REPRO INFO Bull JUNE 2012

J U L Y 2 0 1 2 I N F O B U L L E T I N

PAGE 1

July 201237th Edition

Transmed Medical Fund is one of the few medical schemes that ensures it has staff on the road visiting all the Transnet Business Units on a regular basis. Our Member Liaison Offi cers (MLOs) are Fund representatives responsible for assisting you, our members, with benefi t and membership related queries. The MLOs are also there to ensure that Transnet employees get successfully signed up as members, which ensures the fi nancial health of the Fund.

The Fund’s MLOs embarked on wellness workshops from March to June 2012, to educate members at various Transnet Business Units about the Fund’s benefi ts and contributions for 2012. This campaign was aimed at enhancing service levels and also giving Fund members an opportunity to discuss their concerns and queries directly

with the MLOs, during these important on-site visits.

With a new communication strategy in place, signifi cant improvements have been seen in resolving claims and queries over the past few months. Through our MLOs we strive to engage more with you, our members, in an effort to meet your expectations.

Look out for our MLOs in your region by consulting our website at www.transmed.co.za for dates and venues, or ask your union representatives to request a visit from our marketing department or MLOs. Please contact the marketing representatives in your region should you need any further information; their details can be found on the Transmed website.

TRANSMED

INFOBULLETININ THIS EDITION

rewThTruphe

ThwoedBucoaimgivdi

COMPETITION

Win a Pick n Pay gift card to

the value of R2 300 (fi rst prize)

or R1 000 (second and third

prizes) by solving the

Word Search

Puzzle on

page 12.

k n Pay gift card

of R2 300 (fi rst pprizez ) )

00 (second ananndd d d ththththhiririririrdddddd

by solvingnggg tttthhehehehehee

Searchh

on

e 1111222222.

THE ROLE OF MEMBER LIAISON OFFICERS (MLOs)

PETRUS’S PEN

HEALTH • Eye care for children • How to combat

computer eye strain• Common eye disorders

and conditions in adults

LIFESTYLE• Keeping healthy during

winter • Bullying at school

RULES OF THE FUND• How to claim

HOW YOU CAN HELP US• Healthcare fraud • Feedback and interaction

WATCH THE CALENDAR• Health calendar

IMPORTANT CONTACT DETAILS

With a new communication

strategy in place, signifi cant improvements

have been seen in resolving claims and

queries over the past few

months.

REPRO INFO Bull JUNE 2012.indd 1REPRO INFO Bull JUNE 2012.indd 1 2012/07/04 7:32 AM2012/07/04 7:32 AM

PAGE 2

HealthP

ET

RU

S’S

PE

NWelcome to the second edition of Infobulletin for 2012. In this edition we cover a range of topics that I believe will be of value to you and your family.

We focus on the important role of our MLOs, who are tasked with ensuring that our members are satisfi ed with our services.

2012 has seen a signifi cant increase in pressure on the South African economy. The prices of petrol and electricity, amongst other commodities, have increased, leaving many South Africans cash-strapped. The Fund, however, remains committed to assuring you of its fi nancial stability.

Earlier this year, a ‘Transmed Medical Fund developments for 2012’ communication was sent to you reaffi rming our commitment to serving our members. Transmed aims to provide on-going access to affordable and quality healthcare services to all our members and to ensure the Fund’s continued fi nancial viability through the objectives and future prospects set by the Board of Trustees (BOT). As you know, the BOT consists of representatives from all areas of our member base, namely the unions, pensioners and administrators.

It is important to note that the Fund secured minimal tariff increases for most service provider groups (hospital and other practitioners) for 2012. Our anticipation is that this will further contribute to the improvement of our fi nancial position going forward.

We would really appreciate feedback from you on the look and feel as well as the content of this newsletter. In due course, we will request your input in the form of a survey. We encourage you to participate, as it will assist us in establishing what members would like to read about in future.

I trust you will enjoy reading this edition of Infobulletin. On behalf of Transmed, I would like to wish you well through winter and thank you for your continued support and feedback.

Warm regards

PETRUS WASSERMANNPRINCIPAL OFFICER

EYE CARE FOR CHILDREN

A child with uncorrected vision conditions or eye health problems faces many barriers

in life, including academically, socially and athletically. High-

quality eye care can break down these barriers and help enable your children to reach

their fullest potential! As a parent, make sure you are

giving your children the eye care they deserve.

