve it, please let us know – that’s what we’re here for!
Continuous improvement is what we strive for as Libcare Trustees. It’s our job to help strike a balance between offering you the great medical care you want and keeping the scheme financially strong. It’s always a pleasure when we can add new benefits and services to the scheme, and this year we have added several, as you’ll see in the box on page 1.
If you have any queries about Libcare, please contact one of the many sources of information available to you:
n The toll-free Customer Care line, 0800-12-CARE (2273), where you can get help from professionals dedicated to our scheme. Customer Care is open from 08:00 to 16:00 Monday to Friday. Beginning in January 2008, you can also use this number to access all the other services offered by Libcare, such as Chronic Medicine Management, the Centre for Diabetes and Endocrinology, and the Cancer Management Programme, by choosing the option that suits your needs.
n The Libcare Desk at Liberty Life Centre, open from 09:00 to 16:00 Monday to Friday, where you can get answers to your questions about the scheme or help with your claims.
n The Liberty Life Intranet or Blueprint Online, where you can find an electronic copy of the member guide and a link to our scheme web page, www.libcare.co.za.
n The Libcare website (www.libcare.co.za), where you can access your claims history, personal details and more.
If you need additional assistance, please contact Libcare’s Principal Officer, Tracey Unser, at [email protected].
Yours sincerely,The Libcare Trustees
Lindi Dlamini, Chairperson,
Individual Operations
Stephen Fish, Deputy Chair, Agency
Tracey Unser, Principal Officer
Jeff Hubbard, Group Finance
Natasha Williams,Call Centre
Ian Cleminson, Liberty Retiree
Reyan Adams,Group HR
2. A definition of the Libcare Rate, and other useful information
The Libcare Rate
The “Libcare Rate” means the amount of money the scheme will pay for a particular medical expense (including consultations, medicines, procedures, examinations, etc.).
For many procedures, as well as all consultations with general practitioners (GPs) and special-ists (in- and out-of-hospital), the Libcare Rate is about double the old “medical aid rate” (now known as the National Health Reference Price List, or NHRPL) or the rate established by the Department of Health.
We determine the Libcare Rate for every single expense each year, because medical costs change from year to year – mostly they go up, and the Libcare Rate goes up too.
Libcare consults and reviews the information issued by a range of experts to arrive at the Libcare Rate. These experts include Vmed (the Liberty Health-owned company that administers Libcare), the South African Medical Association, the Department of Health (which develops the NHRPL), Libcare and other expert sources.
Because there are so many different medical expenses, there is no printed list of the Libcare Rates. If you or your doctor want to know how much Libcare will pay for a particular item or procedure, please phone Libcare on 0800-12-CARE (2273) and make sure you have the treatment/tariff code on hand.
Some healthcare providers charge the Libcare Rate and some don’t
n If your provider charges more than the Libcare Rate, you must pay the difference between the Libcare Rate and his or her fee. If you have a positive balance in your Medical Savings Facility (see page 23), the difference will come from there. If not, you will have to pay out of your own pocket.
n You have the power to try to negotiate fees. Many providers will charge the Libcare Rate, or at least lower their fees, if you ask them to or if you pay cash at the time of service.
Other useful information You will find coloured text in the sidebars throughout this member guide containing contact details, definitions, information of general interest and mini-worksheets to help you calculate your contribution rates and benefits.
Help is available if you need itIf you need any help understanding this guide or the scheme, please visit the Libcare Desk or call Libcare Customer Care on 0800-12-CARE (2273).
3
3. What Libcare coversYou have different types of healthcare needs, and Libcare provides for them in four general categories:
What you need Your Libcare coverWhere to find it in this member guide
To stay healthy Cover for preventative care Page 4
To treat short-term illnesses with medicines and visits to doctors and healthcare providers; andto take care of routine health matters such as getting your eyes tested
Cover for day-to-day expenses
Page 6
To manage ongoing health conditions like heart disease, diabetes or depression
Cover for chronic illnesses Page 8
For hospitalisation or other major expenses if you’re injured, ill, have a baby, etc.
Cover for major medical expenses, including hospitalisation
Page 12
3.1 Cover for preventative careWe all want to stay healthy. Libcare can help you by:
n paying for a variety of annual consultations, procedures and vaccinations
n sponsoring a comprehensive wellness programme. Libcare Wellness offers many ways to help you improve your health and well-being (see page 5)
Cover for consultations, procedures and vaccinationsYour preventative cover pays for the following expenses each year, at the Libcare Rate; this means the cost will not affect your Out-of-Hospital Benefit or your Medical Savings Facility as long as it is within the Libcare Rate.
First visits to doctors and dentists:
Consultation Ages covered
General practitioner All
Dental consultation (basic) All
Annual procedures (first procedure or test):
Examination Ages covered Genders covered
Cholesterol screening (including a lipogram) 15+ Both
Blood glucose All Both
Pap smear 16+ Female
Mammogram 40+ Female
Bone density scan 50+ Female
Two 2D pregnancy scans (months 3 and 6) All Female
Prostate examination 50+ Male
Adult vaccinations (one per year):
Vaccination Ages covered
Flu All
Pneumonia 65+
Libcare pays for preventative care expenses at the
Libcare Rate; you are responsible for
any amount over this rate. The difference
will be deducted from your Medical Savings
Facility if you have a positive balance, otherwise you will
have to pay from your own pocket.
4
PREVENTATIVE CARE
Childhood vaccinations:
VaccinationAges
At birth 6 weeks 10 weeks 14 weeks 9 months 18 months 5 years
BCG; Polio n
Polio; Diphtheria, Tetanus and Whooping Cough (DTP); Hepatitis B; Haemophilus Influenza B (HIB)
n n n
Polio; DTP; Measles or MMR
n n
Polio; Diphtheria and Tetanus
n
Libcare Wellness: Providing support for your health and wellnessLibcare Wellness will provide a practical wellness programme that empowers you to take ownership of your health and wellbeing, targeting key lifestyle factors including stress, obesity, smoking, diet, nutrition and exercise. Libcare Wellness provides access to health and fitness assessments, clinical expertise and guidance that will equip you with vital information necessary to benchmark your health.
It’s easy to join Libcare Wellness; you can do it by phone or on the Internet. The contact details are 0800-12-CARE (2273) or www.libcare.co.za. You will need your Libcare number and ID number to join.
Libcare Wellness gives you access to a wide range of free assessment tools that will give you an insight into your current health status and potential health risks. Once you’ve got your assessment results, Libcare Wellness can help you get healthier:
n Get weekly e-mails on topics that relate to your personal health profile.
n Use online tools to manage your health, including articles, health news, quizzes, calculators and a lot more.
n Consult the Libcare Wellness dietician on the e-Dietician service.
n Use the stress management service, which offers personalised support by a specialist nurse who can help you or refer you to a service provider near you.
Libcare pays for preventative care expenses at the Libcare Rate; you are responsible for any amount over this rate. The difference will be deducted from your Medical Savings Facility if you have a positive
balance, otherwise you will have to pay from your own pocket.
5
There are more living organisms
on the skin of a single human being
than there are human beings on
the surface of the earth.
Your body is fascinating – aren’t you glad Libcare cares about it?
FAST FACT
3.2 Cover for day-to-day expensesThis category of cover provides for:
n illnesses that don’t require hospitalisation
n certain routine examinations such as eye exams and x-rays
Expenses covered under this benefitThese providers, services and medicines are covered under this benefit:
Providers and services
What this benefit covers
General practitioner
All visits to the GP except for the first one. The first visit (for you and each of your dependants) is paid from preventative cover.
Specialists Visits to specialists. Note: You must get a referral from a GP before you see a specialist other than a gynaecologist or an ophthalmologist – these you can consult directly.
Dentists and dental hygienists
All visits except for the first one, which is paid from preventative cover, subject to the dental management programme.Standard procedures like fillings, crowns and orthodontia.
Optometry Examinations, frames, lenses and contact lenses.
Mental health Consultations with psychologists and psychiatrists.
Alternative healthcare providers
Visits to alternative healthcare providers with valid, registered practice numbers.
Pathology Blood tests requested by a doctor in the course of your day-to-day consultations.
Radiology Out-of-hospital x-rays.
Paramedical services
Audiology, dietetics, genetic counselling, hearing aid acoustics, occupational therapy, orthoptics, physiotherapy, podiatry, social work and speech therapy.
Medicines Medicine needed for day-to-day illnesses. This benefit includes prescribed medicines as well as homoeopathic remedies dispensed by a homoeopath and over-the-counter medicines bought at a pharmacy.
How much Libcare will pay for day-to-day expenses
Limits per medical expenseEach consultation, procedure and medicine is subject to the Libcare Rate. Because there are so many different day-to-day medical expenses, there is no printed list of the Libcare Rates. If you or your doctor want to know the Libcare Rate for a particular item, please phone Libcare on 0800-12-CARE (2273) and make sure you have the treatment/tariff code on hand.
In many cases, such as consultations with GPs and specialists, the Libcare Rate is double the rate set each year by the South African Department of Health (previously set by the Council for Medical Schemes).
Limits per categoryThere are limits to how much Libcare will pay for each category of expense, such as the categories in the above table. These category limits are summarised in the 2008 Benefit Table on page 24 of this guide.
