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LLindiwe Mashinini
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PPramjeeth, Nikita
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DDlamini, Nqobile
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FW: Kaelo Health Refresher
Heidie Banks
Aug 15 2024, 8:00 PM
English (Global)
Health insurance
Primecure network
GP visits
Chronic medicine
Accident cover
Employee wellness
Overview
The Kaelo Health Refresher session, hosted by Pramjeeth and Nikita with a
presentation by Lindiwe Mashinini, provided attendees with a comprehensive
overview of Kaelo Health as a health insurance option, distinct from traditional
medical aid. Key points discussed included the Primecure network of service
providers, the unlimited GP visits policy (with specifics for
pre-authorization), and access to virtual clinics, along with a variety of
additional benefits such as dentistry, eye care, accident cover, and lifestyle
programs. The Q&A segment addressed practical concerns regarding the Kaelo
membership card, the connection to Dischem, and the pre-authorization process
for doctor visits. The meeting concluded with action items such as downloading
the Kaelo Health app and engaging with HR for policy documentation.
Notes
🏥 Introduction and Kaelo Health Overview (00:54 - 04:44)
 * Meeting hosted by Pramjeeth, Nikita
 * Lindiwe Mashinini presenting Kaelo Health refresher
 * Kaelo Health is a health insurance, not a medical aid

💊 Network and Benefits (04:45 - 23:38)
 * Primecure network for service providers
 * Unlimited GP visits, first 3 without pre-authorization
 * Virtual clinics and out-of-network doctor visits
 * Clinic visits at Clicks and Dischem
 * Health screenings and flu vaccinations
 * Specialist benefits with pre-authorization
 * Scripted and over-the-counter medicine benefits
 * Chronic medicine and HIV program

🦷 Additional Benefits (25:13 - 42:48)
 * Dentistry coverage for basic procedures
 * Eye care benefits including tests and glasses
 * X-rays, scans, and blood tests coverage
 * Accident cover for private hospital treatment
 * Accidental disability and death cover
 * Lifestyle benefits including Ask Nelson employee wellness program

❓ Q&A Session (43:43 - 49:18)
 * Obtaining Kaelo members card
 * Connecting Dischem card with Kaelo card
 * Clarification on pre-authorization for doctor visits

🔄 Wrap-up and Final Questions (49:18 - 51:01)
 * Further clarification on pre-authorization process
 * Conclusion of the meeting

Action items
unassigned
 * Download the Kaelo Health app to access digital membership card (42:45)
 * Liaise with HR or broker to check Kaelo system loading status and request
   policy document if needed (45:20)
 * Obtain pre-authorization for doctor visits starting from the fourth visit
   onwards (48:00)



Transcript

PPramjeeth, Nikita

00:53

It is going to give it a few more minutes to allow others to join. Give it a few
minutes more. 
LLindiwe Mashinini

02:15

Good evening, everyone. 
PPramjeeth, Nikita

02:18

Hi Mohadi. 
LLindiwe Mashinini

02:19

Hi, Mukhari. Who do we have from Gailo today? Lindiwe. Oh, Lindiwe. Okay, I can
say there's two Lindiwe. There's another one from confused. 
PPramjeeth, Nikita

02:35

Our Lebanese from Transunion is not joining us for the session. 
MMaepa, Mokgadi (Johannesburg)

02:40

Okay. All right. 
PPramjeeth, Nikita

02:41

Hi, Lebo. 
SSpeaker 4

02:44

Hi. 
PPramjeeth, Nikita

02:45

We're just going to give it two minutes more to allow others to join. Okay. 
DDlamini, Nqobile

03:12

Okay. 
PPramjeeth, Nikita

03:12

We're going to give it 1 minute more. Okay. I'm going to get started while we
have others that are joining us. Thank you so much, everyone that has joined us
for our session. We've got Lynn Diwe who is going to be taking you through the
Kahlo health refresher. If you have any questions, you're more than welcome to
ask them at the end of the session. Okay, Lindiwe, over to you. 
LLindiwe Mashinini

04:15

Good evening, everyone. So my name is Lindiwe and I will be taking you through
the Gaelo health plus benefits. Please feel free to ask questions if you have a
question, you can also post this in the chat box and I will respond to all
questions after the presentation. Please just. Nikita, can you see my screen
there? 
PPramjeeth, Nikita

04:42

Yes, I can. 
LLindiwe Mashinini

04:44

All right, thank you so much. Let's go through the presentation. 
LLindiwe Mashinini

04:57

Okay, so we are, in short, by centric and small disclaimer is that this. 
LLindiwe Mashinini

05:02

Is not a medical scheme. 
LLindiwe Mashinini

05:04

And the COVID is not the same. 
LLindiwe Mashinini

05:06

As that of a medical scheme. 
LLindiwe Mashinini

05:08

The policy is not a substitute for medical scheme membership. So what this means
is that Gaelo health is a health insurance. It is not a medical aid. It does not
have the same benefits as a medical aid. It does not substitute a medical aid. 
LLindiwe Mashinini

05:24

It is a health insurance. So we've got a network. Our network is called
Primecure. 
LLindiwe Mashinini

05:31

And when you are using your Gaelo health membership, you need to make sure. 
LLindiwe Mashinini

05:36

That you are using service providers that are within the primecure network. So
you cannot just go to any doctor or any pharmacy. You need to familiarize
yourself with the Primecure website. This is where we check for all our service
providers. So all you need to do, you. 
LLindiwe Mashinini

05:52

Log into Primecare co dot za. You click on search for network provider. You
click which service provider you need, whether it's a pharmacy, it's a GP. 
LLindiwe Mashinini

06:02

It'S a dentist, you enter your physical address and then it will show you all
the service providers in your area, okay. That you can use, that are in the
network. So we've got pharmacies in the network. So as you can see, we've got. 
LLindiwe Mashinini

06:19

Clix, we've got discam, we've got Maryright. 
LLindiwe Mashinini

06:22

And we've got spa. So here we are listing the four major pharmacies. 
LLindiwe Mashinini

06:26

But it's not just limited to these four pharmacies. 
LLindiwe Mashinini

06:30

When you log on to the Prime. 
LLindiwe Mashinini

06:32

Cure website, you will also see that. 
LLindiwe Mashinini

06:34

There is other small pharmacies that you will find on the website. Here we are
listing the four major ones. 
LLindiwe Mashinini

