CAMAF Member Option Guides & Info

5 1.5 Why do scheMes IMPose forMulArIes? as set out in 1.1, a medical scheme has the responsibility to manage the members' investment in the pool of funds to ensure the most appropriate and successful health outcomes. A formulary is a defined list of preferred medication to treat specific diseases, based on clinical effectiveness and cost. it can include generic medication and patented medication, where a generic is not available. the formulary is updated regularly as new medication is registered, new generics become available or prices change. 1.6 hoW cAn I AssIsT In curTAIlIng MedIcAl scheMe PreMIuM IncreAses? members are often unaware of the impact they can have on their medical scheme contributions. since schemes do not have the profit motive, any excess funds are accumulated for the future benefit of members for improving benefits, for limiting contribution increases and for building reserves for unforeseen circumstances. Members can reduce claim costs by undertaking the following: • looking after personal health. seek regular screening of blood pressure, glucose levels, cholesterol and hIV status. If any risks are identified, a visit to the doctor is essential. If a diagnosis is made, immediately contact your scheme disease management programme for educational material and approval of your medication. this will provide you with an enhanced understanding of your disease and how best to limit the impact of the disease on your daily living experience; • exercise regularly and follow a healthy eating plan. Take your medication as prescribed, in particular chronic medication, to prevent deterioration of your health and possible future hospitalisation; • request an appropriate generic equivalent for prescribed medication from your doctor or pharmacist; • Interact with your medical service providers to determine if they charge 'medical scheme' rates (to which many providers still refer) for your hospital procedure or PMB condition; • do not treat your annual medical scheme benefits as a shopping list. When the year comes to an end, some members look at their remaining benefits to identify what they can still claim. This merely drives up the claims cost often without any clinical benefit.

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