6
How Libcare pays for your day-to-day expensesPlease read the explanation on page 22 for how Libcare pays your day-to-day expenses from the Out-of-Hospital Expense Benefit, your Medical Savings Facility and the Threshold Benefit.
Keeping down the cost of prescription medicines: The Generic and Therapeutic Reference PricingLibcare sets limits for how much it will pay for all prescribed medicines – whether they are paid from your day-to-day, chronic or major medical cover. This is because there are often lower-cost options or “generic” medicines that have the same chemistry as the prescribed medicine but are cheaper. (Once the patent on a particular medicine has expired, other companies are allowed to make the exact formulation at a much lower price.)
Libcare has adopted the industry-related Generic Reference Pricing to help us manage the costs of prescription medication. Generic Reference Pricing is a reference pricing system that uses a bench-mark (reference) price for generically similar products.
Medicines within a specific generic group are either identical to one another (except for their appearance or their packaging) or otherwise very similar (for example, only the inactive ingredients differ slightly). Therefore, a given illness can be treated with any one medicine within such a group.
The principle behind this pricing system is that it does not restrict your choice of medicines for your illness. Rather it is a guide for the amount that Libcare will pay. Generic Reference Prices are set in such a way that they ensure availability of medicines without co-payments being necessary. In other words, you will be able to afford the medicine you need without paying from your own pocket, but you may have to select a generic over a brand name product.
If you choose to take the more expensive product, Libcare will only pay up to the Generic Reference Price. You will then have to pay the difference (or co-payment) to the pharmacy. Note that these co-payments may not be paid from your Medical Savings Facility. To avoid unnecessary co-payments, ask your doctor and pharmacist to prescribe and dispense medicines that are fully reimbursed within the Generic Reference Price list.
Therapeutic Reference Pricing usually only impacts on medicines funded from the Chronic Benefit. Therapeutic Reference Pricing gives Libcare the opportunity to control costs beyond Generic Reference Pricing, while allowing funding beyond the Maximum Medical Aid Price (MMAP). Therapeutic Reference Pricing depends on the severity of your chronic condition and the general clinical dosage required to treat an applicable condition. Combined, these two pricing systems provide a Reference Price Limit for all associated medicines that can be used to treat your conditions.
For more information on the General Reference Price list, please visit www.libcare.co.za.
For more information on the Generic Reference
Price list, please visitwww.libcare.co.za.
7
By the time you turn 70, your heart
will have beaten some 2,5 billion
times, based on an average 70 beats
per minute.
Your body is fascinating – aren’t you glad Libcare cares about it?
FAST FACT
3.3 Cover for chronic conditionsA chronic condition is:
n permanent or lasts a long time
n usually life-threatening if not managed on an ongoing basis
Libcare covers the following chronic conditions. The conditions in List A are on the govern ment’s list of Prescribed Minimum Benefits (PMBs), which all medical schemes must cover. Libcare also covers the 39 conditions on List B.
List A
Addison’s Disease Chronic Renal Disease Epilepsy Multiple Sclerosis
Asthma Coronary Artery Disease Glaucoma Parkinson’s Disease
Bipolar Mood Disorder
Crohn’s Disease Haemophilia Rheumatoid Arthritis
Bronchiectasis Diabetes Insipidus Hyperlipidaemia Schizophrenia
Cardiac FailureDiabetes Mellitus Types 1 and 2
HypertensionSystemic Lupus Erythromatosis
Cardiomyopathy Disease
Dysrhythmias Hypothyroidism Ulcerative Colitis
Chronic Obstructive Pulmonary Disorder
List B
Allergic Rhinitis DystoniaMotor Neuron Disease
Post-Traumatic Stress Disorder
Alzheimer’s Disease Eczema Myasthenia GravisProstatic Hypertrophy (benign)
Ankylosing Spondylitis
Endocarditis Narcolepsy Psoriasis
Aplastic Anaemia Gastric Ulcer Disease Osteoarthritis Psychosis
Attention Deficit Hyperactivity Disorder
Gastro Oesophaegal Reflux Disease (GORD)
Osteoporosis Scleroderma
Barrett’s & Erosive Oesophagitis
Gout Paget’s Disease Thrombocytopaenia
Cushing’s SyndromeHormone Replacement Therapy
Para-/QuadriplegiaThyroid disorders (other than Hypothyroidism, which is covered above)
Cystic Fibrosis Hyperuricaemia Pemphigus Tourette’s Syndrome
Depression HypoparathyroidismPeripheral Vascular Disease
TB (Tuberculosis)
Dermatomyositis MenopausePituitary Adenomas
How much Libcare will pay for chronic conditionsChronic conditions are often expensive to manage, so Libcare has partnered with a specialist company with expertise in managing chronic illnesses and the costs that go along with them.
If you or one of your dependants has a chronic condition, Libcare Chronic Medicines Management
8
chronic care
Department will work with you to ensure that you’re getting the best possible treatment at the best possible price.
Overall Chronic Benefit coverThere is an overall Chronic Benefit limit for each member or dependant of R17 280 per year. Costs that accumulate toward this limit include:
n medicines for all conditions listed in the tables at left
n certain related expenses (consultations, procedures, etc.) for conditions in List A, subject to specific conditions. Other related expenses for conditions in List A, as well as those for conditions in List B, will come from your day-to-day cover (as long as you have funds available and up to benefit sub-limits)
Libcare will pay above the R17 280 limit for:
n medicines for conditions in List A if approved by the Libcare Chronic Medicines Management Department
n certain related expenses for conditions in List A
Payment for any chronic condition depends on two things:
n registering with the Libcare Chronic Medicines Management Department (details at right)
n supplying the correct diagnostic code (ICD-10 code) when your doctor submits claims related to the condition
What to do if you or a dependant has a chronic conditionYou will only have access to the funds from the Chronic Benefit if you have registered with Libcare’s Chronic Medicines Management Department and it has approved your medication.
1. Your doctor or your pharmacist is required to contact the Libcare Chronic Medicines Management Department on 0800-12-CARE (2273) or e-mail on [email protected].
2. Your doctor or pharmacist will be asked to submit specific information relating to the condition and the medication he/she will use for your treatment.
3. Libcare’s Chronic Medicines Management Department will review the application and, if necessary, contact you or your doctor for any additional information.
4. The Chronic Medicines Management Department’s pharmaceutical experts will evaluate the medications recommended by your doctor and may suggest alternatives that they feel are less expensive or more effective.
5. If everything is in order and your authorisation is granted, it will be immediately available for processing from your medicine supplier (pharmacy/doctor).
6. If your application is approved, the Chronic Medicines Management Department will send you a confirmation letter. You will also be able to immediately view all your authorisations on the Libcare web page. (If you have not yet registered for your secure login, please do so at www.libcare.co.za.)
7. To have your medicines dispensed, you will still need a hand-written repeat script from your doctor for the medicines listed, as per your authorisation. The authorisation is not a prescription and cannot be used to have medicines dispensed.
Libcare Chronic Medicine Management:
Phone: 0800-12-CARE (2273)
Fax: 021-657-2611
E-mail: [email protected]
Web: www.libcare.co.za
To register for web access allowing you to view your
medicine authorisations on line, visit www.libcare.co.za
or contact 0800-12-CARE (2273) for
more information.
You will need to present your medicine access card each time you fill your chronic
medicine prescription. You will also need a
written prescription or a valid refill on file with
your pharmacy.
Please note: Processing an
application for chronic medication takes at least five days. If you
will need medication in the meantime, ask your
doctor for a separate prescription.
9
8. The duration of the authorisation varies from medicine to medicine – some medicines may be authorised on an ongoing basis, while others may only be authorised for a limited period. The confirmation letter/web information will indicate the duration for which the medicine has been authorised. Your doctor will advise you how often s/he needs to see you to monitor your condition.
9. If your doctor wants to change your prescription, he or she must contact the Libcare Chronic Medicines Management Department. The quickets way is to phone 0800-12-CARE (2273) or e-mail [email protected]. They may also fax a written prescription to 021-657-2611. Once Libcare has approved the change, you will receive an updated confirmation letter as well as a telephone call from Libcare to confirm the change. Please note that you can view changes immediately on your personal web page (www.libcare.co.za – member access portal).
3.3.1 Special cover for members with cancer, diabetes or HIV/AIDS
The following programmes provide benefits to members (or dependants) with cancer, diabetes or HIV/AIDS, but only if the patient is registered with the relevant programme. If you are not, Libcare may reject your claims or pay them from your day-to-day cover (which could deplete those funds very quickly).
Cancer benefitFor 2008, Libcare provides up to R306 130 for the costs associated with cancer treatment, but only if you’re registered with the Libcare Cancer Management Programme.
The Libcare Cancer Management team will help ensure that you get the most appropriate treat-ment and that it is as cost-effective as possible. They will review your treatment plan and, if necessary, contact your doctor to discuss alternatives they believe may be more appropriate or cost-effective.
After the team has assessed and approved your treatment plan, they will send you and your doctor authorisation letters indicating the treatment authorised, the approved quantities and the period for which the authorisation is valid. Your doctor must advise the team of any change in your treatment, as they will need to re-assess and update your authorisation. Failure to do this may result in Libcare rejecting your claims or paying them from an incorrect benefit (e.g. your Medical Savings Facility or other day-to-day benefit) as there will not be a matching oncology authorisation.