06:41

With that said, not all Clix pharmacies take that Giello health card. 
LLindiwe Mashinini

06:46

So that is why you need to make sure that you just log on. 
LLindiwe Mashinini

06:48

To the prime care website and check. 
LLindiwe Mashinini

06:51

Which pharmacies you can go to in your area. 
LLindiwe Mashinini

06:55

And then we've got general practitioners. 
LLindiwe Mashinini

06:57

These are our doctors, our gps, and we've got dispensing doctors and non
dispensing doctors. 
LLindiwe Mashinini

07:05

So a dispensing doctor will see you, will have a consultation and assess you,
and then give you medication. 
LLindiwe Mashinini

07:12

That's a dispensing doctor, while a non dispensing doctor does not give you any
medication. 
LLindiwe Mashinini

07:19

Yes, they will have the consultation with. 
LLindiwe Mashinini

07:21

You, they will assess you, but they. 
LLindiwe Mashinini

07:23

Will not give you any medication. What they will do is they will. 
LLindiwe Mashinini

07:27

Write you a prescription to go collect your medication at a pharmacy. 
LLindiwe Mashinini

07:32

We've got hospitals in the network, we've got optometrists, we've got
psychologists and social. 
LLindiwe Mashinini

07:37

Workers, and we've got dentists. 
LLindiwe Mashinini

07:39

Okay? So let's go into the benefits. We've got doctor visits. So these are our
GP consultations. Okay? 
LLindiwe Mashinini

07:47

You've got unlimited, you are covered for. 
LLindiwe Mashinini

07:50

Unlimited GP visit per insured party per annum. 
LLindiwe Mashinini

07:54

So we don't limit you in terms. 
LLindiwe Mashinini

07:55

Of how many times you go to. 
LLindiwe Mashinini

07:57

The doctor, but your first three visits, you do not need any pre authorization. 
LLindiwe Mashinini

08:02

So you go for your first, your. 
LLindiwe Mashinini

08:04

Second and your third. You do. 
LLindiwe Mashinini

08:06

You do not need any pre authorization. As soon as you now go for your fourth,
your fifth going forward, you. 
LLindiwe Mashinini

08:13

Now need to start obtaining pre authorization prior to going to the doctor. 
LLindiwe Mashinini

08:18

At some practices or some doctors, the. 
LLindiwe Mashinini

08:21

Receptionist can call on your behalf and obtain the pre authorization. Others,
they don't call. They want you to come with the pre authorization when you come
see the doctor. So please make sure that you do obtain your pre authorization
from your fourth visit. 
LLindiwe Mashinini

08:40

And then we've got virtual clinics. This is also unlimited consultations and you
do not need any pre authorization for a virtual consultation. So a virtual
consultation. Virtual clinics is a telephonic or a virtual consultation with the
doctor. 
LLindiwe Mashinini

08:57

So for an example, if you do not want to consult or physically go to the doctor,
want to consult at home. 
LLindiwe Mashinini

09:05

What you can do is you need. 
LLindiwe Mashinini

09:07

To call prime cure, set up an appointment, and then at the time that. 
LLindiwe Mashinini

09:11

You have chosen a doctor will then. 
LLindiwe Mashinini

09:12

Give you a call and then you will have that consultation via video call or teams
call or a telephone call. 
LLindiwe Mashinini

09:21

Okay? 
LLindiwe Mashinini

09:21

So the doctor will then call you. 
LLindiwe Mashinini

09:23

At the time that you have chosen. 
LLindiwe Mashinini

09:24

And, and then have the consultation with you. Another way of doing this is you
can go to a book a nurse consultation at Discam clinic where the nurse will
first assess you. So you can go to any discem clinic. There is a nurse there is
an on site clinic, you can go. 
LLindiwe Mashinini

09:44

Have a consultation with the nurse. 
LLindiwe Mashinini

09:46

The nurse will assess you and if. 
LLindiwe Mashinini

09:48

The nurse feels that you need to. 
LLindiwe Mashinini

09:49

See a doctor or consult with the. 
LLindiwe Mashinini

09:52

Doctor, the nurse will video call a. 
LLindiwe Mashinini

09:54

Doctor and then you will have that. 
LLindiwe Mashinini

09:57

Video call consultation with the nurse and the doctor virtually. And then once
the consultation is done, the doctor will send you a prescription. 
LLindiwe Mashinini

10:05

And then you collect your medication at the pharmacy. 
LLindiwe Mashinini

10:08

So as you can see, you are covered for unlimited consultations. Then we've got
out of network doctors visits. 
LLindiwe Mashinini

10:16

So we are giving you a a consult, one consultation to see a. 
LLindiwe Mashinini

10:21

Doctor that is not in the network. So if it's just you on your. 
LLindiwe Mashinini

10:24

Health insurance, we give you one consultation. If it's a family, if it's two or
more, then we're giving you two visits per family to see a doctor. 
LLindiwe Mashinini

10:34

That is not in the prime care network. Maybe it's a Sunday, it's after hours. 
LLindiwe Mashinini

10:39

Is a, it's a Sunday and your. 
LLindiwe Mashinini

10:42

Doctor that is within the prime care. 
LLindiwe Mashinini

10:44

Network is not available, then you can visit an out of network doctor and have
your consultation. 
LLindiwe Mashinini

10:51

You will need to authorize this visit. If you went to a doctor that. 
LLindiwe Mashinini

10:55

Is not in the network, you need. 
LLindiwe Mashinini

10:58

To authorize that visit within 72 hours. 
LLindiwe Mashinini

11:00

We're giving you 72 hours to authorize the visit. 
LLindiwe Mashinini

11:05

And then secondly, because this is an out of network doctor, you will have to
pay cash for this consultation and then complete the refund process. 
LLindiwe Mashinini

11:14

We will refund you whatever it is that you paid to the doctor up to 1100. Okay,
there is a refund process. You complete the refund form and when. 
LLindiwe Mashinini

11:26

You send it back it has to. 
LLindiwe Mashinini

11:27

Come with the proof of payment and the doctor's invoice. And then we will refund
you the amount that you paid to the doctor. 
LLindiwe Mashinini

11:35

Provided that you authorized this visit within 72 hours. And then we've got
clinic visits, clicks. 
LLindiwe Mashinini

