If you want to avoid having to make co-payments on your dental or optical claims, make a point of familiarising yourself with how your benefit option design caters for these services. Read on to find out how your dental and optometry benefits work, which processes you should follow when submitting a claim, and where to find a network provider.

Medihelp's dental and optometry networks

To ensure that you receive the best possible benefits, Medihelp has partnered with accredited dental and optometry benefit management service providers who are well-established and experienced:

Dental Risk Company (DRC) is Medihelp’s dental benefit management partner. Necesse members must use a dentist in the DRC network to avoid out-of-pocket expenses, while members of all other options (including the Prime network options) may visit any dentist of their choice.

Preferred Provider Negotiators (PPN) manages Medihelp’s optometry benefits for all options except Unify and Prime 1 (network and non-network). Members of all other options must use an optometrist in the PPN network to avoid out-of-pocket expenses.

Remember: Visiting a network provider can save you money, since their tariffs are usually more in line with the Medihelp tariff. You can search for a DRC and PPN network provider here.

Your benefit schedule

You will find everything you need to know about your dental and optometry benefits in your member guide. To access your guide online, log in to Medihelp’s Member Zone, click on “Benefits” and select “My benefit option” in the dropdown menu.

Before you make an appointment at your dentist or optometrist, read your member guide and find out the following:

• Confirm from which benefit the services will be paid. Will the claim be paid from your insured benefits, which are available separately from your pooled day-to-day benefits, or will it be deducted from your medical savings account? Will you perhaps have to pay for the services yourself?
• Understand what the benefit entails. If your benefit states that you are covered for “one pair of standard clear Aquity single vision or bifocal lenses per beneficiary per 24-month cycle (multifocal lenses paid at the cost of bifocal lenses)” it means that PPN will only cover those specific lenses. Should you receive any other lenses or anything in addition, it will be for your own account, including tinted lenses, custom frames or accessories.
• Get a quotation and first confirm what your benefit option will cover and what not, before you receive the service. Otherwise, you may end up with unexpected out-of-pocket expenses or you may have to use your savings account funds to pay for these expenses.
• Remember to pre-authorise your procedure, otherwise co-payments may apply.

Submitting a dental claim

Depending on your dentist, you will either be required to pay upfront and claim from DRC later, or the practice will submit the claim on your behalf.

Submit your claim in any of the following ways:

1. Log in to Medihelp’s Member Zone, select “Claims” and choose “Submit claim” from the dropdown menu. Make sure your statement contains all the required information before submitting.

2. Email your statement to claims@dentalrisk.com

If you have gap cover, you can claim any shortfalls or co-payments on in-hospital treatments from the insurer. Your gap cover provider will need a statement from DRC before reimbursing the amount to you. é

Contact details: DRC

Tel: 087 943 9618
Fax: 086 687 1285
Email: auth@dentalrisk.com, claims@dentalrisk.com, medihelp@dentalrisk.com
Website: www.dentalrisk.com

Contact details: PPN

Tel: 086 1103 529 / 086 1101 477
Email: info@ppn.co.za
Website: www.ppn.co.za

Fitness takes on a whole new meaning once you understand its benefits not only for your body, but also for your mind and spirit.

The obvious benefits like weight loss and a more firm and toned body should become your secondary objectives, while being healthier, reducing stress, gaining mental clarity and improving your self-esteem should be what you’re primarily aiming for when starting an exercise routine. Once you’ve been able to make this mind shift, chances are you’ll most probably feel better regardless of your physical measurements.

The basic principles

• Make it a habit. Once it’s part of your routine and you don’t have to think about it anymore, it will be much easier.
• Get an exercise buddy. Pick someone who is committed to their health and hold each other accountable.
• Set realistic goals. If you aim to get fit within a month, you most probably won’t succeed. But if you aim to just get out there from time to time, you will definitely not succeed either. Set yourself small, reachable, measurable but challenging goals.
• Get over yourself. If you haven’t been exercising for a while, the mirror is most probably not going to paint a pretty picture of you all sweaty in tight exercise gear. But just get over it, okay? In two months, you’re going to look better than you look now.
• Keep it short and practical. Don’t aim for an hour, aim for 30 minutes, three or four times per week.
• If you don’t like routine, add variation to your exercise. You can even vary your walking or running routine by simply choosing a different route.
• Keep track of your improvements. Don’t do it too often, though – you’ll most probably not see any change in your measurements or weight in two days. Do not focus on bodily changes only, but rather on your overall feeling of wellness, strength, endurance and flexibility.
• Record your measurements (bust, chest, waist, hips, thighs and upper arms) rather than weighing yourself. Muscle mass is heavier than the fat you’re burning, so you might be discouraged by slow weight loss while you are actually burning fat and building muscle mass.
• Remember that exercising alone is not good enough. Follow the three golden rules to be physically healthy: exercise, a healthy eating plan, and drinking enough water.