Note: In addition to the authorisation from the Libcare Cancer Management team, you will need to get pre-authorisation from Libcare Hospital Management for any hospitalisation, specialised radiology (e.g. CT scans, MRI scans and angiography) or private nursing/hospice services.
DiabetesLibcare members with diabetes have the option of special coverage through the most prominent diabetes programme in the country, run by the Centre for Diabetes and Endocrinology (CDE). Once you have registered on this programme, all eligible diabetes-related medicines and equipment will be provided under this benefit.
CDE is linked to specialist clinics throughout South Africa, each dedicated to providing optimum care to individuals with diabetes. Each clinic provides access to a team of specialists such as doctors with diabetes training, dieticians, podiatrists, ophthalmologists, pharmacists, exercise specialists and psychologists. Once you have registered, CDE will refer you to a clinic or accredited doctor near you.
For more information on this new benefit, visit the Libcare Desk at Liberty Life Centre or call Customer Care. For more information on CDE or to register, contact CDE (details at left).
Centre for Diabetes and Endocrinology:
Phone: (011) 712-6000
E-mail: [email protected]
Web: www.cdecentr.co.za
Libcare Cancer Management
Programme:
Phone: 0800-12-CARE (2273)
E-mail: [email protected]
10
Dedicated care and support for members with HIV/AIDSAs with other common chronic conditions in South Africa, HIV/AIDS can be managed very effectively.
Diagnosis of this condition (the earlier the better) together with an effective treatment plan as provided by Libcare’s LIFEWORKS HIV/AIDS management programme, will allow you to live a normal, healthy life.
The LIFEWORKS’ programme includes:
n Confidentiality – we respect the right to confidentiality and will not discuss your case with any-one without your consent.
n Personalised counselling and support – you will be allocated your own patient manager who will assist with all aspects of your treatment plan.
n Assistance where requested, for example, in finding the appropriate clinician or a registered emotional counsellor.
n Regular monitoring and review of your medical condition by qualified medical professionals.
n Support for your attenting clinician – including regular treatment advisory updates, telephonic referral support, etc.
n Ongoing benefits review – making sure that you receive the benefits you deserve.
n Medication delivery support – ensuring that you receive your chronic medication in the most convenient, confidential way possible.
n Treatment and prevention of opportunistic infections, including TB.
n Vaccinations to prevent illnesses such as flu.
n Provision of approved multivitamins and other appropriate supplements to support the immune system.
n Treatment for the prevention of mother-to-child HIV-infection (PMTCT).
n Post-exposure prophylactic (PEP) treament for all members and their registered dependents to prevent HIV infection following possible exposure.
How to registerIf you are worried that you may have HIV/AIDS, or if you have already been diagnosed, contact LIFEWORKS as soon as possible to arrange a confidential HIV test or to register with the LIFEWORKS programme.
1. Telephone LIFEWORKS on 0860-50-55-55 to start the registration process. Your doctor can also contact the programme on your behalf.
2. You and your doctor must each complete parts of the application form and fax it to the confidential LIFEWORKS fax number provided on the form.
3. The LIFEWORKS medical team will review your details and discuss an appropriate treatment plan with your doctor. Both you and your doctor will be sent a detailed plan explaining all the aspects of your condition and the treatment thereof, including your medication, a monitoring schedule and any other requirements.
Your programme going forward Once treatment is agreed upon, you and your doctor will be sent a detailed plan explaining the medicine and the tests that must be done regularly to ensure that the drugs work correctly and safely. LIFEWORKS aims to be your partner in managing your illness, so you can live your life to the fullest.
If you’re diagnosed with
HIV or AIDS, register early to improve your quality of
life and stay healthy.
LIFEWORKS:
Phone: 0860-50-55-55
E-mail: [email protected]
Web: www.lifeworks.co.za
11
3.4 Cover for major medical expenses, including hospitalisation
Now and then, you or a member of your family may need hospitalisation or another expensive medical treatment – and Libcare will be there to help.
The cover we provide under this category includes:
n costs while you’re in hospital
n emergency transport to hospital
n hospitalisation for childbirth
n MRI and CT scans
n private nursing immediately after hospitalisation
n haemodialysis and peritoneal dialysis
n oncology
n crime trauma
How much Libcare will pay for major medical expensesThere is no overall limit on your major medical cover. However, some categories of major medical expenses are limited. To check your limits, refer to the 2008 Benefits Table starting on page 24 of this guide, or contact Libcare Hospital Management for information.
If you or one of your dependants requires hospitalisation or any other care falling under this category, Libcare will work with you to ensure that you’re getting the best possible treatment at the best possible price.
Cover while you’re in hospitalWe will pay up to a maximum of the Libcare Rate for procedures and consultations during your stay in hospital, including:
n ward rates (Libcare will pay for a general ward in a private hospital)
n GP and specialist (e.g. anaesthetist) fees
n medicines obtained on the same day you are discharged, subject to the sub-limit
What is not covered under this benefitYou will be personally responsible for any amount over the Libcare Rate for costs while you are in hospital. Your portion of the costs will be drawn from your Medical Savings Facility on written request, if you have a positive balance available, otherwise you will have to pay them from your own pocket.
There are specific medical expenses that Libcare does not cover, not even from a positive balance in your Medical Savings Facility. For more information please check the summary of exclusions on page 16 of this guide or contact Libcare.
Libcare pays only if you get pre-authorisationPre-authorisation allows Libcare to ensure that the most appropriate treatment is provided at the most appropriate cost. It also enables us to monitor the quality of care you receive.
1. To get pre-authorisation, phone Libcare Hosital Approvals on 082-12-CARE (2273). You or your doctor may phone for pre-authorisation or, in the case of an emergency, the hospital may phone.
For more information on major medical expense limits,
contact:
Libcare: 0800-12-CARE (2273)
The Libcare Rate is based on a nationally-
established list of prices called the National Health
Reference Price List (NHRPL).
Libcare’s pre- authorisation
process ensures that we can help manage how much you are charged for your hospital stay or
other major medical expense.
12
mAjOR
mEDICAl CARE
Whoever phones must be able to provide the following information:
n your membership number
n the name and date of birth of the member or dependant who is in hospital
n reason for admission and the applicable treatment/tariff code for the proposed procedure (the doctor or hospital should be able to provide the treatment/tariff code)
n date of admission and the proposed date of the procedure
n name of the doctor and his or her telephone number and practice number
n name of the hospital and its telephone number and practice number
n the provider’s name and practice number, if the procedure (e.g. an MRI or dialysis) will be performed outside a hospital
n the relevant ICD-10 diagnostic code(s)
2. When your request for pre-authorisation is granted, you will receive these details:
n an authorisation number, which you will need to provide to the hospital admissions clerk
n an approved number of days in hospital (if a stay is required)
n the approved treatment/tariff codes
If you need to stay in the hospital longer than your initial approved length of stay, your doctor, the hospital case manager or a family member must inform the Libcare Hospital Approvals Department. If there is a valid clinical reason, Libcare will approve the extra days.
If there is a medical emergencyIn the case of a medical emergency, you, your doctor or a family member must call Libcare within 48 hours or, if it is a weekend or public holiday, on the next working day. If you do not, your treatment might not be covered.
Follow these steps prior to hospitalisation:
1. Phone for pre-authorisation at least 48 hours before you are admitted to hospital. In the case of a medical emergency, phone within 48 hours of admission.
2. Give the authorisation number to the admission clerk or other service provider, along with the other required information (such as your medical aid number, personal details, etc.).
3. Libcare will manage your admission and monitor the quality of care you receive.
Make sure you can afford the treatmentLibcare Hospital Management can determine if you are eligible for a particular procedure in terms of the scheme rules, as well as advise you whether you have funds available to pay for it. However, it is up to you to confirm that you have funds available by checking with Libcare or referring to the Benefit Table on page 24, and asking the doctor or hospital what they will charge for your procedure.
Remember, you have to pay for costs above the Libcare Rate yourself, e.g. for specialists like surgeons and anaesthetists. There are also limits on certain categories of expenses, and you will be personally responsible for any amount over those limits.
To get authorisation, you may phone, fax or e-mail
your information to Libcare:
Phone: 0800-12-CARE (2273)
E-mail: [email protected]
13
4. Cover for emergency transportAs a member of Libcare, you can rest assured knowing you have access to emergency response and evacuation. Netcare 911 will provide emergency transport anywhere in South Africa as well as in Namibia, Botswana, Swaziland, Lesotho or Mozambique (as far north as Beira inland or Vilan Culos along the coast).
Our emergency response partner is Netcare 911, which will provide:
n emergency medical response by road or air to the scene of a medical emergency
n transfer of life-saving medication and emergency blood to the scene of an accident
n a refundable financial guarantee of up to R5 000 to ensure hospital admission or immediate and appropriate emergency medical care
n transfer by road or air to the most appropriate medical facility when medically justified
n inter-hospital transfers (one way), when medically justified and motivated by a medical practitioner
Please note: If you use the services of another provider for emergency transportation, you must notify Netcare 911 within 48 hours. Failure to do so may result in you being held liable for payment of the service.