11:44

And discam have an on site clinic. 
LLindiwe Mashinini

11:47

So you can go have a consultation. 
LLindiwe Mashinini

11:49

With the nurses there. 
LLindiwe Mashinini

11:50

For minor illnesses, okay? 
LLindiwe Mashinini

11:53

So you've got eight visits per annum. Eight visits per annum per insured
party. Okay, so for coughs to asthma, skin rashes and allergies, nebulization
and minor wound care. 
LLindiwe Mashinini

12:08

Baby weigh ins and checkups. So here it's just the weighing of the baby. 
LLindiwe Mashinini

12:12

Not the immunization or the injection that they give the baby. Just the weighing
of the baby and checkup. A general checkup. 
LLindiwe Mashinini

12:20

They can check your blood glucose and your blood pressure. And also you can get
a flu vaccine. 
LLindiwe Mashinini

12:25

So if the nurse recommends some medication, you can purchase those medicines
from your over the counter benefits. 
LLindiwe Mashinini

12:36

If you do have money available, we. 
LLindiwe Mashinini

12:38

Will explain the over the counter just now. 
LLindiwe Mashinini

12:42

Then you've got health screenings. This is health assessment. 
LLindiwe Mashinini

12:46

You're not sick. You're just doing a general checkup of yourself. So you are
covered for two health assessments per annum. So each insured party has two
health assessments, okay? Per annum. So health screenings. 
LLindiwe Mashinini

13:02

Assessments include. They check your height, your weight and. 
LLindiwe Mashinini

13:06

Your body makes index your glucose, your blood pressure, your cholesterol, and
also optional HIV testing. 
LLindiwe Mashinini

13:15

If you do not want to do. 
LLindiwe Mashinini

13:16

An HIV test, that's okay, you don't have to. 
LLindiwe Mashinini

13:20

Okay, so. But they will do all the other checks. 
LLindiwe Mashinini

13:22

So you've got two checkups per annum at any clicks or discount clinics in the
network. 
LLindiwe Mashinini

13:33

And then you can go for a flu vaccine. 
LLindiwe Mashinini

13:36

We will pay for one flu vaccination every year for insured parties older than
six months. So each insured party has one flu vaccine. Then you are also covered
for Covid-19 tests. 
LLindiwe Mashinini

13:55

We will pay for one positive Covid-19 test. 
LLindiwe Mashinini

14:00

Up to 850 per insured party per year. 
LLindiwe Mashinini

14:05

So with the COVID test, you are. 
LLindiwe Mashinini

14:07

Required to pay upfront for the test. And then if your results come positive,
then we will refund you the amount that you paid for your COVID test. Up to 850
rent. 
LLindiwe Mashinini

14:21

Okay. If your results come back negative, unfortunately, that test is not
covered. Only if your results are positive. 
LLindiwe Mashinini

14:31

We will then refund you the amount that you paid for your Covid-19 test. Then
we've got the specialist benefits. 
LLindiwe Mashinini

14:44

We know what a specialist is. 
LLindiwe Mashinini

14:45

These are your cardiologists, urologists, gynecologists. Those are specializing
doctors. Those are specialists. And we do not have any specialists. 
LLindiwe Mashinini

14:56

In the primecure network. 
LLindiwe Mashinini

14:58

This means that you can go to any specialist that you want or that you are
comfortable with. We do not have any specialists in the network. 
LLindiwe Mashinini

15:07

Okay. So an inshore party can go to. 
LLindiwe Mashinini

15:10

A specialist once a year. 
LLindiwe Mashinini

15:12

And in the case of a family. 
LLindiwe Mashinini

15:14

We allow up to two visits a year. 
LLindiwe Mashinini

15:17

Okay. 
LLindiwe Mashinini

15:17

So if it's just you and your health insurance, you've got only one
consultation. If it's a family, then you've got two consultations. Payer and
then insured parties will need. 
LLindiwe Mashinini

15:29

To pay for the specialist visit upfront. 
LLindiwe Mashinini

15:32

And then submit their claims to us for a refund. We will cover up to 2000 for
the specialist visit. Yes. 
LLindiwe Mashinini

15:40

So because the specialist is not a. 
LLindiwe Mashinini

15:42

Doctor within our network, again, you will need to pay upfront for that visit
and then complete the refund process so that we can refund you what you paid to
the doctor. We will pay up to 2000 rand for the specialist visit. And then
before you go to your. 
LLindiwe Mashinini

16:01

Specialist, you will need to authorize that visit. 
LLindiwe Mashinini

16:04

First, you don't just go there. 
LLindiwe Mashinini

16:06

You need to call prime care first. 
LLindiwe Mashinini

16:08

And obtain pre authorization to see the specialist. And then once we give you
the authorization, then you can go and have that consultation with your
specialist. And then when you call us to obtain pre authorization for the
specialist, we need your name and surname. We need your policy number. And then
we need the name and. 
LLindiwe Mashinini

16:34

The practice number of the specialist. This one is very important. 
LLindiwe Mashinini

16:38

We need the practice number of the specialist that you're going to see. 
LLindiwe Mashinini

16:46

And then you also covered for scripted medicine. 
LLindiwe Mashinini

16:50

So scripted medicine is prescription medication that. 
LLindiwe Mashinini

16:54

Is prescribed by a doctor. 
LLindiwe Mashinini

16:56

They give you a script, then you go collect the medication. So you are covered
for unlimited scripts. 
LLindiwe Mashinini

17:03

Okay. 
LLindiwe Mashinini

17:05

We will cover the medication if it is, if the medication or the prescription was
given to you by a prime cure network doctor, whether it is a dispensing or a non
dispensing doctor. 
LLindiwe Mashinini

17:19

But it has to be a doctor. 
LLindiwe Mashinini

17:20

That is in the primecure network that is prescribing the medication. Secondly,
the medication must be collected from. 
LLindiwe Mashinini

17:28

A primecure network pharmacy. 
LLindiwe Mashinini

17:31

You don't just collect anyway. You need to go to a pharmacy that is within the
prime care network. 
LLindiwe Mashinini

17:37

So we've got a formulary list. This is a list of medicines that we cover. So
please don't be shocked when you. 
LLindiwe Mashinini

17:44

Go to a pharmacy and you ask for pinealin for flu and they tell you that it's
not on the formulary. 
LLindiwe Mashinini

17:51

List or it's not covered by Giello, it's because it's not on the list. 
LLindiwe Mashinini

