In today’s world, companies operate in a complex and highly competitive environment where returns on investment and productivity are key to on-going sustainability and success.
There are a number of contributing factors to the above, one of the most important being an organisation’s workforce — The Human Capital.
Medicall Healthcare understands that in the current competitive environment, companies are required to offer a comprehensive Employee Benefits solution in order to:
- Attract and retain the best employees
- Demonstrate a duty of care to employees
- Encourage employees to become healthier and enhance their productivity
- Provide financial support in the event of absence, illness and death
- Comply with the Labour Relations Act.
Chronic diseases and stress have a major impact on productivity, whether through absenteeism, presenteeism or low morale.
Below are a few interesting statistics that may pertain to your workforce.
1 in 6 employees = HIV+
1 in 4 employees = Suffer from a form of emotional distress
1 in 3 employees = Have a chronic condition
Whether you are a major corporate with thousands of employees or a small micro-enterprise, the health and wellness of your people is a priority for your business.
Medicall OPTIMA – Employee Healthcare Plans are a suite of innovative and flexible
workplace healthcare products with solutions that are truly bespoke in design and implementation.
Our entire offering is developed around the philosophy of being innovative, flexible and affordable, regardless of which industry your organisation is in. Furthermore, our offerings can either stand alone or be integrated to offer measurable benefits to your business and ensure legal compliance whilst addressing the wellbeing of one of your most important assets — your human capital.
We understand that each organisation is different and that the effect an individual’s wellness has on a business is never simple or without complications.
We can assist you by addressing your employees’ needs around emotional wellbeing, chronic health conditions, HIV/AIDS and supporting wellness in the workplace.
The result is a happier, healthier and more productive workforce.
Thriving organisations rely on motivated healthy people to prosper.
Medicall Healthcare supports organisations through the promotion of health and wellbeing of their employees to improve productivity and reduce absenteeism.
| Benefit | Service | Optima Core | Optima Establish | Optima Enhance |
| GP VISITS | Members can choose from any Medicall Healthcare Network GP only. Benefits include unlimited medically necessary consultations and specified minor trauma treatment from the Network GP. Referral by Network GP to state facility if required. Subject to 30 day waiting period (waiting period can be waivered) |  | | |
| MATERNITY GP | Pre and post-natal care, supervision of an uncomplicated pregnancy up to week 20 including one 2D sonar scan per pregnancy. Referral by Network GP to a state facility if required. | | | |
| BASIC PATHOLOGY | Basic blood tests as requested by Medicall Healthcare provider; subject to Medicall protocols and approved list of codes. | | | |
| BASIC RADIOLOGY | Basic Black and White X-Rays as requested by Medicall Healthcare provider, subject to Medicall protocols and approved list of codes. | | | |
| ACUTE MEDICATION | As dispensed by a Medicall Healthcare Network GP or via prescription through a Network Pharmacy according to the Medicall Healthcare medication formulary. | | | |
| HIV BENEFIT | Included in cost of day-to-day benefits. HIV Elisa blood test, Symptomatic treatment due to HIV Infection. Referral by Network GP to state facility required. | | | |
| CHRONIC MEDICATION | 26 Chronic Conditions covered. Subject to registration and approval from Medicall Clinical Department and issued according to the Medicall Healthcare medicication formulary. (Waiting Periods Apply) 6 Month Waiting Period from the commencement date of the cover | | | |
| HIV CHRONIC MEDICATION | Subject to quote request by employer. (Waiting Periods Apply) | | | |
| ONSITE NURSING | Chronic disease management, primary health and wellness management. Subject to group size. Refer to On Site Nursing table below. | | | |
| BASIC DENTISTRY (Waiting Periods Apply) | Members can choose from any Medicall Healthcare Network Dentist. Benefit includes consultations, fillings extractions, infection control, cleaning and polishing of teeth. Subject to a list of approved dental codes. 6 Month Waiting Period from the commencement date of the cover. | | | |