For emergency transport, call:
082 911 if you’re in
South Africa or
+27 11 254-1443 if you’re in Namibia,
Botswana, Swaziland, Lesotho or
Mozambique
14
The most common blood type in the
world is Type O. The rarest is Type A-H.
It has been found in fewer than a dozen
people since the type was discovered.
Your body is fascinating – aren’t you glad Libcare cares about it?
FAST FACT
EmERgENCyCARE
5. Cover when travelling overseasNetcare 911 will cover you and each of your dependants for up to R10 million for specified emergency medical expenses and evacuation costs when you travel overseas, but only if you notify Netcare 911 at least 48 hours before you depart South Africa and again at the time of the emergency. Cover is for up to 90 days per trip, and 180 days per year, as long as you are returning to South Africa.
Medical treatment in another country could cost you millions of Rands – but you can avoid this by making one smart phone call.
If you don’t notify Netcare 911 of your overseas travel, you will be personally liable for all of your overseas medical costs.
Follow this procedure to arrange coverOrganising overseas medical cover is easy – just phone Netcare 911 or log on to the Libcare website and click the International Travel Insurance link. You will need to provide:
n your Libcare member number
n your exact travel dates
n details about your destination
You will receive a travel insurance certificate and a copy of the policy wording by e-mail or fax. Take this policy with you when you travel.
What to do if you have a medical emergency overseasIf you have a medical emergency while overseas and have previously arranged cover through Netcare 911, follow these easy steps:
1. Phone the Netcare 911 control centre on +27 11 254-1443.
2. Netcare 911 will give you a guarantee of what they will cover.
3. Your eligible international accounts will be settled directly by Netcare 911.
4. You will be liable for a R1 000 fee but Libcare will reimburse you from your Major Medical Benefit.
If you don’t contact Netcare 911 when you receive emergency treatment, even if you phoned them before departure, you will be liable for all expenses over R1 000.
Important exclusionsInternational cover is for emergencies only. Out-of-hospital expenses, medicine and elective or planned procedures are not covered.
If you need emergency medical
attention while overseas, call
Netcare 911 on: +27 11 254-1443
To arrange overseas cover call
Netcare 911 on:(011) 254-1443
You must arrange this cover at least 48 hours
before you travel.
15
6. What Libcare doesn’t coverLibcare, like most medical schemes, does not cover certain costs at all. Here is a list of the most common exclusions. For a full list, please refer to the rules of the scheme on the Intranet or call Libcare on 0800-12-CARE (2273).
Exclusions
4D pregnancy scansAbdominoplastiesAccidents that happen at workAcne preparations (topical and oral)All costs in respect of wilfully or self-inflicted injuriesAll expenses incurred outside the Republic of South Africa (cover can be organised through Netcare 911 – see page 15)Anabolic steroidsAnti-addiction and anti-habit agentsAppointments not keptAromatherapyArt therapyArtificial disc replacementsAutopsiesAyurvedics Back rests, chair seats, beds, mattresses, orthopaedic shoes and bootsBlood pressure monitorsBreast augmentation and reductions Bulk-forming and stimulant laxativesCochlear implantsCosmetic preparations, emollients/moisturisersDrugs for the treatment of impotence and sexual dysfunction, aphrodisiacsEpilation treatment for hair removalErectile dysfunction surgical procedures Erythropoietin Evening primrose oil and fish liver oil preparations and combinations Food, nutritional supplementsGender re-alignmentGrowth hormonesHumidifiers
Hyperbaric oxygen treatmentImmuno-suppressives and immuno-stimulantsInfertility treatment, except as specified in the Medical Schemes ActIridology Keloid surgery and revision of scars, except following burns or for functional impairment occurring during the period of cover under LibcareMassagesMedicated shampoos and conditioners, including those for hair lossMotor vehicle accident-related expenses (see note at left)MRI scans ordered by a GPCertain obesity-related surgical treatmentOrgan donations to any person other than a member or dependant of a member of LibcareOrthodontic treatment over the age of 21 yearsOrthognatic surgery (to correct jaw misalignment)Otoplasties Pain-relieving machinesReflexologyReversal of vasectomyRhinoplastiesSleep studiesSlimming preparationsSoaps, scrubs and other cleansersSunglasses, readers, repairs to spectacle frames, coloured contact lensesSunscreening and suntanning preparationsTelephone consultations Travelling expenses Tubal ligationVeterinary productsVitamin and mineral supplements
Third-party claimsPlease inform Libcare whenever you are claiming compensation from alternative sources for medical expenses incurred as a result of injuries. If you are treated for injuries due to an accident at work, these costs should be covered by workmen’s compensation. Please consult your HR consultant for assistance in this regard.
Please note:Your claims may not be paid until
the completed ARF is submitted to
Libcare. The Accident Verification Unit can
be contacted on (011) 669-3166/67/69.
If you are treated for injuries resulting from a motor accident, and intend claiming from
the Road Accident Fund, you must
complete an Accident Report Form (ARF).
Please contact Libcare for assistance when
submitting your claim to the Road Accident
Fund. Libcare will liaise directly with the person or institution involved through its contract Accident
Verification Unit at Alexander Forbes. If Libcare has settled
your claim(s) on your behalf, you must
reimburse this amount to Libcare when you
receive payment from the Road Accident
Fund.
16
mEm
bERshIP INfORm
ATION
7. Who can belong to LibcareIf you are an employee or agent of Liberty Life, and you work more than 5,25 hours per day, then you must belong to Libcare. The only exception is if you are a member of another scheme through your spouse’s employer.
You may continue to belong to Libcare after you retire if you choose to do so at the time you retire.
You can also enrol the following dependants:
n your spouse or partner
n your children under 21 years of age
n children over 21 if they are full-time students or financially dependent on you for care and support (earning less than the monthly state pension)
n other family members (such as parents but excluding in-laws) who live with you and are dependent on you for care and support. These are called “special dependants” and you will need to apply to the Trustees for approval of their membership.
How to enrol a dependantYou will need to complete a form whenever you want to add a dependant to the scheme. You can get this form on the Intranet, from your Payroll Administrator or from the Libcare Desk.You will also need to provide evidence as follows:
n To add a child:
o a birth or adoption certificate or a certified ID document for an older child. Please register babies within 30 days of birth or adoption. After 30 days, Libcare may pro-rate benefits or impose waiting periods. There is also a risk that all claims associated with the baby’s medical care will be rejected if it isn’t registered
n To add a spouse or partner:
o a certified ID document
o a marriage licence or similar document if the marriage is performed under traditional African law or Asiatic or Islamic law
o a sworn affidavit in the case of a common-law partner
n To add a special dependant:
o a certified ID document
o a sworn affidavit confirming their relationship to you and stating that the family member is financially dependent on you for care and support
o proof that the dependant’s income is less than the minimum state benefit
For all of the above, except infants, you must provide certified copies of the membership certificates confirming previous medical cover.
To remove a dependantTo remove a dependant from Libcare, for example if you get divorced or your child gets a job and no longer requires cover, you must complete a form and submit it to Libcare. You can get this form on the Intranet, from your Payroll Administrator or from the Libcare Desk. Please note: ex-spouses can not stay on the scheme. His or her membership will cease at the end of the month in which the divorce becomes final.
Be sure to inform Libcare promptly if you need to change
your member or dependant details, such as changing
your address, adding a dependant or
removing a dependant.
17
Please note: A grandchild will only
be considered for cover if its mother is a single minor who is registered as a
dependant on Libcare and lives with her parents. Trustee
approval is required.
18
The average human body contains enough
iron to make a 7cm nail; enough sulphur
to kill all fleas on an average dog; enough
phosphorous to make 2 200 match heads;
and enough carbon to make 900 pencils.
Your body is fascinating – aren’t you glad Libcare cares about it?
FAST FACT
Membership for retireesIf you are a Libcare member when you retire, you may continue to be a member as long as you:
n are at least 55 years old
n have contributed to Libcare or any other medical scheme for five consecutive years (or any shorter period that may be provided for in the Libcare rules), or have paid contributions in respect of any shortfall in the required period of membership
What happens if you resign or are retrenchedIf you resign or are retrenched, your Libcare membership will stop at the end of your last month of employment. Normally, Libcare allows you four months after the date of service to submit claims. Therefore, you can still submit claims for up to four months after you leave the company, provided that you received the treatment before you left the service of Liberty Life. At the end of four months, no further claims will be processed.
If you have a positive balance in your Medical Savings Facility:
n it must be transferred to your new medical aid if that scheme has a medical savings account (this is required by law), or
n it will be paid out to you four months after leaving Libcare, with interest, at the rate of prime less 6%
If, however, your Medical Savings Facility has a negative balance, you must repay Libcare the outstanding funds.
What happens if you die
n If you die, your dependants may continue their Libcare membership as long as they:
o were registered as dependants at the time of your death
o have been dependants on Libcare or another medical aid scheme for five consecutive years (or any shorter period that may be provided for in the Libcare rules)
o meet the other membership requirements outlined previously
n Your spouse or partner may remain on the scheme until he or she:
o cancels their membership in writing, or
o remarries and is registered as a dependant on the new spouse’s medical scheme
8. How to claimYour medical expenses can be paid in two ways:
n You can pay the healthcare provider (doctor, pharmacy, etc.) and claim the money back from Libcare.
n Alternatively, your healthcare provider can bill Libcare directly.