How to combat computer eDo you have regular headaches, blurred vision, scratchy eyes, neck or shoulder pain? You could be suffering from eye strain caused by prolonged computer use.

If you spend long hours in front of a computer screen, try these helpful tips to reduce eye strain:• Adjust your chair’s height so that your computer screen is slightly below

eye level.• Ensure the background lighting is adequate – it should be brighter than

the computer screen.• Contact lens wearers may be more comfortable wearing glasses when

working at the computer.• Position yourself so that you face into open space beyond the computer

screen, not facing a wall.

INFANT VISION CAREYour baby has a lifetime to see, learn and experience. But did you know your baby actually has to learn to see? As a parent, there are many things that you can do to help your baby’s vision develop.

At the age of about six months, you should take your baby to your doctor or optometrist (eye care specialist) for his or her fi rst thorough eye examination. Things that the optometrist will test for include excessive or unequal amounts of short-sightedness, vision and eye movement ability, as well as eye health problems.

These problems are not common, but it is important to identify children who have them at this stage, as vision development and eye health problems can be more easily corrected if treated in the early developmental stages.

Unless you notice a need, or your doctor or optometrist advises you otherwise, your child’s next examination should be around age three, and then again before he or she enters school.

SOURCEPrimary Eyecarehttp://www.primaryeyecarevision.com/



PAGE 3

HE

AL

TH

CATARACTCataract is a gradual clouding of the eye’s lens, leading to blurred or dull vision. Although some babies are born with congenital cataracts, it more commonly occurs in older people (over 60 years).

RETINAL DETACHMENT Although it can occur at any age, retinal detachment is more common in people older than 40 years. Symptoms include fl oaters or specks, fl ashes of light or the appearance of a ‘curtain’ over your fi eld of vision. Surgery is usually required to correct this condition. If you suspect you may have a detached retina, see a healthcare professional immediately.

GLAUCOMA Glaucoma is caused by an increase in pressure in the eye, and initially causes no pain or specifi c symptoms. Most people don’t know that they have glaucoma until they experience lack of vision. Although the condition can be successfully treated, lost vision cannot be restored. It is therefore important to have your eyes tested for glaucoma regularly, after the age of 40 years.

DIABETIC RETINOPATHY Diabetes can cause sight-threatening retinal damage. Diabetic Retinopathy is not just a condition of the retina – it’s a condition of the blood vessels in the retina. This condition affects the walls of blood vessels throughout the body, which is why patients who fail to manage their condition effectively can suffer with heart and kidney disease, nerve damage and limb amputation.

Often diabetic eye disease has no symptoms or early warning signs. If you have diabetes, it is recommended that you get a dilated eye examination at least once a year.

This test allows an eye care professional to view the retina to detect early damage to blood vessels, and to adjust your medication if necessary.

SOURCEAll About Visionhttp://www.allaboutvision.com/conditions/

r eye strain

Common eye disorders and conditions in adults

• Computer screens attract dust - clean yours regularly.• Take a 10 minute break every couple of hours.• Glance away from the screen from time to time, to focus on distant

objects or look out of the window.• Adjust the size of too small text so you don’t have to squint.• Use an eye lubricant if necessary to reduce dryness. • Combat glare and refl ections with curtains, blinds or a special anti-glare

screen.

SOURCE All About Visionhttp://www.allaboutvision.com/conditions/


PAGE 4

LIF

ES

TY

LE

Keeping healthy during winter

During the winter months it is important to take care of your health and fi tness too.



PAGE 5

We live in a day and age where health and fi tness has not only become a necessity, but also a passion for many people. During the winter months it is important to take care of your health and fi tness too. Sometimes getting sick in winter is inevitable but there are things you can do to help soften the blow and strengthen your immune system when it is really needed. Since we tend to burn more calories during winter due to our bodies’ efforts in keeping ourselves warm, it is important to eat a well-balanced meal three times a day to keep our energy levels up.

There are many indoor activities you can do to keep active during the winter months, including:• yoga or simple stretches• stationary cycling• walking/running on a treadmill• dance/aerobics workouts• turn on some music while doing household

chores.

Winter can deplete many of us of our spirited moods, with the cold weather sending us into a health and fi tness lag.

Five tips to stay healthy during winter months:

• Drink the optimal amount of water. It’s more important than ever to consume the right amount of water for your health.

• Keep stress to a minimum. Studies have linked high stress levels to making a person more vulnerable to catching colds and fl u.

