Financial Advisers
  • Overview
  • Forms and Guides
  • Accreditation
  • FAQs
  • Medware Log-In
  • Downloads
  • Communication
  • Escalation Process

Overview

Financial advisers, this is your exclusive resource for: servicing LMS members, accessing information, unpacking new developments and mastering relevant systems. On this page are links to an array of useful intermediary tools, forms, downloads and guides from Liberty Medical Scheme, incorporating Medicover. And once you log in, you´ll have access to a host of additional information, documentation, functions including the online servicing system.

Document Library
Use our Document Library to easily access important medical aid related documents, forms or guides.
 
 
Ask a Question
Have a specific healthcare need or requirement? Wondering how the system works? Or just need a little more information on a certain topic? Our handy Ask-A-Question function should be able to assist you.





Forms and Guides

Marketing
Liberty Medical Scheme wants to make it easier for you to do your job. Use this page to access marketing material including the LMS brochure (full and abbreviated versions), Corporate Network brochure, LiveWell brochure, Medical Pre-Funder brochure, up-to-date fact sheets per LMS option and the LMS annual report.

New Business Forms
Here you´ll find the relevant application forms for individual membership and for group membership.

Member Amendment Forms
Here intermediaries are able to access the forms that members must complete when there is a change in their membership details: contact details, status, bank account details, intermediary appointment, option changes and need for duplicate membership cards.

Accreditation

IFAs
This section details the procedure to be followed and the requirements to be met by independent financial advisers (IFAs) who would like to accredit themselves with the Council for Medical Schemes. Click here to download all the documentation.

Agency & Franchise
This section details, the procedure to be followed and the requirements to be met in order for agents and franchise consultants to accredit themselves with the Council for Medical Schemes. Click here for all the information.

FAQs

Here you´ll find an array of frequently asked questions that are relevant to the intermediary / broker function, with up-to-date and accurate answers to clarify things for you. If you can´t find the question and answer you´re looking for in this section, please give us a quick call on the FA line: 0860-002-168.