17:56

Of medicines that we covered. 
LLindiwe Mashinini

17:59

So if a doctor has prescribed something. 
LLindiwe Mashinini

18:01

And when you get to the pharmacy. 
LLindiwe Mashinini

18:04

It'S not part of our formulary list. 
LLindiwe Mashinini

18:06

Or it's not covered by Giello, all you need to do is ask the pharmacist to check
if there is no generic. 
LLindiwe Mashinini

18:12

We call them generics. Maybe they can check for a generic. 
LLindiwe Mashinini

18:15

That they can give you, or they can check for something similar to what the
doctor has prescribed that is available on the formulary list. 
LLindiwe Mashinini

18:28

Then we've got over the counter medicine. So over the counter, guys, this is. 
LLindiwe Mashinini

18:33

Medication that is not prescribed by the doctor. You just decide to go by and it
is brought at the over the counter section at the pharmacy. 
LLindiwe Mashinini

18:43

So over the counter medicine is medicine. 
LLindiwe Mashinini

18:45

That can be collected from a pharmacist without a script. 
LLindiwe Mashinini

18:49

Okay? 
LLindiwe Mashinini

18:50

So again here guys, even though it. 
LLindiwe Mashinini

18:52

Is over the counter, you still need. 
LLindiwe Mashinini

18:54

To purchase medication that is on our formulary list. You don't just purchase
anything, you purchase medicines that are in the formulary list. So you've got a
maximum of 460 rent per annum payer. This 460 you can't just use all at once. 
LLindiwe Mashinini

19:12

It is split into four quarters, meaning. 
LLindiwe Mashinini

19:15

That you've got 115 every three months to buy medication. So you've got 115 per
quarter to buy medication. 
LLindiwe Mashinini

19:25

If you do not use your 150. 
LLindiwe Mashinini

19:28

In the first three months, it carries over to the next three months or the next
quarter, then you've got 230. If you do not use it again, it carries over to the
next quarter. 
LLindiwe Mashinini

19:39

But you need to use this by. 
LLindiwe Mashinini

19:41

The end of the year, because if. 
LLindiwe Mashinini

19:43

You do not use this benefit, it does not carry over to the next year. This means
that you will forfeit the benefit. If you haven't used it, you haven't. 
LLindiwe Mashinini

19:52

Used it, you forfeit the benefit. So that's why you need to use it, all of it. 
LLindiwe Mashinini

19:57

If you haven't used it so far. 
LLindiwe Mashinini

19:59

By the end of day, you need to use the whole amount or you forfeit the
benefits. If you go to the pharmacy and purchase medication with 120, then we
will cover 115. That means you will have to pay the balance of five rent to the
pharmacist. Then we've got a chronic medicine benefit. So if you are diagnosed
with a chronic condition, or you already are diagnosed with a chronic condition,
then you can register to be in the chronic program. 
LLindiwe Mashinini

20:33

These are the 27 conditions that you are covered for. So if you've got any of
these. 
LLindiwe Mashinini

20:37

Conditions, then you can visit your nearest prime cure network doctor and
register to. 
LLindiwe Mashinini

20:43

Be in the chronic program. 
LLindiwe Mashinini

20:45

Okay, there is a chronic registration form. 
LLindiwe Mashinini

20:51

That you will complete with the doctor. The doctor will then send this form with
all the required documents to us. 
LLindiwe Mashinini

20:59

Then once we have assessed all the documents and you have been approved, then. 
LLindiwe Mashinini

21:05

You will start collecting your medication from. 
LLindiwe Mashinini

21:07

Clix from this camp. Okay, so the doctor sends us your. 
LLindiwe Mashinini

21:12

Prescription of medication that you need to. 
LLindiwe Mashinini

21:14

Take, the registration form and all other required documents. 
LLindiwe Mashinini

21:19

And then once you have been approved. 
LLindiwe Mashinini

21:21

You will get a message to say that you have been approved. 
LLindiwe Mashinini

21:24

Then you will start collecting your medication. 
LLindiwe Mashinini

21:27

From clicks and the scam and so on. 
LLindiwe Mashinini

21:31

And then we've got an HIV program. 
LLindiwe Mashinini

21:33

Okay, so if you are HIV positive currently or maybe you are later diagnosed with
HIV, then you can register again to be in the HIV program. Just like the chronic
program, you need to go to your prime care network doctor. There is what we call
an HIV disease management form that you will complete with the doctor. And then
once you have been approved. 
LLindiwe Mashinini

22:03

Everything that has to do with your HIV condition. 
LLindiwe Mashinini

22:06

So your counseling and testing, your arvs. 
LLindiwe Mashinini

22:09

Your treatment support from Giello healthcare providers. 
LLindiwe Mashinini

22:15

Your HIV related blood tests, your treatment of approved list of HIV related
infections, emergency medicine for post exposure and then prevention of mother
to child transmission. So as you can see everything here will be covered. Once
you have registered you complete the. 
LLindiwe Mashinini

22:39

HIV disease management form with your primcure network daughter. 
LLindiwe Mashinini

22:44

And then once you have been approved you're good to go. Then moving over to
dentistry. So guys, here we've got dentists in the network. 
LLindiwe Mashinini

22:53

When you log on to the prime. 
LLindiwe Mashinini

22:54

Care website you can search for dentists that are in the network. 
LLindiwe Mashinini

22:59

So there is one consultation in short party payer with a prime care network. 
LLindiwe Mashinini

23:05

Dentist for a full mouth examination and oral hygiene advice. 
LLindiwe Mashinini

23:10

So you can go for a full mouth examination. 
LLindiwe Mashinini

23:13

You do not need any authorization, you just go there and get your full mouth
examination. 
LLindiwe Mashinini

23:20

Then you also have cover for one preventative treatment which includes cleaning,
scaling and polishing. Each insured party has one preventative treatment per
year. 
LLindiwe Mashinini

23:31

Okay, so you just go to your prime care network dentist and get your teeth
cleaned. And then we've got fluoride treatment for children under the age of
twelve years. Then we've got basic dentistry. So guys, Gaillo covers only basic
dentistry. So your braces, your gold teeth or gold tooth and your crowns, those
are not covered because those fall under specialized dentistry. 
LLindiwe Mashinini

24:03

Extraction of the wisdom tooth, that also. 
LLindiwe Mashinini

24:06

Falls under specialized dentistry and is covered by medical aids. So health
insurances cover basic dentistry. So there is cover for restorations and
composite fillings. 
LLindiwe Mashinini