Here is the process you must follow if you pay the provider:
1. Send the original invoice to reach Libcare within four months of treatment. This must include:
o the principal member’s name and initials
o the patient’s name (as indicated on the membership card, not a nickname)
o your Libcare membership number
o the treatment date
o the amount charged
o the treatment/tariff code, where applicable and
o the applicable ICD-10 diagnostic code(s)
o proof of payment if the refund must go to you
Libcare cannot pay a claim unless it contains all the information listed above.
Libcare will not pay if you send:
o a photocopy of your invoice
o an account sent to you from the doctor’s office marked “for your information only”
o an account/statement sent to you from the doctor’s office showing only a balance brought forward
If you need to submit a second invoice for any reason, you’ll have to get another original from your doctor.
2. If you paid the healthcare provider, attach your receipt and clearly mark the account “PAID”.
3. Keep a copy of the invoices you send to Libcare for your records. It will help you keep track of what Libcare owes you, and will be helpful if you need to follow up on your claim.
4. Submit your claim promptly for quick payment. We process claims every week but can only process yours if your information is in order (and, of course, if you have funds available). Libcare will only pay claims within four months of the treatment date.
5. Libcare will pay your claims directly into your bank account. Keep your banking details up to date. If they change, you must inform Libcare right away.
Tips for claiming for prescription medicine:
Ensure the claim contains your personal
details and member number as well as the
correct quantity of medication dispensed.
Tips for claiming for dental costs:
If you had work done by a dental technician as well as the dentist,
you may get a separate account from each of them. Be sure to submit both. Each must have your full details and member
number.
19
Please note: It is your
responsibility to ensure claims reach
Libcare on time. If we receive them more
than four months after the date of service,
they will not be paid. If your provider says that he or she will
submit the claim on your behalf, follow up
to ensure it is submitted timeously.
How to track your claims once they’ve been submittedLibcare will send a printed statement each month if you have submitted one or more claims. In addition, if we have your e-mail address we will send an electronic statement each time we process a claim. If we have your cell phone number, you will receive an sms when a claim is paid.
If you are not currently receiving e-mail statements and would like to, make sure we have your correct e-mail address. Please contact the Libcare Desk or Customer Care on 0800-12-CARE (2273).
How Libcare pays claims submitted in the following calendar yearIf you incur medical expenses at the end of 2007 but only submit them in 2008:
n they will accumulate toward your 2007 limits
n Libcare may draw funds from your 2008 Medical Savings Facility to pay your claims. This may result in a self-funding gap (see page 22)
Waiting periodYou may have to wait to take advantage of Libcare for a certain period after you join if you:
n were not a member or dependant of a medical scheme for at least 90 days before you applied to join Libcare
n have never been a member of any medical aid scheme
n have a pre-existing medical condition – Libcare may exclude cover for that particular condition for up to 12 months
n were a member of another medical scheme before joining Libcare but were still under a waiting period with that scheme
A certain amount of cover (i.e. Prescribed Minimum Benefits) may be available to you during a waiting period.
For more information about any aspect of waiting periods, speak to Libcare Customer Care on 0800-12-CARE (2273) or the Libcare Desk.
20
There are some 97 000km of blood
vessels in every human, and the
body produces and destroys about
15 million blood cells every second.
Your body is fascinating – aren’t you glad Libcare cares about it?
FAST FACT
9. How much you pay for Libcare Below is the contribution table for 2008. A few pointers will help you understand this table:
1. Your contribution rate is based on your income level (pensionable base).
2. Generally speaking, the company pays half your contributions – the table below shows the full contribution.
3. “Late joiners” pay more – see below for definitions of late joiners.
4. Your total monthly contribution will depend on how many dependants you have enrolled on the scheme. To calculate your total monthly contribution, use the contributions calculator below.
5. You can see how much you’re paying each month by checking your salary slip or by contacting Libcare.
6. Children over 21 pay adult rates even if they are full-time students.
2008 Contributions – the amount you pay each month
Monthly pensionable base
Principal member Adult dependant Child under 21
R0 – R3 349 R696 R639 R173 R3 350 – R4 069 R751 R691 R187 R4 070 – R4 959 R813 R751 R203 R4 960 – R5 699 R964 R887 R240 R5 700 – R6 519 R1 016 R935 R253 R6 520 – R8 259 R1 105 R1 017 R276 R8 260 – R9 869 R1 175 R1 079 R295 R9 870 – R11 329 R1 251 R1 148 R312 R11 330 – R16 409(includes commission-only
earners)R1 336 R1 228 R335
R16 410 + R1 427 R1 311 R356
Late joiners are members or dependants who:
n are 35 years of age or older and were not a member of a medical scheme before 1 April 2001, or
n were a member of a medical scheme before 1 April 2001 but had a break in membership of more than three months after 1 April 2001
Libcare may increase late joiners’ contributions between 5% and 75%, depending on their age.
Contribution calculator: Use the following table to calculate your monthly contribution rate.
Type of member (e.g. principal, spouse, child)
Monthly contribution from table above
Multiply by no. of dependants at this rate
Total amount per category of
dependant
Add the amounts in the last column to get your monthly rate:21
10. How Libcare pays your day-to-day medical expensesLibcare pays your preventative, chronic and major medical expenses from the overall “pool” of contributions made by all members. Day-to-day medical expenses are paid a bit differently, however:
A certain portion comes from the overall contributions poolEach member of the scheme is allocated a certain amount of money from the total pool of contribu-tions each year. If you have dependants, your allocation from this pool is added together and you are given a family total for the year. The amount allocated for 2008 is given in the table on page 23. This pool of money is called your Out-of-Hospital Expense Benefit (OHEB). When you incur a day-to-day medical expense, payment up to the Libcare Rate comes out of this benefit first.
Part of your contribution goes into a separate fund just for youTwenty-five percent (25%) of your total contribution each month is allocated to a Medical Savings Facility that only you and your dependants may use.
n Credit savings refer to the savings that Libcare has made available but that you haven’t yet funded through your monthly contributions. If you leave the scheme before contributing the amount you’ve withdrawn, you will owe Libcare the difference.
n A positive savings balance refers to contributions you have made but haven’t yet used. This will roll over to the following year and earns interest (at prime less 6%). If you leave Liberty Life, a positive balance will be paid to you or transferred to your new medical aid after a four-month period during which we hold onto it to pay any outstanding claims. However, if you join a new medical scheme which also provides a savings facility, this balance has to be transferred to your new scheme option in terms of the Medical Schemes Act and may NOT be paid out to you.
There is a safety netLibcare will pay your day-to-day medical expenses from a special fund called the Threshold Benefit if:
n you use all the money in your Out-of-Hospital Expense Benefit and your savings during the year
n your total claims reach a Threshold level set each year by the scheme (see page 23)
n you have settled any potential self-funding gap towards your Threshold level
n you have not yet reached your annual benefit sub-limits (see table on page 24 and the back flap).
You may experience a self-funding gapIf you exhaust your OHEB and savings before you reach the Threshold level, you may have to pay your medical expenses out of your own pocket. This can happen for a variety of reasons:
n If you use healthcare providers who charge more than the Libcare Rate, only the value of the Libcare Rate accumulates toward your Threshold level. The rest is deducted from your savings.
n If a dependant leaves the scheme during the year, your Threshold level stays where it is, but your monthly contributions to your savings will be lower.
n If you submit claims from late 2007 at the beginning of 2008, the expense accumulates towards your 2007 benefit limits. However, your claims may be paid from your 2008 savings if you didn’t have any savings rolled over from 2007.
n If you submit claims for a benefit category that you’ve already exceeded, then these claims will not accumulate toward your Threshold level, but may be paid from a positive savings balance.
Please note: Any amount over
the Libcare Rate (for approved day-to-day
expenses) will automatically be
drawn from a positive savings balance.
Day-to-day expenses that exceed the
benefit limits specified on page 24 and the back flap, will also come from your
savings if you have a positive balance available. Libcare makes your entire
annual savings amount available to you from 1 January,
even though you contribute to it
on a monthly basis over a full year.
22
2008 bENEfITs
OHEB benefit calculator
My portion: R 1 600
No. of adult dependants
multiplied by R750 + R ______
No. of children under 21
multiplied by R650 + R ______
My total benefit for 2008 is: ________
MSF calculator
My MSF (from table): R ______
No. of adult dependants
multiplied by their MSF + R ______
No. of children under 21
multiplied by their MSF + R ______
My total MSF for 2008 is: ___________
Threshold calculator
My Threshold (from table): R ______
No. of adult dependants
multiplied by
their Threshold +R ______
No. of children under 21
multiplied by
their Threshold +R ______
My Threshold for 2008 is: __________
23
11. 2008 BenefitsOut-Of-Hospital Expenses Benefit (OHEB)Your day-to-day expenses will be paid – up to the Libcare Rate – from this fund until you reach your limit. If you have dependants on Libcare, your combined limits are available to you as a group. This means that one member may claim more than their allocated limit, but then less will be available to the others.