[+] GENERAL MERGER INFORMATION:
  1. What was the reason for the merger between Liberty Health Medical Scheme (LHMS) and Medicover?
  2. What’s in it for the members?
  3. What’s the new scheme called?
  1. The evolving medical scheme environment dictates that growth is an important element of scheme sustainability. The amalgamation has resulted in a scheme that is a more dominant force in the industry – at least the 4th largest open scheme. It is therefore in a far better position to attract additional members and negotiate improved benefits and services for its members.
  2. An amalgamation provides access to well-established distribution channels and broad marketing expertise, which will ensure better market penetration, both geographically and within the corporate market sector. The members of both schemes have access to a wider range of benefit options from which they can choose, depending on their healthcare needs. The larger risk pool provides a more stable - and hence, predictable - claims experience, which should result in more stable member contributions from year to year.
  3. “Liberty Medical Scheme”
[+] COSTS:
  1. What will this move cost me?
  2. It is assumed one of the driving forces of the merger was to improve the financial performance of both schemes. Does this mean that members will be saving on their premiums or will members from both schemes be required to pay more for their plans going forward?
  3. How will the merger affect the premiums of the two schemes?
  1. Administration costs are included in your monthly contribution. There will be no additional cost to you.
  2. Yes. It is anticipated that members will be positively impacted in these areas, going forward. For Medicover, which has a high GEMS contingent, with the increased membership and larger risk pool in the new Scheme, it is anticipated that members will benefit positively going forward. LHMS members will benefit positively due to the reserves being bolstered and a smaller factor for reserve build having been passed on to members.
  3. Members will be positively affected.
[+] BENEFITS:
  1. Will my savings still be available?
  2. What will happen to my savings if I move to an option without savings?
  3. Will my benefits change?
  4. As two medical aids have merged, will a wider range of benefit options/plans be provided to members? If so, what will these benefits be?
  5. With regard to existing LHMS members, is there the possibility that existing plans will fall away in future?
  6. If so, when can members expect to see this and what will happen to members on those plans?
  7. Will my benefits change?
  8. With regard to existing Medicover members, is there the possibility that existing plans will fall away in future? If so, when can members expect to see this and what will happen to members on those plans?
  9. Why is it closing?
  10. How will I pre-authorise a surgery?
  11. I have a pre-authorisation number. Will this change?
  12. I am pregnant and my baby is due in January 2010 (or any future month in 2010). Can I still book my hospital bed in advance?
  13. What happens to the existing Medicover members’ hospital and chronic authorisations? Will they have to re-apply?
  14. How will the Medicover members who are currently on the HIV Managed Care Programme be affected?
  15. Do I need to re-submit a prescription?
  16. Will there be any change to the current services provided by the scheme/s?
  17. Can I continue to visit my existing walk-in branch?
  18. Does the merger bring any loyalty type benefits/programme?
  1. Yes. All financial transactions will continue to operate as they have always done.
  2. If you choose to move to a Liberty Medical Scheme option that does not have a savings component, your positive savings left from your old option will be paid to you in accordance with Medical Scheme legislation. The Medical Scheme legislation requires Liberty Medical Scheme to retain your savings for a period of four months (to allow for claims from 2009 to be submitted up to end-April 2010. Liberty Medical Scheme will pay out the remaining savings balance directly to you during the course of May 2010.
  3. They may. Members on Medicover Alta and LHMS Gold Complete will be affected. For other members, the benefits are embedded in the Rules of the Scheme and will not change significantly as a result of the merger, but changes may occur due to normal year-end changes.
  4. Yes. Medicover members currently have three benefit options, and LHMS members have eight benefit options. With the merging of the schemes, there will be nine benefit options available to members in total.
  5. LHMS Gold Complete will fall away with the merger. At this stage, there are no plans for any other option to fall away, but this depends on the membership and financial performance of the options.
  6. Members on the Gold Complete option will be defaulted to the Titan option on 1 January 2010. However, they are welcome to chose another option if they wish.
  7. The Alta plan will close on merger. The members affected will be able to choose an appropriate option from the nine remaining.
  8. No more changes are envisaged at this stage.
  9. This option is currently running at a significant loss and the Council for Medical Schemes will not allow it to continue to be cross-subsidised by the other options.
  10. Continue to use the current contact details until you are advised of new contact details. Where your medical service provider obtains the pre-authorisation on your behalf, you need take no action.
  11. No. Your pre-authorisation number is logged in our database system against your membership number, and will remain available and valid.
  12. Yes. This authorisation is logged against your membership number and will not be lost. Members will retain their existing membership numbers.
  13. No. They need not re-apply. The same administration system is being used by LHMS.
  14. These members will not be affected. LHMS and Medicover are administered by the same administration system and use the same HIV Managed Care Provider.
  15. No. Your medication is logged into the computer system against your membership number. Members will retain their existing membership numbers.
  16. All current services enjoyed by scheme members and intermediaries will continue to be provided.
  17. Yes.
  18. No.
[+] ADMIN-RELATED QUERIES:
  1. How will the database be transferred to the new administration?
  2. Does Liberty Health foresee any administration problems in terms of:
    • Members moving from Medicover to LHMS?
    • Existing members having to re-register their details?
    • Delays on claims because of the merger (for both LHMS and Medicover)?
    • Processing of new business applications for both LHMS and Medicover?
    • Payment of broker commission?
  3. How will they know my case history?
  4. Do I need to advise my doctors of this change?
  5. My doctor liaises with a managed care professional. Who should he contact?
  6. My doctor submits his account directly. How will he know where to send it?
  7. I may have a query that hasn’t been resolved. What will happen to this?
  8. Will membership numbers change?
  9. Will Medicover members receive new membership cards, and if so, by when?
  10. Will there be any change to the Board of Trustees and Executive Principal Officer?
  11. What are the new contact details of the scheme once the merger has taken place?
  12. Will I have to re-submit my personal details?