24:21

Pre authorization is needed for four or. 
LLindiwe Mashinini

24:24

More repairs to the teeth or five or more composite fillings per family
pair. There is unlimited cover for repairs to the teeth and then we've got
extractions. Pre authorization is needed for five or more extractions. 
LLindiwe Mashinini

24:41

Then there is unlimited cover for extractions. 
LLindiwe Mashinini

24:44

And then oral radiography. 
LLindiwe Mashinini

24:47

This is dental x rays. You cover for a maximum of dental. 
LLindiwe Mashinini

24:52

X rays per family pair and then pre authorization is needed from your third x
ray. And then you also have cover for emergency dentistry. 
LLindiwe Mashinini

25:02

So diagnosis and treatment for pain and. 
LLindiwe Mashinini

25:04

Sepsis, infection control and local anesthetic. Okay, then there's unlimited
cover for root. 
LLindiwe Mashinini

25:12

Canal treatment, subject to a list of approved codes. 
LLindiwe Mashinini

25:16

Pre authorization is needed for a root canal treatment and then we've got out of
network dentist. 
LLindiwe Mashinini

25:25

So an insured party can see a dentist that is not part of the. 
LLindiwe Mashinini

25:29

Prime cure network, limited to one. 
LLindiwe Mashinini

25:34

Per. 
LLindiwe Mashinini

25:35

Family per year, and only covers emergency. 
LLindiwe Mashinini

25:38

Treatment for pain and sepsis. 
LLindiwe Mashinini

25:40

So there's only one consultation available for the family, whether it is just
you. 
LLindiwe Mashinini

25:44

On your health insurance or it's a. 
LLindiwe Mashinini

25:46

Family, there's only one consultation available for you to see a dentist that is
not in the network and we only go there for the treatment of pain and sepsis. So
if you just want to clean. 
LLindiwe Mashinini

26:01

Your teeth, do a preventative treatment, or. 
LLindiwe Mashinini

26:03

Do feelings, you need to go to a doctor that is within the prime care network or
a dentist that is within the prime care network. 
LLindiwe Mashinini

26:10

But if it's treatment for pain and. 
LLindiwe Mashinini

26:12

Sepsis, then you can go to a dentist that is not in the network. We will cover
up to 800 rand for the visit. And again, because this is a doctor. 
LLindiwe Mashinini

26:23

That is not in the network, you. 
LLindiwe Mashinini

26:25

Pay upfront and then you claim the money back from us. And then you need to
authorize this. 
LLindiwe Mashinini

26:32

Visit within 72 hours. 
LLindiwe Mashinini

26:34

So if you went on a Sunday or on a Saturday afternoon, on Monday, you need to
call us and authorize the visit. 
LLindiwe Mashinini

26:41

We give you 72 hours to authorize. 
LLindiwe Mashinini

26:44

An out of network consultation. 
LLindiwe Mashinini

26:49

Then there is also cover for dentures. There's cover for plastic or acrylic
dentures. 
LLindiwe Mashinini

26:54

For in short parties over the age of 21. So this is false teeth. So in short
parties will need to pay an upfront copayment of 20% of the total accounts to
the dentist and the lab. 
LLindiwe Mashinini

27:09

And then you covered for one set. 
LLindiwe Mashinini

27:11

Of dentures per family every two years. Then moving over to I care. So you are
covered for one eye test per insured party payer at a. 
LLindiwe Mashinini

27:26

Prime cure network optometrist. 
LLindiwe Mashinini

27:29

So you can go for an itest. 
LLindiwe Mashinini

27:31

You do not need any authorization for an itest. 
LLindiwe Mashinini

27:33

You just go to a primary care network optometrist and get your eye test
done. Then you also have cover for glasses and lenses. 
LLindiwe Mashinini

27:45

You have cover for one pair of. 
LLindiwe Mashinini

27:47

Glasses, which is one frame and one pair of lenses every two years per in short,
party includes standard clear plastic lenses, single vision and bifocal lenses,
and a selection of approved frames. So guys, when you go to the optometrist to
get classes, the optometrist will. 
LLindiwe Mashinini

28:13

Show you a selection of frames that. 
LLindiwe Mashinini

28:15

Giello will cover and then you choose from those frames. If you then maybe don't
like any. 
LLindiwe Mashinini

28:22

Of these frames that the optometrist is. 
LLindiwe Mashinini

28:25

Showing you choose another frame. 
LLindiwe Mashinini

28:28

Let's say you want a la cost. 
LLindiwe Mashinini

28:29

Frame and it's not part of the Gaylord selection. 
LLindiwe Mashinini

28:33

This means that we will only pay. 
LLindiwe Mashinini

28:36

600 rents towards that lacoste frame. So if the LA cost frame is. 
LLindiwe Mashinini

28:41

5000 reals, we will only pay 600 towards that frame. 
LLindiwe Mashinini

28:45

Then you have to add the rest of the money because you chose a frame that is not
part of our selection. And then with the lenses, we cover single vision or by
focals. 
LLindiwe Mashinini

28:56

If you now need more lenses, if. 
LLindiwe Mashinini

28:58

You maybe need multifocal lenses, then the doctor will tell you how much you
need to add. 
LLindiwe Mashinini

29:04

If you need extras like you need. 
LLindiwe Mashinini

29:06

Your glasses tinted, the doctor will tell you how much you need to add. 
LLindiwe Mashinini

29:10

But if you're just choosing a standard. 
LLindiwe Mashinini

29:12

Frame that is part of our selection. 
LLindiwe Mashinini

29:14

And your lenses are single vision or. 
LLindiwe Mashinini

29:16

Bifocals, they covered in full. 
LLindiwe Mashinini

29:20

Then you've also got cover for x rays and scans. So there's cover for x rays and
soft tissue ultrasounds. 
LLindiwe Mashinini

29:28

So what you need to do is. 
LLindiwe Mashinini

29:31

You first go to your GP so. 
LLindiwe Mashinini

29:33

You don't wake up. 
LLindiwe Mashinini

29:34

Maybe let's say you've got a sore. 
LLindiwe Mashinini

29:36

Back and then go to the radiologist. You need to first go to your GP and then if
the GP will. 
LLindiwe Mashinini

