WELCOME to your HERITAGE HEALTH MEDICAL AID FUND Newsletter

We publish Newsletters at regular intervals to keep our members informed, to motivate new readers to join Heritage Health Medical Aid Fund and to be of service to you. In the Newsletters we will be addressing issues such as improving your health, how to manage your benefits and the associated costs, how risk is managed, and your responsibilities.  You may also contact us on topics that you wish to be addressed.

The Board of Trustees of Heritage Health

Heritage Health is managed by a Board of Trustees duly appointed to manage the business of the Fund. The Board of Trustees represents the members belonging to the Fund. The principal officer attends to the responsibilities bestowed in terms of the Medical Aid Funds Act.

The Board of Trustees of Heritage Health:

• C Maxwell (Chairperson)
• P de Haan (Vice Chairperson)
• C Gilbert
• A Maree
• G Kloppers
• J Strydom
• K Mbaukua (Principal Officer)

What is HEPATITIS

Hepatitis is an inflammatory condition of the liver and is commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Hepatitis is most prevalent in developing countries.

The Hepatitis E Transmission route:

• Transmission from pregnant mother to foetus
• Infected blood products (transfusions mostly)
• Eating food prepared by infectious people
• Direct contact with infectious people
• Food borne transmission from ingestion of cut/uncooked fruits and vegetables.

The symptoms are mainly:

• Fatigue and tiredness
• Loss of appetite
• Nausea and vomiting
• Dark urine and pale stool
• Yellow/Discolouration of the skin and sclera of the eyes.
• Fewer
• Tenderness and abdominal pain
• Joint pain

How to Prevent the infection of Hepatitis E?

Prevention is always safer and better then cure thus precautionary measures can be taken:

• Maintain safe and quality standards for water supplies especially for drinking.
• Create proper practices such as hand washing with clean safe water and soap, particularly before handling food and after the use of toilets.
• Use boiled water for drinking and avoid drinking water/ice of unknown purity.

Take Note: When Travelling

When travelling to South Africa or SADC, you must inform Heritage Health before you leave to ensure that you are covered. You will be required to submit a copy of your valid passport or permanent residence. You will receive a letter and contact details to be used when in need of cover. When travelling abroad, before you leave to ensure that you are covered, you must submit a copy of your valid passport or permanent residence and air tickets. You will receive a letter and contact details to be used when in need of cover. Failing to do so will result in no cover.

Admissions to a Hospital

All members must always obtain pre-approval prior to being admitted to any hospital by contacting Heritage Health.

Why are Pre-authorisations a Necessity

• The pre-authorisation process alerts the Fund that a member is scheduled for hospitalisation.
• The member, doctor and hospital can be informed beforehand to what extent the treatment/procedure will be covered in terms of the available Benefits and the Rules of the Fund.
• By complying with the process of obtaining pre-authorisation, you are assisting the Fund in managing these costs and ultimately containing increases to the annual monthly contributions.
• Pre-authorisation is granted based on the validity of your membership, clinical appropriateness, waiting periods, exclusions, length of hospital stay, terms and conditions of the rules and evidence based on clinical guidelines.

What is pre-authorisation?

For all hospital admissions whether in Namibia or in South Africa a pre-authorisation is required prior to admission for non-emergency treatments.  For all non-emergency procedures at least 48 hours prior to obtaining the treatment/procedure you must contact the Fund to obtain the pre-authorisation. For all emergencies or after office hour admissions the hospital will contact the Fund to obtain the necessary pre-authorisation.

Please Note:  All clinical services available in Namibia will not be covered in South Africa.

What is the definition of an emergency?

Any emergency medical condition is a medical condition which is of sudden and unexpected onset that requires immediate medical or surgical treatment where failure to provide this treatment would result in serious impairment of bodily functions, serious dysfunction of a bodily organ or part, or would place the person’s life in serious jeopardy.

How do I obtain Pre-authorisation?

To obtain a pre-authorisation number prior to admission you, your attending doctor and/or the hospital must contact the Fund and provide the necessary clinical details.

The following information must be provided:

• Membership number
• Patient: name and date of birth
• Treating doctor: name, telephone and practice numbers
• Hospital: name and practice number
• Clinical reason for admission/primary diagnosis
• Codes: Tariff and/or ICD-10 code(s)
• Date of admission. The Fund does not cover pre-admissions – day prior to procedure.

When your request is authorised, you will receive:

• An authorisation number
• The approved number of days in hospital where stay is necessitated

If your hospital stay is extended, the hospital case manager will inform the Fund with the clinical motivation and pending available benefits.

Submission of Invoices

All invoices whether being submitted by the healthcare provider or member must be submitted within four months from date of service.