Management

Fund Management
General
Cost Containment Tips

Board of Trustees

SEDMED is governed on behalf of its members by a Board of Trustees. The members of the Board of Trustees are elected by the members of SEDMED who are present at the scheduled Annual General Meeting. Trustees serve a term of office of 3 years at a time and may be re-elected or re-appointed to serve additional terms. In addition, Trustees may appoint an additional member if they require someone with a particular skill or expertise that the Board finds lacking.

The focus of the Board of Trustees is to innovatively improve service delivery to its members while promoting sustainability. One of the Board’s main objectives is to ensure that SEDMED provides the best possible benefits at affordable contribution rates.

The current Trustees are:

Principal Officer

The Board of Trustees appoints a Principal Officer who is the chief executive officer, managing the day-to-day affairs of the Fund. The Principal Officer of SEDMED is Mr Andrew du Preez.

All requests or correspondence to the Board of Trustees should be sent via the Principal Officer.

Contact details:

Contributions are payable in advance

SEDMED contributions are payable in advance. Both members and employing organisations should take cognisance of the fact that contributions normally increase on 1 January every year which means that the increased member share is to be deducted from employee’s salary in December of the previous year.

Prescription formalities

Members are requested not to detach the upper part of the prescription, but to submit the prescription in its entirety. SEDMED will only accept and process a prescription for payment of benefits in respect of which the upper part is still attached and no exceptions will be made in this regard.

Electronic banking

Each member must ensure that SEDMED has his or her correct banking details as benefits are paid electronically into the main member’s bank account.

Late payment of contributions

Late payment of contributions jeopardises the member’s continued SEDMED membership. In this event, SEDMED will not pay any benefits which would otherwise be due to a member. Where the employing organisation has deducted the member’s share from his or her salary but fails to pay the contribution over to SEDMED, such organisation is guilty of fraud, exposes itself to a claim for damages from the member and runs the risk of the SEDMED membership being cancelled.

Disputes

Any dispute by prospective, current or former members must be directed in writing to the Principal Officer of SEDMED. The dispute will be dealt with by the SEDMED Dispute Committee. If a member is not satisfied with the finding/decision of the Dispute Committee, he/she may appeal to the Council for Medical Schemes for adjudication.

Fraud

The Board of Sedmed (“the Fund”) does not condone fraud of any form against the fund. Therefore the trustees have put fraud prevention initiatives in place to prevent fraud. One of these initiatives is aimed at providing the members of Sedmed the opportunity to report any suspected incidents of fraud, abuse, corruption, unethical behaviour and misconduct, through utilising any of the following channels:

WAYS IN WHICH YOU CAN MAXIMISE YOUR MEDICAL FUND BENEFITS BY CONTAINING COSTS

Medication

Ask your doctor/pharmacist whether generic medication can be substituted for your medication.
Obtain prescribed medication from your pharmacist rather than from your doctor.
Make use of the over-the-counter ('OTC') medication benefit – Schedule 0, 1 and 2 medication (confirm schedule with your pharmacist) can be claimed without a prescription.
Make use of pharmacies with whom Sedmed has Preferred Provider Agreements (Dis-chem and Clicks) if readily available. Members who make use of other pharmacies than Dis-chem or Clicks, and in the event that the other pharmacy’s fee structure is higher than the agreed fee structure of Dis-chem and Clicks, will be responsible for the payment of the difference between the fee structure agreed to with Dis-chem and Clicks and the fee structure of the other pharmacy.

Hospitalisation

Make use of the hospitals with whom SEDMED has an undertaking (MediClinic and Netcare) if such readily available. Members who fail to observe this arrangement and make use of another hospital facility even though a MediClinic or Netcare is available, may be held responsible for the payment of any possible difference in the cost structure.
Check your hospital accounts (dates, name of patient, procedures undergone, admission and discharge times, etc.) in order to ensure that the charges are for actual services rendered.
If possible always negotiate the best possible rate with all service providers before being admitted to hospital as this has a direct impact on your own pocket due to the limitations set on your hospital-related benefits

Management

Board of Trustees

The current Trustees are:

Principal Officer

Contact details:

Rules of Sedmed