  13. Will I need to change my contribution debit/stop order?
  14. Where can I post/fax/email/deliver my claims from 1 January 2010?
  15. What further communication will there be with stakeholders?
  16. Can you tell me first, before you tell my client?
  17. What will be the effective date of change?
  18. Is the Council for Medical Schemes involved?
  1. The same administrator currently administers both schemes and an amalgamation should not pose any administrative problems. It is likely to lead to a more efficient administration.
  2. Due to both Schemes being on the same system, the likelihood of risks associated with a merger is minimised. Although there can be teething problems with such mergers, no significant issues are expected.
    • No.
    • No.
    • No delays are expected; however, over a period of transition, one has to be vigilant with the details and submission of claims.
    • No delays are expected.
    • No delays are expected.
  3. Your case history is logged into the computer system against your membership number, so it will remain available.
  4. The Scheme will communicate the change to all medical service providers, but Medicover members should remind their doctors, pharmacists, etc. of the name change as they may have missed our multiple communication efforts.
  5. The Scheme will directly communicate contact detail changes to all medical service providers. You may also provide them with the general contact centre number on the new membership card you will receive in November 2010.
  6. The Scheme will communicate contact detail changes to all medical service providers where applicable. Should he/she send it to the old Medicover address, however, plans are in place to ensure that it is appropriately redirected.
  7. The same administrator currently administers both schemes and an amalgamation should not pose any administrative problems. A centralised client services team will deal with your enquiry.
  8. Less than 1% of existing members will be issued with new membership numbers ahead of 1 January 2010. They will receive a special communication in this regard along with new membership cards.
  9. Over 99% of Medicover members will retain their number, but receive new membership cards. (A very small percentage will change membership numbers, less than 1%, but members and their brokers will be communicated with directly.)
  10. Yes. To ensure the protection of members’ interests, continuity of experience and knowledge from the existing Medicover and Liberty Boards of Trustees will be critical. For this reason the Board of Trustees of Liberty Medical Scheme on 1 January 2010 shall consist of 5 board members each from Liberty and Medicover. LHMS currently has a full time Executive Principal Officer, while Medicover has a part-time Principal Officer. Mr Andrew Edwards, who currently serves Liberty, will therefore continue in this role.
  11. The Scheme’s call centre number will remain unchanged, but consolidation may happen after six months. This aims to improve efficiencies and make contacting us easier. Please refer to the contact details on the new membership cards, as well as those contained in the 2010 Member Guide.
  12. No. There will be no change to the operating environment where your data is stored.
  13. No. Your banking details will be kept for debit/stop order purposes as per current arrangements. At some future point in 2010 Medicover members who pay their contributions via cash deposits will have to do so into a new account. The relevant details will be released closer to the time.
  14. You will be advised of the new contact details in good time, by email, SMS or post. Claims can be faxed to 021-673-9583, emailed to claims@libertyhealth.co.za or sent to the Liberty Medical Scheme postal address at Private Bag X35?Claremont?7735.
  15. Members who are directly affected by the change will be advised of the merger and any changes on an individual basis. LHMS members will also be advised of changes in the Newsbreak, as well as via SMS or e-mail. Intermediaries will receive a letter with details of the merger. In addition, intermediaries will be advised of any changes that impact their client base.
  16. The communication plan is designed to keep intermediaries advised of all progress made, ahead of any communication with their clients.
  17. 1 January 2010.
  18. Yes. Approval from the Council of Medical Schemes has been received.
[+] IMPACT ON THE MARKETPLACE:
  1. Historically, LHMS has appealed to a small segment of the market, predominantly white middle-class individuals in a higher LSM bracket. How will the merger affect this profile? And how will the perceptions of LHMS members be managed?
  2. And the perceptions of Medicover members?
  3. Does the merger with Medicover re-position LHMS in the marketplace?
  4. How has the merger impacted on LHMS’ profile (solvency and demographics)?
  5. Is the Scheme still financially secure?
  6. As LHMS and Medicover members come from very different LSM groups, what will LHMS’ focus be over the next 18 months, in order to ensure seamless integration?
  1. The merger will improve LHMS’ profile, bringing two different market segments together and expanding the offering to a wider audience of members i.e. the lower LSMs.
  2. We don’t foresee a problem here - LHMS’ fastest-growing option is in the low LSM market, so there is some success in this area already. Medicover members’ interests will be taken care of by a governance structure representing both constituencies. Option names will be retained. The same membership numbers will be used. A ‘subscript” will be used on the cards for brand association with the previous name and careful communication will be undertaken to manage any negative perceptions.
  3. Yes. The LHMS will be positioned as one of the top five open medical schemes in the healthcare industry.
  4. The solvency ratio will improve from 23% to approximately 30%. The merger will improve LHMS’ profile and demographics. The Medicover average age is slightly lower than LHMS’.
  5. Yes. The merger has no effect on the financial stability of the Scheme. In fact, the scheme is enhanced financially due to a larger risk pool and extra solvency funds available to bigger scheme.
  6. The focus will fall on enhanced and clear communication spanning the whole membership.

Medware Log-In

Log in to our online system, Medware, to view member listings, contact details and other information.

Downloads

Download the Electronic Membership Interface (EMI) to create individual quotes and load new applications electronically. The EMI User Manual is also available. Log on by entering your username and password to access these tools.

Communication

Newsbreak and Sales Toolbox pages, as well as archived communication items, are accessible here.

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Contact Centre

Call Centre hours:
Monday to Friday
08h00 – 17h00
Medical emergencies:
082911
(24 hours a day)
Members and Providers
Tel: 0860-002-163
Fax: +27 (21) 657-7571
For email enquiries:
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Intermediary Centre
Tel: 0860-002-168
Fax: +27 (21) 657-7581
For email enquiries:
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Hospital Approvals
Tel: 0860-002-163
Fax: +27 (21) 657-7711
For email enquiries:
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Chronic Medicine
Tel: 0860-002-163
Fax: +27 (21) 657-7681
For email enquiries:
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