Pensionable base Principal member Adult dependants Child under 21All income bands R1 600 R750 R650
Your total OHEB will be adjusted upward if you add a dependant during the year.
Medical Savings Facility (MSF)Twenty-five percent of your contributions go into your Medical Savings Facility and are for your (and your family’s) use only. These funds will be used to cover eligible expenses once your OHEB is depleted or for expenses that are not covered by your other Libcare benefits or that are higher than the Libcare Rate. Any remaining funds are carried over from year to year and earn interest at prime less 6%.
Your annual savings amount
Pensionable base Principal member
Adult dependants Child under 21
R0 – R3 349 R2 088 R1 920 R516 R3 350 – R4 069 R2 256 R2 076 R564 R4 070 – R4 959 R2 436 R2 256 R612 R4 960 – R5 699 R2 892 R2 664 R720 R5 700 – R6 519 R3 048 R2 808 R756 R6 520 – R8 259 R3 312 R3 048 R828 R8 260 – R9 869 R3 528 R3 240 R888 R9 870 – R11 329 R3 756 R3 444 R936 R11 330 – R16 409(incl. commission-only earners) R4 008 R3 684 R1 008
R16 410 + R4 284 R3 936 R1 068
Your MSF will be adjusted if you add or remove a dependant during the year.
Threshold levelOnce the Libcare Rate portion of your family’s total out-of-hospital claims reaches your Threshold level, Libcare will pay your eligible claims at 100% (up to the Libcare Rate and benefit category limits).
Pensionable base Principal member
Adult dependants Child under 21
R0 – R3 349 R3 752 R2 677 R1 206 R3 350 – R4 069 R3 913 R2 828 R1 244 R4 070 – R4 959 R4 327 R3 207 R1 354 R4 960 – R5 699 R4 539 R3 406 R1 402 R5 700 – R6 519 R4 693 R3 547 R1 440 R6 520 – R8 259 R4 956 R3 788 R1 504 R8 260 – R9 869 R5 158 R3 968 R1 559 R9 870 – R11 329 R5 380 R4 173 R1 610 R11 330 – R16 409(incl. commission-only earners) R5 634 R4 407 R1 678
R16 410 + R5 900 R4 651 R1 742
Your Threshold level is not adjusted if you add or remove a dependant – it is fixed in January each year.
2008 Benefit TableNote: This summary is for information purposes only and does not supersede the rules of the scheme. In the event of any discrepancy between the summary and the rules, the rules will prevail.
Benefit category p.b. = per beneficiary
p.f. = per familyBenefit sub-category Monetary limit
Covered by the Major Medical
Benefit
Covered by OHEB, MSF and/
or Threshold Benefit
Authorisation and/or pre-requisites
required
% of Libcare Rate payable unless otherwise indicated
100% 100%
Annual limit No overall annual limitAlternative healthcare providers (see note 1)
Registered homoeopaths, naturopaths, osteopaths, phytotherapists, acupuncturists
Included in out-of-hospital consultation limit (see below)
n
Appliances, prostheses and devices (see note 2)
General and surgical, including wheelchairs, glucometers, hearing aids, large orthopaedic orthotics (e.g. back braces), low-vision appliances
R8 590 p.f. n
Stoma products R11 130 p.f. n
Home oxygen, cylinders, concentrators and ventilation expenses, CPAP for treating sleep apnoea
R11 130 p.f. n LMC
Artificial limbs and prostheses, long leg callipers Subject to MA and Trustee approval
n MA and Trustees
Internal prostheses (surgically implanted) R95 600 p.b. n LMCBlood, blood equivalents and blood products
Blood, blood products and transportation R178 080 p.b. n LMC
Casualty (see note 3) Emergency after-hours or out-of-town casualty treatment R1 100 p.b. n LMCConsultations and visits – out-of-hospital
GPs, nurses, specialists, alternative healthcare providers, antenatal classes by a registered nurse
R3 820 p.b. / R7 530 p.f. n
Consultations and visits – in-hospital
GPs, specialists and dental specialists Unlimited n LMC
Crime trauma (see note 4)
HIV prophylaxis for rape victims Unlimited n LIFEWORKS
Rehabilitation related directly to crime trauma R17 810 p.f. n LMC
Psychologists, psychiatrists and social workers R2 330 p.b. n LMCDay procedures done in doctors’ rooms (see note 5)
Routine diagnostic upper and lower gastro-intestinal fibre-optic endoscopy (excl. rigid sigmoidoscopy and anoscopy); cyctoscopy; laser tonsillectomy; vasectomy; lumbar puncture; needle aspiration of joint, bursa or ganglion; prostate needle biopsy; breast fine needle biopsy; 24-hour oesophageal pH studies; oesophageal motility studies; circumcision
Unlimited n
Dentistry (see note 6) Basic (out-of-hospital) – Consultations, removal of teeth and roots, plastic dentures, dental technician, etc.
R5 300 p.b. / R8 160 p.f. n
Advanced (out-of-hospital) – Inlays, crowns, bridges, orthodontic treatment (younger than 21 years), oral surgery, etc.
R10 490 p.f. n Libcare’s Dental Advisor for
Orthodontics
Elective (in- and out-of-hospital) – All costs relating to dental implants, the removal of impacted wisdom teeth, apicectomies and basic dentistry under general anaesthetic for children eight years and younger
R7 000 p.b. / R10 490 p.f. n LMC,in and out of hospital
Maxillo-facial surgery (in-hospital) – Facial fractures, trauma, cancer and sepsis, tumours, neoplasms and congenital abnormalities of children born into the scheme
Unlimited n LMC
Emergency transport (see page 14)
Local (only if provided by Netcare 911) Unlimited n Netcare 911
International emergency cover (only if authorised by Netcare 911) R10 million p.b. per trip n Netcare 911Hospitalisation (general ward rates apply)
Accommodation, intensive care, high care, theatre fees, apparatus and material and medication used in hospital
Unlimited n LMC
Medicines to take out (TTO) R580 per admission n LMC
Alternatives to hospitalisation such as physical rehabilitation facilities (excludes frail care in old age homes)
R21 000 p.f. n LMC
Hospice services in lieu of hospitalisation Unlimited n LMC
Sub-acute facilities in lieu of hospitalisation Unlimited n LMC
Nursing services (excluding midwifery services) in lieu of hospitalisation
Unlimited n LMC
Immune Deficiency Syndrome related to HIV infection (see note 7)
Antiretroviral medicines, related medicines, pathology and related consultations
Unlimited, subject to prescribed
minimum benefit guidelines and registering on
LIFEWORKS
n LIFEWORKS
Preventative treatment, e.g. mother-to-child, needle stick injury, accidental exposure to blood
n LIFEWORKS
Maternity Confinement for normal birth and Caesarean section, in- and out-of-hospital
Unlimited n LMC
Medicine (see note 8) Routine/acute, including homoeopathic medicine dispensed by a registered homoeopath
R3 920 p.b. / R11 130 p.f. n
Over-the-counter medicine and pharmacy-advised therapy R610 p.f. n
Chronic medication R17 280 p.b. n LCMMD
Specialised drugs for the treatment of MS, inflammatory arthritis, inflammatory bowel disease and chronic hepatitis
Subject to MA and Trustee approval
n MA and Trustees
LMC = Libcare Managed Healthcare MA = Medical Advisor LCMMD = Libcare Chronic Medicine Management Department
Mental health In hospital (all costs for psychologists, psychiatrists and social workers, including rehabilitation for substance abuse)
R23 430 p.f. n Y – LMC
Out-of-hospital consultations and visits R5 290 p.b. / R7 940 p.f. n Y – LMC
Non-surgical procedures and tests
In hospital Unlimited n Y – LMC
Out of hospital (applying plaster of paris, stitches, etc.) R2 230 p.b. / R5 830 p.f. n
Oncology (see note 9) Radiotherapy, chemotherapy and oncology medication. PET and PET-CT scans are limited to one per member family and restricted to staging of malignant tumours
R306 130 p.b. n Y – LMC
Biological medicines, e g, Herceptin, subject to clinical guidelines, protocols and managed healthcare programme
R120 000 p.b. included in limit above
n Y – LMC
Associated diagnosticsw R30 613 p.b. included in R306130 above and further
limited to 12 months post active treatment
n Y – LMC
Optometry(note: readers are excluded)
Eye examination R320 p.b. n
Frames R950 p.b. n
Lenses and/or contact lenses R2 440 p.b. / R6 150 p.f. n
Refractive surgery Included in limit above, subject to the approval of the Medical
Advisor and the scheme
n Y – MA & scheme
Organ Transplants Harvesting, transplantation and anti-rejection medication Unlimited n Y – LMCParamedical Services In hospital Unlimited n Y – LMC
Out-of-hospital (Audiology, dietetics, genetic counselling, hearing aid acoustics, occupational therapy, orthoptics, physiotherapy, podiatry, speech therapy, social workers, frail care at registered sick bay facilities)
R3 070 p.b. / R4 660 p.f. n
Pathology and Medical Technology
In hospital Unlimited n Y – LMC
Out of hospital R3 070 p.b. / R4 660 p.f. n
Physiotherapy In and out of hospitalIncludes biokinetics and out-of-hospital chiropractics
Included in paramedical services (above)
Y – In hosp.LMC
Radiology (see note 10) In hospital (general and specialised) Unlimited n Y – LMC
In of hospital (MRI and CAT scans) R18 020 n Y – LMC
Out hospital (general and specialised) R3 070 p.b. / R4 660 p.f. n
Out of hospital (MRI and CAT scans) Up to Libcare Rate for first two MRI or CAT scans per family
n Y – LMC
Renal Dialysis (Chronic) Haemodialysis R183 700 p.b. n Y – LMC
Peritoneal Dialysis R153 590 p.b. n Y – LMCLMC = Libcare Managed Healthcare MA = Medical Advisor LCMMD = Libcare Chronic Medicine Management DepartmentPreventative Care Benefit
Specified consultations, examinations, procedures and vaccinations as outlined on page xx of this member guide.