29:44

Assess you and if they see a. 
LLindiwe Mashinini

29:46

Need for you to go get an x ray or a scan, they will write you a radiology
referral form. Then you can then go and get your x rays done. So you need a
referral first. You don't just go there, you start at your GP. They will refer
you. So there is unlimited cover for x rays and scans. 
LLindiwe Mashinini

30:10

Then you also have cover for blood tests as well. Blood tests are limited to a
list. 
LLindiwe Mashinini

30:15

Of approved pathology codes. So this means that blood tests are covered, but not
all blood tests are covered. 
LLindiwe Mashinini

30:24

There is a selection or a list. 
LLindiwe Mashinini

30:27

Of approved pathology codes. Okay, so for an example like your allergy tests,
your DNA test, they not covered here. Okay, so please note that, there is a list
of approved pathology codes. 
LLindiwe Mashinini

30:42

Okay? 
LLindiwe Mashinini

30:43

And then also, with the blood. 
LLindiwe Mashinini

30:46

Test, you first started your GP and then they will take bloods and send. 
LLindiwe Mashinini

30:50

Them to the lab or they will send you to a lab. 
LLindiwe Mashinini

30:53

We work with four labs. 
LLindiwe Mashinini

30:55

The labs are ampath, lancet path care, or lab 24. So if your doctor sends you
to. 
LLindiwe Mashinini

31:03

Take blood tests or they send your. 
LLindiwe Mashinini

31:05

Blood to a lab, it needs to go to any of these four labs. So you've got
unlimited cover for blood tests. Then you also have cover for 2d sonar scans per
pregnancy. Here it is just the scans only. 
LLindiwe Mashinini

31:22

It does not cover your consultation with. 
LLindiwe Mashinini

31:24

The gynecologist or your antenatal visit. It is just the scans only. So youve
got 2d sonar scans per pregnancy at a prime care network healthcare provider or
a prime care network radiologist when referred by a prime care network
doctor. Okay, so we've got accident cover, guys. 
LLindiwe Mashinini

31:49

This is where the private hospital comes in. 
LLindiwe Mashinini

31:53

So if you are sick, if you just sick, maybe and you need hospitalization or
you've got a planned procedure, illness related, you will have to go to a state
facility because Giello health does not cover illness in a private hospital. The
only thing we cover is accidental injury, a stroke or a heart attack. That's the
only time you can go to a private hospital if it's accidental injury, a stroke
or a heart attack. 
LLindiwe Mashinini

32:24

So you've got cover for emergency department visits. So this is casualty
treatment. Okay? 
LLindiwe Mashinini

32:32

Because you know when you go into a hospital, you started casualty, they
stabilize you. If you need admission, they admit you. 
LLindiwe Mashinini

32:40

If not, they send you home, but. 
LLindiwe Mashinini

32:42

They give you treatment in casualty. So if it's accidental injury, stroke or
heart attack, unlimited visits. Paid up to 20,000 rand per visit. 
LLindiwe Mashinini

32:53

Sorry. Per person. Per visit. 
LLindiwe Mashinini

32:55

So we will pay up to 20,000 rent for. 
LLindiwe Mashinini

32:58

For your casualty treatment. 
LLindiwe Mashinini

33:02

And then we've got in hospital treatment. So if they admit you now. So let's say
your injuries are serious and you need hospital admission. So we will cover your
in hospital treatment. So for accidental injury, we will pay up to 380,000 rent
per event. Per person. And the overall limit is 1.5 million. Guys, can I just
explain accidental injury. 
LLindiwe Mashinini

33:32

We're not just limiting this to a motor vehicle accident. If you fall and you
break an arm, you break a leg, that's accidental injury. If you cut yourself,
you burn yourself, they stab you, they shoot you. 
LLindiwe Mashinini

33:45

Any external body harm, that is accidental injury. So we'll pay up to 380,000
rent, should they admit you. And then the benefit has an overall limit of 1.5
million payer person. Then for heart attack and stroke, we'll pay up to 200. So
for a heart attack and stroke, we'll pay up to 250,000 rent per event person. 
LLindiwe Mashinini

34:16

And. 
LLindiwe Mashinini

34:16

And the benefit has an overall limit of 500,000. Then we've got a sub limit of
20,000 rand on allied health care services. 
LLindiwe Mashinini

34:26

So, allied healthcare services is your physiotherapy. 
LLindiwe Mashinini

34:29

That you get while you are still in hospital. While you are still
hospitalized. Okay? So cover will end on hospital discharged discharge, or when
the event or annual limit has been reached, whichever occurs first. And then
we've got emergency stabilization and ambulance service. So there's unlimited
cover for stabilization and road transportation by Netcare 911 to an. 
LLindiwe Mashinini

35:03

Appropriate hospital emergency department. So if you need an ambulance, you. 
LLindiwe Mashinini

35:08

Will dial Netcare 911. Netcare 911 guys fetches insured parties only. So you
can't call Netk 911 for your neighbor that is not insured on your Gallo health
benefits. It only fetches insured parties. So if you call Netk 911 and it's
illness related and it's not a heart attack or a stroke, Netk 911 will transport
you to the nearest state facility or the nearest public hospital. But if it is
accidental injury, a heart attack, or a stroke, then they. 
LLindiwe Mashinini

35:48

Will take you to a prime care network hospital. 
LLindiwe Mashinini

35:52

So this would be a private hospital in the prime cure network. Okay, then we've
got accidental disability cover. So it's a lump sum payment in the event of
total permanent disability of. 
LLindiwe Mashinini

36:09

An insured party due to accidental injury. 
LLindiwe Mashinini

36:12

So if an insured party is permanently disabled due to accidental injury, we
will. 
LLindiwe Mashinini

36:21

Pay out 25,000 rents. If the insured party is 18 years. 
LLindiwe Mashinini

36:25

Or older, and then under 18, there is no cover. 
LLindiwe Mashinini

36:30

Then there is an accidental death cover. 
LLindiwe Mashinini

36:33

So a lump sum payment in the event of the death of an insured. 
LLindiwe Mashinini

36:37

Party as a result of accidental injury. 
LLindiwe Mashinini

36:41

So if you are. 
LLindiwe Mashinini

36:43

If you pass away or an insured. 
LLindiwe Mashinini

36:44

Party passes away due to accidental injury, then insured parties under six, we
pay out 20,000 rand. And then all other insured parties, we pay 25,000 rand. And
then we've got lifestyle benefits. So these are not add ons with your health
insurance. Okay, we've got what we call ask. 
LLindiwe Mashinini