| BASIC OPTOMETRY (Waiting Periods Apply) | Members may choose from any Medicall Healthcare Network Optometrist. Benefits include one optical test per beneficiary, per 24 months, one pair of standard mono or bi-focal lenses in a standard frame or contact lenses to the value of R585.00 Medicall protocols apply. SUBJECT TO A 6 MONTH WAITING PERIOD. | | | |
| HOSPITAL TRAUMA ** (Stabilisation following emergency) | An Emergency Room / Trauma Room Benefit is payable in the event of a life threatening incident, as assessed and authorized by Medicall Healthcare, up to a maximum of R20,000 per member. This benefit is limited to one incident per year, per member. Subject to a 30 day waiting period from the commencement date of cover. | | ||
| ACCIDENTAL IN-HOSPITAL BENEFIT ** | Payable per accident for transportation and emergency medical treatment. Up to R100,000 per accidental event to a maximum of R500,000 per annum. | | ||
| ACCIDENTAL DEATH ** | Up to R100,000 where accidental bodily injury results in the death of a member. | | ||
| ACCIDENTAL DISABILITY ** | Up to a limit of R100,000 where accidental bodily injury results in the permanent total disability of a member as defined in the policy definition. | | ||
| DAILY BENEFIT ** | Daily cash benefit for non-medical expenses as a result of hospitalisation following accidental bodily injury up to a maximum limit of R1000 per day / 20 days per annum. Requires hospital confinement of more than 24 hours. * Subject to pre-authorisation. | | ||
| AMBULANCE | All members enjoy the benefit of ambulance services when an ambulance service is required for an accident or life threatening emergency as assessed by the emergency call centre. Up to R35,000 per event. | | ||
| FUNERAL BENEFIT (Waiting Periods Apply) | COSTS QUOTED BELOW ARE PER MEMBER Death Benefit of R10,000 for Principal Member. 6 month waiting period from the commencement date of cover | | | |
| ** – Underwritten by LionHeart Risk Management (Pty) Ltd, a licensed life insurer in terms of the Insurance Act. | ||||
Unknown or untreated chronic diseases or non-compliance with medication can significantly affect the ability of employees to function optimally resulting in absenteeism and presenteeism. Onrsite nursing provides an onsite health service at your premises, saving valuable time spent away from work by employees seeking medical attention in turn, allowing the employer to maximize productivity.(Subject to a minimum of 20 employees at one location).
20 to 39
40 to 79
80 to 149
150 to 499
500 to 1000
2 Working Hours
3 Working Hours
4 Working Hours
8 Working Hours
12 Working Hours
To manage and monitor the health of chronically ill employees within the work environment:
- Address and continuously monitor their conditions e.g. diabetes, hypertension and asthma
- Preventive health monitoring — Biomarkers / Biometrics
- Wellness education programmes and counselling
- Encourage enrolment on a care programme of employees with HIV/AIDS
- Assist collaboration with local health facilities.
Maximum age 64
Compulsory Groups greater than 100 members (Group or Level of Employ):
Pre-Existing Conditions waivered. Subject to Medicall Healthcare approval.
Compulsory Groups less than 100 members: Pre-Exisiting Conditions are underwritten and may result in an endorsement being applied.
Employee Only — Employer / Employee relationship.
Employers > 1 Employee
None
R35 take on fee per employee an R90 once off per group, up to 100 members WAITING PERIODS 30 Day Waiting Period for Hospital Trauma. 6 Month Waiting Period for Chronic, Dentistry, Optometry and Funeral Benefit (Natural Death).
Inclusive
Amendments on group plan upgrades or downgrades allowed once annually on the 1st of January, with notice of change to Medicall confirmed no later than the 30th of November of the preceding year.
Medicall Healthcare Providers — National Coverage.
PROVIDER SEARCH 0860 077 722 and / or www.medicallhealth.co.za
Medicall Healthcare is a product of Xperia Financial Services (PTY) Ltd, a Licenced Financial Services Provider, registered with the FSCA (Financial Sector Conduct Authority) FSP Number 45551 with demarcation exemptions DM1051 and hospital benefits is underwritten by Lion of Africa Life Assurance Company Ltd (FSP: 15283).
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