Benefits and Contributions 2019
It is said that each year goes faster and faster, and I have found that this year is no exception. It seems that writing to you each year to share the information about the following year comes around sooner and sooner. The Product Committee started reviewing the benefits and contributions in May this year, and after much thought and a review of the market, we are excited to be sharing the Benefit and Contribution information for 2019.
To assist you with understanding what your benefits and contributions will be for 2019, click here to view your 2019 Benefit Guide. In reading through the information, if you feel that these benefits will not be enough to meet your healthcare needs for you or one of your family members, information about the other options that are available can be found right here on our website, or you can contact your broker or the Client Services Team on 0860 00 21 58 for more information.
We are also pleased to share our new website with you. The website has been redesigned and enhanced to ensure that the functionality and information available to you is clear, simple and easily accessible. We trust that you will enjoy it!
On behalf of the Board of Trustees, we thank you for your continued support and we look forward to being part of your health journey into the future, as together we manage the healthcare needs of you and your family.
Yours in Health
Barbara J Duffy
Topmed offers a wide range of options which we believe caters for all individuals and families with different healthcare needs and income levels.
To ensure that you know and understand what your benefits are, we would encourage you to go through the information in the Benefit booklet provided, so that you can feel safe in the knowledge that you will have the right cover for this next year, remembering that you may only change options with effect 1 January each year.
Should you need additional information such as how to claim, membership rules, obtaining pre-authorisations, query resolution, etc. all of this information is also available in the Member Area of the website, under the FAQ section at the bottom of the page.
Below is a summary of the benefit changes for 2019. However, as noted above, we would really encourage you to take time to read through the information on your specific option so that you are fully informed about your benefits and contributions for 2019. Whilst most options have had very few changes, we are very excited about the enhancements to Active Saver, which are noted below.
Summary of changes
|OPTION||OVERVIEW OF BENEFITS|
|All Options||The majority of benefit limits, deductibles and co-payments have been increased by an average of CPI|
|There have been no changes to the benefits covered on these options|
|Active Saver||A day-to-day GP consultation and preventative Dentistry benefit have been added to assist members who have run out of Savings. Specific rules and limitations apply, and these benefits are only available once your Savings Account has been completely depleted. In addition to this, a day-to-day MRI/CT scan benefit has also been included however please note that a co-payment applies. Please refer to the Benefit Guide for details.|
|Limited||The Limited Option will not be available for 2019. If you are currently on the Limited Option, you will be defaulted to the Essential Option. However, if this does not seem suitable for you, please feel free to review the information on our website and change to the option that will best suit your healthcare needs for this coming year.|
|Network||There has been an adjustment to the income bands so please review the contribution table to ensure you know what your monthly contribution will be.|
PLEASE TAKE NOTE
Proof of your income is required if you are currently on the Network Option or you choose the Network Option for 2019. The contribution payable is determined by the highest income of the principal member and/or spouse/partner. If we do not receive the necessary proof of income by 7 December 2018, your contribution for 2019 will be defaulted to the highest income category.
Should you change to the Network Option for 2019 please ensure that you complete the Confirmation of Income Form and submit it together with a copy of either a payslip or latest tax return. A copy of the Confirmation of Income Form can be obtained from our website www.topmed.co.za or by calling the Client Services Department on 0860 00 21 58.
Please note that backdated changes will not be accommodated therefore if you miss the deadline stated above your contribution will only be updated from the month following the receipt of your proof of income.
Members with student dependants between the ages of 21-24
Topmed provides a contribution concession for dependants between the ages of 21 – 24 who are studying. However, in order to qualify for, or continue with this concession, please note that proof that your dependant is studying in 2019 must be provided by the end of February 2019. If the necessary documents are not provided to us, your dependant’s contribution will default to an adult contribution with effect from 1 March 2019.
Please note that backdated changes will not be accommodated therefore if you miss the deadline stated above your contribution will only be updated from the month following the receipt of proof of your dependant studying.
In terms of the rules of the Scheme you may only change your option with effect from 1 January of each year.
In reviewing your option for 2019 ask yourself the following:
Has my health or that of anyone in my family changed?
- Is there going to be a change in my income for next year?
- Does my current option definitely cover the level of care that I need?
- If not, should I be looking at one of the other options?
If you are an individual member you can change your option by:
Simply calling Client Services on 0860 00 21 58
- Emailing your choice of option to firstname.lastname@example.org
- Logging onto the web under your user ID and selecting your option
If you are part of an employer group on Topmed you will need to submit your option change form to your payroll or HR contact so that they can ensure the correct contributions are deducted from your salary. Please ensure that you understand what your company’s option change deadline is so that you can submit your option change to your payroll or HR contact in time.
You can get an Option Change Form from the website or by contacting Client Services.
Please act now if you want to change your option as you will not be allowed to change your option during the year. The deadline for submitting all 2019 option changes to Topmed is 7 December 2018.
And, if you haven’t already got it – don’t forget to download our mobile app which provides access to your Scheme information at the tip of your fingers.
To access your information via the website:
Go to www.topmed.co.za and click on Login and then click Member
- To register click on New User and complete the details
To access your information on your mobile device:
To download the Mobile App go to Google Play or the AppStore
- Search for Topmed Medical Scheme and click Install
- To register for a username and password click Register
REGISTER ONCE: Use the same username and password to access the Website and the Mobile App