37:13

Nelson, which is an employee wellness program. 
LLindiwe Mashinini

37:16

That is available for you and your family members. So whether your family
members are on your health insurance or nothing, they can. 
LLindiwe Mashinini

37:23

Use the ask Nelson. 
LLindiwe Mashinini

37:25

But this has to be your immediate family member. So your spouse, your children,
your siblings. 
LLindiwe Mashinini

37:31

Your parents, they can use arsenals. 
LLindiwe Mashinini

37:34

Or if maybe you have family members. 
LLindiwe Mashinini

37:37

That you stay with at home, even. 
LLindiwe Mashinini

37:39

Though they're not your immediate family members, but they are financially
dependent on you. 
LLindiwe Mashinini

37:44

Then they can use the arsenals and benefit. Okay, so the services that we
offer. 
LLindiwe Mashinini

37:49

We offer digital mental health support and. 
LLindiwe Mashinini

37:52

Text based chat support. 
LLindiwe Mashinini

37:53

We've got 24 hours telephonic counseling. 
LLindiwe Mashinini

37:57

So we've got professional psychologists and we've. 
LLindiwe Mashinini

38:00

Got registered counselors and social workers that we work with. So when you call
that line for. 
LLindiwe Mashinini

38:06

Assistance, please know that you will be speaking to a qualified mental health
professional. 
LLindiwe Mashinini

38:12

Our telephonic counseling is available in all official languages. If you are
zulu speaking and would like to have your counseling session in Zulu, you are
more than welcome to do that. 
LLindiwe Mashinini

38:24

You request for someone to speak to. 
LLindiwe Mashinini

38:26

You in Zulu and then you can have your counseling session. 
LLindiwe Mashinini

38:30

Guys, you can call us at 02:00. 
LLindiwe Mashinini

38:31

A.M. If you call this line at 02:00 a.m. There will be someone that will be able
to assist you on the line. It is a 24 hours telephonic counseling line. We've
got trauma support, we've got off site face to face. This is when we refer you
to a psychologist to go and have a face to face session. 
LLindiwe Mashinini

38:52

So it all starts telephonically. A clinical assessment is done. If we see a need
for you to go see someone face to face. 
LLindiwe Mashinini

39:00

We will then allocate you some sessions. 
LLindiwe Mashinini

39:02

Then you can go to the psychologist and have your face to face sessions. 
LLindiwe Mashinini

39:07

We've got on site counseling. 
LLindiwe Mashinini

39:09

We've got virtual face to face with virtual face to face. You have to set up an
appointment. Okay. 
LLindiwe Mashinini

39:15

And then the counselor will call you via WhatsApp video call or via teams, but
you will be able to see your counselor. 
LLindiwe Mashinini

39:26

We've got managerial support, we've got children and teenager support. This is
cancelling for our children. 
LLindiwe Mashinini

39:33

There is a lot that our children. 
LLindiwe Mashinini

39:34

Deal with out there, and sometimes they're not comfortable with speaking to us
as parents. So you see your child is not okay. 
LLindiwe Mashinini

39:41

They struggling at school, they acting up, there's behavioral concerns, but you
do not know what's happening. So you can refer them to us, Nelson, so that they
can get the professional assistance and support that they need. 
LLindiwe Mashinini

39:56

And then we've got coaching services, we've. 
LLindiwe Mashinini

39:59

Got life coaching, we've got parent coaching. 
LLindiwe Mashinini

40:02

We'Ve got leadership coaching, and we've got career guidance. So, guys, if you
do not need. 
LLindiwe Mashinini

40:07

Any counseling, you might as well utilize the coaching benefit. This is
available to you for free. You know, we've got coaches that are available to
help you with reaching your goals. 
LLindiwe Mashinini

40:21

Most of us have goals that we have set for ourselves, but maybe there is
obstacles that keep blocking us from reaching those goals, whether it's a lack. 
LLindiwe Mashinini

40:30

Of knowledge, a lack of information. 
LLindiwe Mashinini

40:33

Or maybe you do not have the self confidence. 
LLindiwe Mashinini

40:36

Or maybe there's other things that keep blocking you. Coaches have proven
strategies of how to overcome these obstacles that keep blocking us. 
LLindiwe Mashinini

40:47

From reaching our goals. 
LLindiwe Mashinini

40:49

So guys, you can utilize the coaching benefit. 
LLindiwe Mashinini

40:52

All this is available at no cost. 
LLindiwe Mashinini

40:55

And then lastly, we've got extra by discount. Guys, this is a very nice. 
LLindiwe Mashinini

41:01

Benefit that all Kailo health members have access to. So you are getting an
instant 20%. 
LLindiwe Mashinini

41:07

Discount on over 3100 items at this camp. That's a lot. Okay, so if an item is
on. 
LLindiwe Mashinini

41:18

Extra by discount, you will see the. 
LLindiwe Mashinini

41:19

Screen logo on the price of the item. 
LLindiwe Mashinini

41:23

If you've purchased five items that have. 
LLindiwe Mashinini

41:25

This extra by discount, you are getting 20% of each item. So if it's five items,
you're getting 20% of each. Sometimes, you know, this cam has promotions. So if
an item is on promotion and has the extra by this camp benefit, you are getting
both discounts. This means that you might even end up saving up to 50% on an
item. Okay, so guys, as you can see here, this is brands that most of use daily
at home and you will be saving quite a lot. 
LLindiwe Mashinini

42:01

Okay? 
LLindiwe Mashinini

42:02

All you need to do is have that green benefit card from discount. It has to be
registered on the policyholders name. 
LLindiwe Mashinini

42:11

Okay? If you don't have a card, you. 
LLindiwe Mashinini

42:12

Can go to your nearest discount and get one. 
LLindiwe Mashinini

42:15

If not, whenever you pay at the. 
LLindiwe Mashinini

42:18

Top, you can just give them your id number and start saving. 
LLindiwe Mashinini

42:23

Okay? 
LLindiwe Mashinini

42:26

Oh and yeah, we done. 
LLindiwe Mashinini

42:29

Do we have any questions? 
PPramjeeth, Nikita

42:34

Lindiwe? There is a question in the chat, how would one obtain the Kaelo members
card? 
LLindiwe Mashinini

42:44

Okay, so if you would like to. 
LLindiwe Mashinini

42:47

Have a physical card, what you can. 
LLindiwe Mashinini

42:49

Do is you can call our prime Q line, they will request a card for you. Or you
can also send me an. 
LLindiwe Mashinini