No overall limit, but specified costs paid up to the Libcare
Rate.
n Costs exceeding the Libcare Rate will come from your positive
MSF
No authorisation required
For a summary of expenses that cannot be claimed for, please refer to page 16.
Benefit Category p.b. = per beneficiary
p.f. = per familyBenefit sub-category Monetary Limit
Covered by the major medical
benefit
Covered by OHEB, MSF and/
or Threshold level
Authorisation and/or pre-requisites
required
For a summary of expenses that cannot be claimed for, please refer to page 16.
Benefit category p.b. = per beneficiary
p.f. = per familyBenefit sub-category Monetary limit
Covered by the Major Medical
Benefit
Covered by OHEB, MSF and/
or Threshold Benefit
Authorisation and/or pre-requisites
required 1. Alternative healthcare providers
Providers must have valid, registered practice numbers.
2. Appliances – internal prostheses and devices
Subject to pre-authorisation and clinical protocols. The sub-limits include:
System/devices
Device Sub-limit per prosthesis
Central nervous system
Neuro-stimulation/ablation devicesVagal stimulator for intractable epilepsy (including the carrier)
R35 200
R29 400
Cardiac system Cardiac stents (including carrier)Cardiac valvesCardiac pacemakers
R38 300R30 300R37 300
Orthopaedic prostheses and devices
Ankle replacementShoulder replacementElbow replacementHip replacementKnee replacementBone lengthening devicesSpinal plates and screwsOther approved spinal implant-able devices and intervertebral discs
R30 000R30 000R30 000R30 000R30 000R30 000R30 000R30 800
Ophthalmic system
Intraocular lens R1 900
Endo-vascular devices
Carotid stentsAorta stent graftsPeripheral arterial stent graftsEmbolic protection devicesDetachable platinum coils
R14 100R37 300R24 700R35 200R35 200
Other Internal prostheses and devices not listed
R23 500
3. Casualty
If you are treated in hospital casualty, this is regarded as an out-of-hospital
event. Fees would therefore be paid out of your available day-to-day funds
(OHEB, MSF or Threshold) and not from the Major Medical Benefit.
If hospital admission immediately follows casualty, the casualty fee
will be paid from the Major Medical Benefit up to the Libcare Rate.
(NB: Authorisation is still required for the admission – you or the hospital
or physician must phone Libcare Hospital Approvals and other Scheme
authorisations on 0860-12-CARE (2273).) Some hospitals will send the
account to Libcare, others will ask for payment at the time of service. If
you pay the hospital, forward the paid account with a receipt attached to
Libcare for reimbursement from your available benefits.
After-hours casualty – If you require emergency after-hours treatment
at a registered casualty facility and you obtain an authorisation number
within 48 hours of the event, the treatment may be covered from the Major
Medical Benefit (up to the R1 100 annual casualty benefit).
4. Crime trauma
To access this benefit you will need to provide a valid police case number
as well as the name of the police station when requesting authorisation.
5. Day procedures
No authorisation number is required. Day procedures not listed in the
Benefit Table (e.g. gastroscopy, colonoscopy) may be covered in full by
the Major Medical Benefit. Unlisted procedures may require authorisation.
Please consult the authorisation/approvals department (0860-12-CARE
(2273)) to check whether your day procedure will be covered.
6. Dentistry (elective)
n Only the specified procedures (including all costs, e.g. day clinic,
anaesthetist) will be covered up to the limit, subject to prior
authorisation, whether done in- or out-of-hospital.
n Orthognatic surgery is a scheme exclusion.
n For dental implants, a full quotation is required at the time of
pre-authorisation. All associated costs are subject to your available
elective dentistry limit.
n Pre-authorisation is strictly subject to the benefit limit and funds
available at the time of the procedure, and in no way guarantees
payment in full.
7. HIV/AIDS (subject to registration with the LIFEWORKS programme)
The HIV Preventative Benefit provides prophylactic drugs (subject to the
generic reference pricing) for the prevention of HIV transmission from
mother-to-child (during pregnancy); from needle-stick injury; or from
accidental exposure to blood.
8. Chronic Benefit
Refer to pages 8 and 9 for a full explanation of your Chronic Benefit and
the list of chronic conditions that Libcare covers.
9. Oncology and associated diagnostics
Associated diagnostics (e.g. specified radiology and pathology) will only
be payable from the associated diagnostics oncology benefit during active
treatment. Other scans and tests may be available for the next 12 months,
but are subject to registration with the Cancer Management Programme
and pre-authorisation. See page 10.
10. MRI/CT scans (out-of-hospital)
The first two out-of-hospital MRI and/or CT scans per family may be paid
from the Major Medical Benefit subject to pre-authorisation and clinical
protocols. Thereafter, if a member requires an MRI or CT scan it will be
payable from the available day-to-day specialised radiology benefit.
Notes to 2008 Benefit Table
%LIFEWORKS: 0860-50-55-55
Libcare Chronic Medicine Management: 0860-12-CARE (2273)
Libcare’s Dental Advisor for Orthodontics:0860-12-CARE (2273)
Libcare Cancer Management Programme: 0860-12-CARE (2273)
Libcare: 0860-12-CARE (2273)Libcare Hospital Approvals and other Scheme authorisations: 0860-12-CARE (2273)
Important information about third-party claims
Please inform Libcare if you have had an injury for which someone else
is responsible. Libcare can help by liaising with the person or institution
involved.
n In the event of an accident (or illness) resulting directly from your
work, you should be covered by Workman’s Compensation.
n In the event of a road accident, you may be able to claim from the
Road Accident Fund. See page 16.
You can help lower your medical costs in the following ways:
n Ask your provider to charge the Libcare Rate, or to give you a discount
for paying cash at the time of service.
n Get a second opinion before consenting to expensive treatment.
n Consult a GP before you go to a specialist (except for gynaecologists or
opthalmologists).
n Ask for generic equivalents to prescribed medicines.
n Ask whether prescribed blood tests are medically necessary – if you
had a similar test done recently, ask whether a new test is likely to
show different results (if not, skip it).
Mental health In hospital (all costs for psychologists, psychiatrists and social workers, including rehabilitation for substance abuse)
R23 430 p.f. n Y – LMC
Out-of-hospital consultations and visits R5 290 p.b. / R7 940 p.f. n Y – LMC
Non-surgical procedures and tests
In hospital Unlimited n Y – LMC
Out of hospital (applying plaster of paris, stitches, etc.) R2 230 p.b. / R5 830 p.f. n
Oncology (see note 9) Radiotherapy, chemotherapy and oncology medication. PET and PET-CT scans are limited to one per member family and restricted to staging of malignant tumours
R306 130 p.b. n Y – LMC
Biological medicines, e g, Herceptin, subject to clinical guidelines, protocols and managed healthcare programme
R120 000 p.b. included in limit above
n Y – LMC
Associated diagnosticsw R30 613 p.b. included in R306130 above and further
limited to 12 months post active treatment
n Y – LMC
Optometry(note: readers are excluded)
Eye examination R320 p.b. n
Frames R950 p.b. n
Lenses and/or contact lenses R2 440 p.b. / R6 150 p.f. n
Refractive surgery Included in limit above, subject to the approval of the Medical
Advisor and the scheme
n Y – MA & scheme
Organ Transplants Harvesting, transplantation and anti-rejection medication Unlimited n Y – LMCParamedical Services In hospital Unlimited n Y – LMC
Out-of-hospital (Audiology, dietetics, genetic counselling, hearing aid acoustics, occupational therapy, orthoptics, physiotherapy, podiatry, speech therapy, social workers, frail care at registered sick bay facilities)
R3 070 p.b. / R4 660 p.f. n
Pathology and Medical Technology
In hospital Unlimited n Y – LMC
Out of hospital R3 070 p.b. / R4 660 p.f. n
Physiotherapy In and out of hospitalIncludes biokinetics and out-of-hospital chiropractics
Included in paramedical services (above)
Y – In hosp.LMC
Radiology (see note 10) In hospital (general and specialised) Unlimited n Y – LMC
In of hospital (MRI and CAT scans) R18 020 n Y – LMC
Out hospital (general and specialised) R3 070 p.b. / R4 660 p.f. n
Out of hospital (MRI and CAT scans) Up to Libcare Rate for first two MRI or CAT scans per family
n Y – LMC
Renal Dialysis (Chronic) Haemodialysis R183 700 p.b. n Y – LMC
Peritoneal Dialysis R153 590 p.b. n Y – LMCLMC = Libcare Managed Healthcare MA = Medical Advisor LCMMD = Libcare Chronic Medicine Management DepartmentPreventative Care Benefit
Specified consultations, examinations, procedures and vaccinations as outlined on page xx of this member guide.