• Eat a healthy diet. Maintaining a healthy diet full of fresh fruits and vegetables, and minimal amounts of meats is another way to keep your body clean and in good working order. Try eating an extra piece of fruit or vegetables everyday too!

• Exercise regularly. It is important to exercise regularly, even if it’s only for 15 minutes a day! Get out and take a short walk and enjoy the cooler weather.

• Get the right amount of sleep every night. The average person needs six to eight hours of sleep per night. If you’re not getting enough sleep, your body is extremely vulnerable to illness. Sleep is very much like fuel that recharges you. You’ve got to do it to keep your body functioning optimally.

SOURCEStay Healthy and Wellhttp://stayhealthyandwell.com/10-tips-to-stay-healthy-during-the-winter-season/


PAGE 6

Bullying at school

LIF

ES

TY

LE



PAGE 7

Once bullying has been identifi ed, it is

important for parents to address

the situation as soon as possible with the

school concerned or stakeholders,

where appropriate measures and actions can be discussed and implemented.

WHAT IS BULLYING?Bullying is when a child or a group of children abuse their power to hurt other children or exclude them.

Bullying can be identifi ed by the following types of behaviour: • Deliberate use of aggression.• Unbalanced power relationship between the

bully and the victim.• The causing of physical pain and/or

emotional anxiety.

WHAT ARE THE DIFFERENT TYPES OF BULLYING?There are three main types of bullying: • Verbal and written: Name calling,

negative comments and intimidation or threats.

• Physical: Bumping, scratching, shouldering, hitting, tripping, biting, rolling eyes or showing suggestive signs.

• Social/relationships: Gossiping (verbal or written), revealing personal information and manipulation of the child with a view to humiliation or exclusion from a group.

WHAT ARE THE CONSEQUENCES OF BULLYING FOR THE VICTIM?The effects of bullying vary, but are generally accepted as: • a development of fear of attending school

and absenteeism• victim’s development is affected, meaning a

child might grow up with an inferiority complex

• self-esteem problems• feelings of loneliness• social isolation• emotional problems• psychosomatic (emotional/mental)

symptoms• communication problems• depression• struggle to achieve academically• some victims commit suicide• rule breaking and anti-social behaviour

patterns• risk of criminal behaviour later.

INTERVENTION STRATEGIES Once bullying has been identifi ed, it is important for parents to address the situation as soon as possible with the school concerned or stakeholders, where appropriate measures and actions can be discussed and implemented. Thereafter consultation with a professional psychologist is recommended.

SOURCEWestern Cape Education Departmenthttp://www.westerncape.gov.za/eng/pubs/public_info/B/246961


PAGE 8

Rules of the Fund

RU

LE

S O

F T

HE

FU

ND

HOW TO CLAIMTo make claiming an easier, stress-free experience, the information below will provide you with guidelines that ensure your claim will be processed and assessed correctly and on time and move through our systems faster.

TIME FRAMEKindly ensure that all accounts reach the Fund within four months of the date of treatment. Unfortunately claims received after this date will not be paid as they fall outside of our claims requirements.

MEMBER INFORMATION REQUIREMENTS Claims will only be paid on receipt of the following information:• the original invoice from the doctor or

healthcare provider or• claims that are submitted electronically

(via email only) from the doctor or service provider.

You may also submit a claim via the Transmed website at www.transmed.co.za

Please note: Faxed copies of doctors, dentist or clinic invoices will not be processed as this is not a reliable communications source. For prompt account payment, please ask your service provider to submit claims electronically via email or the internet, where the correct channels have been set up.

Please ensure that all accounts sent to Transmed contain the following details:• a clear indication that you are a Transmed

member• your membership number• the name of the principle member• your surname and initials• the patient’s name and dependant code

as it appears on the principal member’s membership card

• the date on which the service was rendered

• the name and practice number of the service provider (ask for this information from your doctor or nurse).



PAGE 9

You may also submit a claim via the Transmed website at www.transmed.co.za

All claims should be sent to:

Transmed Medical FundClaims DepartmentPO Box 32931Braamfontein2017

MONTH MID-MONTH MONTH-END

January 3/01/2012 27/01/2012

February 17/02/2012 02/03/2012

March 16/03/2012 30/03/2012

April 13/04/2012 27/04/2012

May 18/05/2012 01/06/2012

June 15/06/2012 29/06/2012

July 13/07/2012 27/07/2012

August 17/08/2012 31/08/2012

September 14/09/2012 28/09/2012

October 19/10/2012 02/11/2012

November 16/11/2012 30/11/2012

December 14/12/2012 28/12/2012

CLAIMS RUN DATES FOR THE REMAINDER OF 2012The Fund has two claims runs per month. Please always ensure that you quote your membership number when you submit accounts and correspondence to Transmed.