42:57

Email and I will request a card for you. 
LLindiwe Mashinini

43:00

But you do not need a physical card because you've got a digital card on your
phone. All you need to do is download the Gaelo health app and then get access
to your digital card. You can download the card, you can send the card to
someone. Let's say you want, you are at work and your child is sick at home,
they want to take your child to the doctor. 
LLindiwe Mashinini

43:26

You can download the digital card and. 
LLindiwe Mashinini

43:28

Send it via WhatsApp to the person that will be taking your child to the
doctor. So it's easier that way because we lose our physical cards all the
time. So it's best if we maybe download the app and get access to the. 
PPramjeeth, Nikita

43:42

Digital card and then we have a question from Prudence. How do we connect our
Descam card with our Kaelo Cardinal? 
LLindiwe Mashinini

43:52

So you don't need to connect anything. Prudence. So once, if you are a Gallo
health member, this means that you already have this benefit. 
LLindiwe Mashinini

44:03

You do not need your Gaelo health card, you just need the discam card. Or if you
don't have a discam. 
LLindiwe Mashinini

44:10

Card, you give them your id number at the toll. So whenever you pay, you give
them your id number. Okay, so you don't need to connect anything or link
anything. This is automatically linked to your id number as the policyholder. So
you can, if you already have a benefit card from discam, it's automatically
linked. 
LLindiwe Mashinini

44:32

If not, you can go to your. 
LLindiwe Mashinini

44:33

Nearest discam and apply for the benefit card. Or you can give them your id
number whenever you pay at the till. 
PPramjeeth, Nikita

44:43

Okay, I do have other questions. Anyone else? We have Oria. Betse says, I've
joined Kaelo but haven't received anything from them. What does one do in that
case? 
LLindiwe Mashinini

45:19

Okay, so. 
LLindiwe Mashinini

45:23

What will happen is that you just need to liaise with your. 
LLindiwe Mashinini

45:27

Broker or HR so that they check. 
LLindiwe Mashinini

45:30

With Gaelo if you already loaded to the system. If you are already loaded, then
they. 
LLindiwe Mashinini

45:37

Can request for your policy document to. 
LLindiwe Mashinini

45:40

Be emailed to you or it can be emailed to the broker, then the broker emails it
to you. Okay, so you just need to liaise with HR or the broker and then they
will check with Gaelo. And then if you are loaded on the system, we will request
that they send your policy document and your policy document that has your
policy number. 
PPramjeeth, Nikita

46:07

Lindiwe, we have Fikile who has a request for you to go back to the slide with
the prescribed laboratories. Fikile, do you have a question on the slide? 
LLindiwe Mashinini

46:21

Yes, I don't have a question. I just want to see which laboratories. Yes, which
labs are we supposed to go to? Okay, so it is ampath, Lancet path care or lab
24, right? Thank you so much. Thank you guys. 
LLindiwe Mashinini

46:46

Do we have any other questions? 
LLindiwe Mashinini

46:48

Guys? 
DDlamini, Nqobile

46:52

Hi, I just want to understand on the pre authorization, especially for the
doctor's consultation, I just want to make sure that I understand correctly. So
does that mean if I go to the doctor, because I just had an incident, so I'm not
sure. I want to make sure if I understand. So does that mean that you asked for
authorization if three times in terms of I went to the doctor January, maybe
February or March, then after maybe I want to go April, then ask for
authorization or does it mean I need an authorization. If I went to Janavari the
first, and then I was not well, and I decided, let me just go to another doctor
who's still part of the Gaelo on the maybe on the 7th. 
DDlamini, Nqobile

47:40

And then I decide again, no, I'm not feeling well still, and I go to the doctor
maybe on the 30 January, still under same January. And then do I then need an
authorization after that fourth one? Or the first scenario that I made? I'm not
sure if you understand. 
LLindiwe Mashinini

48:00

So it does not matter when you go to the doctor. It can be Jan, it can be
December, it can be March, and you can go three times in January to a
doctor. Just know that if you have to go for the fourth time in Jan, now you
need to start obtaining your authorization. So it doesn't matter when you go, as
long as it's your fourth visit for the year, then you need to obtain pre
authorization. So it doesn't matter. You can go three times in Jan. So let's say
your policy was active from the 1 January, you go on the 2 January, you go on
the 10 January, you go on the 15 January. There is three consultations
already. So now it means that your next consultation after that one, you need to
start obtaining authorization. 
DDlamini, Nqobile

48:52

Oh, thank you. 
LLindiwe Mashinini

48:54

Thank you. 
PPramjeeth, Nikita

48:59

Do we have any other questions? 
SSpeaker 7

49:17

Hey. 
PPramjeeth, Nikita

49:17

Hi, John. 
DDlamini, Nqobile

49:18

Sorry again. Sorry again. 
LLindiwe Mashinini

49:19

Go for communication. 
SSpeaker 8

49:21

Yes. 
DDlamini, Nqobile

49:21

So just to follow up. So does that mean now every time after then it means that
every time I need to now call in every time? 
LLindiwe Mashinini

49:30

Yes, yes. 
MMaepa, Mokgadi (Johannesburg)

49:32

All right. 
LLindiwe Mashinini

49:32

So from your fourth visit, 4567 going forward, you need to start obtaining
authorization. Some service providers, receptionists, they normally call on your
behalf. Some others they don't. They need you to come with your
authorization. So you can just call us before you go there and obtain your
authorization, then go to the doctor. 
DDlamini, Nqobile

49:56

All right, thank you. 
LLindiwe Mashinini

49:58

And mind you that obtaining an authorization does not mean that maybe we might
reject your consultation. No, it's not to reject your consultation in any
way. We just need to start keeping track of your consultations from your fourth
one going forward. But at no point will we say no, you can't see the doctor. 
LLindiwe Mashinini

50:21

Okay? 
DDlamini, Nqobile

50:22

Okay, thank you. 
PPramjeeth, Nikita

50:26

Anyone else? Okay, if there's no other questions or comments, we're then going
to conclude the session. Thanks so much, everyone, for joining us. And indeed,
we thank you as well for making time to speak to us tonight. 
LLindiwe Mashinini

50:55

All right, thank you so much, guys, and enjoy the rest of your evening. Bye. 
00:0052:52
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