No overall limit, but specified costs paid up to the Libcare
Rate.
n Costs exceeding the Libcare Rate will come from your positive
MSF
No authorisation required
For a summary of expenses that cannot be claimed for, please refer to page 16.
Benefit Category p.b. = per beneficiary
p.f. = per familyBenefit sub-category Monetary Limit
Covered by the major medical
benefit
Covered by OHEB, MSF and/
or Threshold level
Authorisation and/or pre-requisites
required
For a summary of expenses that cannot be claimed for, please refer to page 16.
Benefit category p.b. = per beneficiary
p.f. = per familyBenefit sub-category Monetary limit
Covered by the Major Medical
Benefit
Covered by OHEB, MSF and/
or Threshold Benefit
Authorisation and/or pre-requisites
required 1. Alternative healthcare providers
Providers must have valid, registered practice numbers.
2. Appliances – internal prostheses and devices
Subject to pre-authorisation and clinical protocols. The sub-limits include:
System/devices
Device Sub-limit per prosthesis
Central nervous system
Neuro-stimulation/ablation devicesVagal stimulator for intractable epilepsy (including the carrier)
R35 200
R29 400
Cardiac system Cardiac stents (including carrier)Cardiac valvesCardiac pacemakers
R38 300R30 300R37 300
Orthopaedic prostheses and devices
Ankle replacementShoulder replacementElbow replacementHip replacementKnee replacementBone lengthening devicesSpinal plates and screwsOther approved spinal implant-able devices and intervertebral discs
R30 000R30 000R30 000R30 000R30 000R30 000R30 000R30 800
Ophthalmic system
Intraocular lens R1 900
Endo-vascular devices
Carotid stentsAorta stent graftsPeripheral arterial stent graftsEmbolic protection devicesDetachable platinum coils
R14 100R37 300R24 700R35 200R35 200
Other Internal prostheses and devices not listed
R23 500
3. Casualty
If you are treated in hospital casualty, this is regarded as an out-of-hospital
event. Fees would therefore be paid out of your available day-to-day funds
(OHEB, MSF or Threshold) and not from the Major Medical Benefit.
If hospital admission immediately follows casualty, the casualty fee
will be paid from the Major Medical Benefit up to the Libcare Rate.
(NB: Authorisation is still required for the admission – you or the hospital
or physician must phone Libcare Hospital Approvals and other Scheme
authorisations on 0860-12-CARE (2273).) Some hospitals will send the
account to Libcare, others will ask for payment at the time of service. If
you pay the hospital, forward the paid account with a receipt attached to
Libcare for reimbursement from your available benefits.
After-hours casualty – If you require emergency after-hours treatment
at a registered casualty facility and you obtain an authorisation number
within 48 hours of the event, the treatment may be covered from the Major
Medical Benefit (up to the R1 100 annual casualty benefit).
4. Crime trauma
To access this benefit you will need to provide a valid police case number
as well as the name of the police station when requesting authorisation.
5. Day procedures
No authorisation number is required. Day procedures not listed in the
Benefit Table (e.g. gastroscopy, colonoscopy) may be covered in full by
the Major Medical Benefit. Unlisted procedures may require authorisation.
Please consult the authorisation/approvals department (0860-12-CARE
(2273)) to check whether your day procedure will be covered.
6. Dentistry (elective)
n Only the specified procedures (including all costs, e.g. day clinic,
anaesthetist) will be covered up to the limit, subject to prior
authorisation, whether done in- or out-of-hospital.
n Orthognatic surgery is a scheme exclusion.
n For dental implants, a full quotation is required at the time of
pre-authorisation. All associated costs are subject to your available
elective dentistry limit.
n Pre-authorisation is strictly subject to the benefit limit and funds
available at the time of the procedure, and in no way guarantees
payment in full.
7. HIV/AIDS (subject to registration with the LIFEWORKS programme)
The HIV Preventative Benefit provides prophylactic drugs (subject to the
generic reference pricing) for the prevention of HIV transmission from
mother-to-child (during pregnancy); from needle-stick injury; or from
accidental exposure to blood.
8. Chronic Benefit
Refer to pages 8 and 9 for a full explanation of your Chronic Benefit and
the list of chronic conditions that Libcare covers.
9. Oncology and associated diagnostics
Associated diagnostics (e.g. specified radiology and pathology) will only
be payable from the associated diagnostics oncology benefit during active
treatment. Other scans and tests may be available for the next 12 months,
but are subject to registration with the Cancer Management Programme
and pre-authorisation. See page 10.
10. MRI/CT scans (out-of-hospital)
The first two out-of-hospital MRI and/or CT scans per family may be paid
from the Major Medical Benefit subject to pre-authorisation and clinical
protocols. Thereafter, if a member requires an MRI or CT scan it will be
payable from the available day-to-day specialised radiology benefit.
Notes to 2008 Benefit Table
%LIFEWORKS: 0860-50-55-55
Libcare Chronic Medicine Management: 0860-12-CARE (2273)
Libcare’s Dental Advisor for Orthodontics:0860-12-CARE (2273)
Libcare Cancer Management Programme: 0860-12-CARE (2273)
Libcare: 0860-12-CARE (2273)Libcare Hospital Approvals and other Scheme authorisations: 0860-12-CARE (2273)
Important information about third-party claims
Please inform Libcare if you have had an injury for which someone else
is responsible. Libcare can help by liaising with the person or institution
involved.
n In the event of an accident (or illness) resulting directly from your
work, you should be covered by Workman’s Compensation.
n In the event of a road accident, you may be able to claim from the
Road Accident Fund. See page 16.
You can help lower your medical costs in the following ways:
n Ask your provider to charge the Libcare Rate, or to give you a discount
for paying cash at the time of service.
n Get a second opinion before consenting to expensive treatment.
n Consult a GP before you go to a specialist (except for gynaecologists or
opthalmologists).
n Ask for generic equivalents to prescribed medicines.
n Ask whether prescribed blood tests are medically necessary – if you
had a similar test done recently, ask whether a new test is likely to
show different results (if not, skip it).
Important contact details
Libcare Contact Centre 0800-12-CARE (2273)
Libcare e-mail queries [email protected]
To submit your claims, drop them in the box at the
Libcare Desk or on the bridge between Liberty Life Centre
and Libridge, or post them to:
Libcare
P.O Box 44850
Claremont 7735
Hospital and casualty authorisation Libcare Hospital Approvals and other
Scheme authorisations
0800-12-CARE (2273)
(08:00-17:00 Mon-Fri)
Fax: 021-657-7521
Chronic Medicine Management 0800-12-CARE (2273)
Cancer Management Programme 0800-12-CARE (2273)
Centre for Diabetes and Endocrinology 011-712-6000
LIFEWORKS 0860-50-55-55
Libcare Fraud Hotline 0800-21-26-38
Netcare 911 for emergencies within South Africa 082 911
Netcare 911 for emergencies in neighbouring countries +27 11 254-1443
Authorisation for overseas medical cover (Netcare) +27 11 254-1443
Use the area below to record your healthcare providers’ details
Your healthcare provider Address Phone or fax
This guide will explain:
n What you are covered for
n How to use your
medical aid
The fold-out at the back of the
guide summarises your benefi ts
and limits for 2008.
If you have any questions, please:
n visit the Libcare Desk at
Liberty Life Centre, or
n call Libcare Customer Care
on 0800 12 CARE (2273)
Use this pocket to store important papers
M E M B E R G U I D E
Important contact details
Libcare Customer Care 0800-12-CARE (2273)
Libcare e-mail queries [email protected]
To submit your claims, drop them in the box at the
Libcare Desk or on the bridge between Liberty Life Centre
and Libridge, or post them to:
Libcare
P.O Box 44850
Claremont 7735
Hospital and casualty authorisation Libcare Hospital Approvals
0800-12-CARE (2273)
(08:00-17:00 Mon-Fri)
Fax: 021-657-7521
Chronic Medicine Management 0800-12-CARE (2273)
Cancer Management Programme 0800-12-CARE (2273)
Centre for Diabetes and Endocrinology (011) 712-6000
LIFEWORKS 0860-50-55-55
Libcare Fraud Hotline 0800-21-26-38
Netcare 911 for emergencies within South Africa 082 911
Netcare 911 for emergencies in neighbouring countries +27 11 254-1443
Authorisation for overseas medical cover (Netcare) +27 11 254-1443
Use the area below to record your healthcare providers’ details
Your healthcare provider Address Phone or fax
This guide will explain:
n What you are covered for
n How to use your
medical aid
The fold-out at the back of the
guide summarises your benefits
and limits for 2008.
If you have any questions, please:
n visit the Libcare Desk at
Liberty Life Centre, or
n call Libcare Customer Care
on 0800 12 CARE (2273)
Use this pocket to store important papers
M e M B e r G U I d e
![[trainer] [email/contact details]](https://static.documents.pub/doc/80x56/568139f0550346895da1a89e/trainer-emailcontact-details.jpg)
