Did you know most medical aids fund home care?

Written by Hanri Koekemoer (2023)

By choosing HFN Nursing Agency, you can claim for:

·        Frail care

·        Home Nursing Care

·        Palliative / End of Life Care

·        Post-Op Care

·        RN Call Outs

·        Injections by a RN

·        RN Counselling or Assessment 

 Below is a sample of different Medical Aids and the benefits they offer.

MEDSCHEME

• Advanced Serious Illness Benefit (SIB): Alignd Managed Health Care Program - usually 336 hours of cancer care / palliative care covered & bi-weekly RN visits / available to Bonitas and Fedhealth members.

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

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

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

 DISCOVERY

• Advanced Illness Benefit (AIB) specifically for advanced cancer conditions & Compassionate Care Benefit (CCB) for palliative care (other than cancer conditions) between R45 000 - R65 000 benefit per member per lifetime.

• Care Coordination Program /after Hospitalisation (CCP)

Home-based care authorisation post hospital admission can be requested. Please try request this whilst still in hospital.

• LA Health (AIB program with Discovery)

ANNUAL FRAIL CARE BENEFITS

• Bankmed Comprehensive Care Frail Care Benefit covers homecare to a max. benefit of R520/day. New Authorisations need to be received yearly.

• Anglo Medical Scheme (AMS) Annual Benefit - Accounts for frail care are paid from the Hospital Benefit up to 100% of the scheme reimbursement rate and is subject to the annual limit of R78 155.

• EMBF (Engen Medical Benefit Fund) - paid up to 100% of the Fund rate with a limit of R28 700 per family per year (frail care/end of life care)

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

• Comprehensive Plan has a sub limit of R41 050 per beneficiary per year

• Remedi Classic Plan has a sub limit of R39 100 per beneficiary per year

• Remedi Standard Plan has a sub limit of R14 400 per beneficiary per year

• TFG Health Plus Plan - paid from Overall Annual Limit up to 100% of Scheme rate with a sub-limit of R34 290 per person a year/ R381 per day for 90 days

• Wooltru, Sasolmed & Profmed also have an annual frailcare benefit.

 To assist patients with obtaining authorization HFN requires the name, address, ID, Medical aid name and number, and dependent code as well as a doctors motivation letter including ICD-10 codes.

 Please contact us on 021 7623611 or info@hfn.co.za for more information.