PAGE 10

HO

W Y

OU

CA

N H

EL

P U

S

FEEDBACK AND INTERACTIONLETTERS FROM OUR MEMBERS

Dear Transmed

Kindly allow me to state my gratefulness towards Transmed Call Centre agent, Alta Botha, who assisted me with my mother’s accounts. I am certain that she will continue to provide good service to all Transmed clients; her willingness to help has brought peace to our family.

Kind RegardsMrs M Fryer

To whom it may concern

I, Mrs M.W.J. Pretorius, Mr B.C.R. Pretorius and our son, who is diabetic and nearly lost his leg due to the illness, would like to thank Transmed for the support they gave us during the time our son was hospitalised. Without Transmed, we wouldn’t have been able to make all the payments.

Many thanks to each one of you for your help; you were very helpful and effi cient. We will stay members of Transmed for as long as it takes, simply because of the help that we have gotten. I don’t think anyone can complain about the service that Transmed is giving to their members.

Our son is steadily recovering and there is progress.

Warm RegardsMr & Mrs Pretorius

EDITOR’S COMMENT

Dear Members

Thank you for your feedback. It is always a pleasure to receive positive feedback from members. We strive to do everything in our power to offer members the necessary support and assistance when you need it most.

All members are welcome to provide details about your experiences with the Fund to us in order to share them with other members. As a result of space limitations all letters can unfortunately not be printed. Please indicate your membership number when you make your submission, but please note that personal details will not be published unless specifi ed otherwise.

Important e-mail addresses to communicate with the Fund are as follows:

• Enquiries: [email protected]• Compliments: [email protected]• Complaints: [email protected]• Appeals: [email protected]

Healthcare fraud can affect everyone, including you. Should you suspect your healthcare practitioner or another Fund member of wrong doing, please report this to our fraud hotline as soon as possible. A small amount of healthcare fraud can raise the cost of healthcare benefi ts for everyone.

WHAT IS HEALTHCARE FRAUD?Healthcare fraud is a crime. It is committed when a dishonest provider or member intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of healthcare benefi ts payable or to get paid more than they are entitled to.

Some examples of provider healthcare fraud are:• billing for services not actually

performed• falsifying a patient’s diagnosis to

justify tests, surgeries or other procedures that aren’t medically necessary

• misrepresenting procedures performed to obtain payment for non-covered services

• up-coding/billing for a more costly service than the one actually performed

• unbundling (separate pricing) – billing each stage of a procedure as if it were a separate procedure

• accepting kickbacks for patient referrals

• waiving patient co-payments or deductibles and over-billing the insurance carrier or benefi t plan

• fi ling claims for services or medications not received

• forging or altering bills or receipts.

To report suspected fraud pleasecontact the KPMG Anti-Fraud Hotline anonymously on 0800 200 564.

HOW YOU CAN HELP

US

HEALTHCARE FRAUD



PAGE 11

WA

TC

H T

HE

CA

LE

ND

AR

TH

E C

AL

EN

DA

R

WATCH THE CALENDAR

Services State Plus Network State Plus Own ChoicePrivate Network Saver

Client Service Centre 0861 665 665 0800 450 010

Hospital and major medical pre-authorisation 0800 225 151 0800 225 151

Disease programmes 0861 665 665 0800 225 151

Ambulance authorisation 0800 115 750 0800 115 750

HIV/AIDS programmes 0861 665 665 0861 888 300

Health Advice Line 0800 115 750 0800 115 750

Mahala Loyalty Programme 0860 624 252 0860 624 252

Chronic medication application (fax) 0866 674 374 0800 122 236

KPMG Anti-Fraud Hotline 0800 200 564 0800 200 564

IMPORTANT CONTACT DETAILS

HEALTH CALENDARTo raise health awareness nationally, the Department of Health allocates health awareness themes throughout the year. Below is the list for the third quarter of 2012. Frequently visit the Transmed website at www.transmed.co.za through which you can learn more about these health awareness themes and other health related topics.

July: Mental Illness Awareness Month

August: National Women’s MonthOrgan Donor Month

September:National Heart Awareness MonthNational Oral MonthEye Care Awareness Month

SOURCEDepartment of Healthwww.doh.gov.za


PAGE 12

J U L Y 2 0 1 2 I N F O B U L L E T I NJ

COMPETITION

Win a Pick n Pay gift card

to the value of R2 300 (fi rst

prize) or R1 000 (second

and third prizes)

by solving the

Word Search

Puzzle.

ck

ue of R2 300 (fi rst

R1 000 (seecococooo dndndndndndd

prizes)

g the

earcchhhh

POST YOUR ANSWERS TO: Word Search Puzzle CompetitionPO Box 32759Braamfontein2017

Your entry form must reach Transmed Medical Fund by no later than Tuesday, 31 July 2012.

FULL NAME:PHYSICAL ADDRESS:POSTAL ADDRESS:E-MAIL ADDRESS:MEMBERSHIP NUMBER:CELL PHONE NUMBER:TEL: (H)TEL: (W)

PREVIOUS WINNERSCongratulations to all the winners of the 36th edition (April 2012) of Infobulletin.

FIRST PRIZE:B.N. MaokeMembership Number: 0358139

SECOND PRIZEE.S. BothaMembership Number: 003316730

THIRD PRIZEM.P. JordaanMembership Number: 003943320

Winners will each receive a Pick n Pay gift card. The fi rst prize winner will receive a gift card to the value of R2 300 and the second and third prize winners will each receive a gift card to the value of R1 000.

SOLUTION FROM PREVIOUS EDITION

CO

MP

ET

ITIO

N

TERMS AND CONDITIONS

• The competition is only open to Transmed Medical Fund members and their registered dependants. • Late entries will not be considered for the draw.• Please note that entries may only be posted to the Fund - no faxed entries will be accepted.• Winners will be notifi ed telephonically and their names will be published in the Infobulletin. The Fund may require the publication

of the photographs of the winners.• The judges’ decision is fi nal and no correspondence will be entered into.• Entry into the competition signifi es acceptance of all rules.

• PRESCRIBED

• ANONYMOUS

• PHARMACIES

• SPECIFICATION

• PREGNANCY

• TUBERCULOSIS

• REPRODUCTIVE

• EMBARKING

• AMENDMENTS

• MINIMUM

• PRESCRIBED

• ANONYMOUS

• PHARMACIES

• SPECIFICATION

• PREGNANCY

• TUBERCULOSIS

• REPRODUCTIVE

• EMBARKING

• AMENDMENTS

• MINIMUM

The words may be spelt either horizontically, vertically, forwards, backwards and diagonally. Circle the words that you fi nd.

E V I T C U D O

P

R

R

E

S

S I S O L U C R

B

T

E

U

P

Z R P X Y I P Q

E

P

T

A

E

P H AR

M A C I

S

Y

E

F

C

R

M F D B V E

P

P

L

C

I

E G

EN E M PU

N

T

X

E

F

S N

N U Z Q I P

P

Y

A

G

I

C I

DS

Y N P N

F

P

P

V

C

R K

M P C P G P

B

L

I

D

A

I R

E X K E R B

M

M

N

X

T

B A

NY R I P X

Z

P

O

U

I

E B

T P EZQ P

B

M

V

P

O

D M E

S O U M Y N

N

P

O

A

NPP

EP

PP

RI

FP N

XP

PP

KY

EB M

PQ

PP

PP

BN

XZ

PU P

PP

PPP

P

1 EYE DISORDER

2 GLAUCOMA

3 PSYCHOSOMATIC

4 BULLYING

5 CASH STRAPPED

6 CATARACT

7 DETACHMENT

8 FLOATERS

9 REAFFIRMING

10 DEVELOPMENTAL

The words may be spelt either horizontically, vertically, forwards, backwards and diagonally. Circle the words that you fi nd.

G EP

X P U R S

W

D

I

E

L

WV T O S G C Q

G

E

P

Y

A

Z G N I Y L L U

N

P

B

E

T

D H ER

C A C I

I

P

E

D

N

R

M F H U V E

M

A

L

I

E

S Y

HN

O C PK

R

R

X

S

M

R N

C U S O I P

I

T

A

O

P

E I

AS

O M P O

F

S

P

R

O

T R

T P M A G P

F

H

X

D

L

A P

E X A E R B

A

S

N

E

E

O A

DY T I P X

E

A

O

R

V

L Q

T P IZQ P

R

C

V

P

E

F M V

I O C A T A

A

T

R

C

D


Documents

REPRO INFO Bull JUNE 2012