Exercise to clear your mind

Do you find it easier to work through an issue while on the run, or does inspiration strike you after a workout? Research shows that people who exercise are happier and less overwhelmed at work. Exercise creates new neurons, increases blood flow, and regulates hormones. A 20-minute workout increases blood flow to the frontal cortex, the part of the brain associated with “executive-type” thinking processes such as goal setting, problem solving and planning. Moreover, exercise can help you keep your mind sharp into old age: One study indicated that walking or running 25 km per week can reduce your risk of developing Alzheimer’s by 40%.

Add music to the mix. This does not only relieve boredom, but it can help improve the quality of your workout by increasing your stamina and putting you in a better mood. According to research, the lyrics or catchy rhythm of motivational music inspires you to exercise longer or work harder during your routine.

Exercise at home

It’s possible to get fit at home if you set your mind to it. Every fitness programme should consist of a warmup, a cardiovascular workout, some resistance exercises, flexibility moves and a cooldown. At home, this could mean an easy walk outside to warm up; some brisk walking, jogging, cycling around the neighborhood or on a stationary bike during the cardiovascular portion; some squats, push-ups and abdominal crunches for resistance; some stretches for flexibility and cooling down in the same way as warming up. Consider downloading an app that can assist you with your exercise routine.

Get active at home

• Get active in front of the TV. Find some training material on YouTube, get yourself an exercise program on DVD, or purchase one for your Xbox or PlayStation.
• Use your kids’ trampoline, or purchase a small workout trampoline.
• Use the swimming pool – it’s just so much more fun than jogging. It is also ideal if you’re older, pregnant or overweight and out-of-shape, as water reduces the risk of injuries.
• Use a treadmill or stationary bike.
• Get yourself a set of dumbbells.
• Go cycling, walking or jogging in your neighborhood. If you’re embarrassed of what the neighbors might think, take the dog. Chances are he’s in as much need of some exercise as you are.
• Challenge the kids to join your exercise routine. Make a bet on who will reach their goals first, and add an exciting reward for the winner.

Do something you like

Find out what works for you. Try joining a kickboxing class, dancing, Pilates, aquarobics, a trampoline class or boot camp. Keep on exploring and trying different options until you find something that you truly enjoy.

Whatever you do, just get started! Find something you like, stick to it for two weeks, and start enjoying the results of your new lifestyle.

Don’t wait – join now with Medihelp

• If you’re interested in joining a gym, start by visiting Medihelp’s free online health and wellness programme, HealthPrint, and have a look at the special offer on Planet Fitness gym membership with its free Black Tag membership for a gym buddy.
• HealthPrint members enjoy free participation in all Medihelp-sponsored running and cycling events.
• Do you have a BMI of 30 and higher? Join HealthPrint’s 12-week healthy weight loss support programme and get a one week free pass to a Planet Fitness gym near you. You will also receive a Medihelp goodie bag when you complete the programme.
• Join Medihelp MultiSport for runners and walkers in the Gauteng North area and cyclists nationwide for only R256 annually (members on the 12-week weight loss programme pay only R200). Medihelp members and non-members can join the Medihelp MultiSport club, so you’re welcome to invite your friend to join you on weekends when MultiSport members participate in races. é

Although it’s been around since the beginning of time, everyone is suddenly talking about it: a whole food, plant-based diet. But for those serious about their health, this diet is most probably not going anywhere, unlike some of it’s quick fix counterparts.

What is a whole food, plant-based diet?

Actually, it’s not a diet at all – rather think of it as a healthy lifestyle. The emphasis with a whole food, plant-based diet (WFPB diet in short) is not on an eating plan or by what it eliminates, but rather on what it emphasises: eating a large variety of whole foods, as naturally and healthy as possible.

According to the health website forksoverknives.com, whole food refers to natural foods that are not heavily processed and made from whole, unrefined or minimally refined ingredients. Think fruit, veggies, whole grains, legumes, nuts and seeds. Plant-based refers to all food that comes from plants and doesn’t contain any animal ingredients such as meat, eggs, milk or honey.

A WFPB eating plan excludes refined foods like added sugars, white flour and processed oils. Furthermore, special attention is given to the quality of foods – many elements in a WFPB follower’s diet consist of locally sourced and organic foods.

The basic principles

According to healthline.com, a WFPB eating plan rests on four principles:

• Eat whole plants such as grains, nuts and fruit.
• Avoid animal products such as meat, fish and dairy.
• Avoid processed, artificial foods.
• Avoid added fats and sugars.

How does it differ from a vegetarian diet?

While vegans and vegetarians abstain from eating some or most animal products, followers of a WFPB eating plan eat mostly plants, but animal products aren’t off-limits.

But why?

According to studies mentioned by healthline.com, the diet makes it easier to lose weight and keep it off, and can also prevent, halt or even reverse chronic diseases such as heart disease and type 2 diabetes. Studies have shown that a WFPB lifestyle can help fight cancer and cognitive decline.

Moreover, a WFPB diet is not only good for you – it’s also good for the environment, as it has a smaller environmental footprint.

What do the experts say?

Distinguishing between a fad diet and a healthy, sustainable lifestyle change pivots on a few questions based in sound nutritional science, says Pretoria-based dietitian Lize Snyman. According to Snyman, these questions are:

• Does the diet necessitate the use of various multivitamins or minerals? Any healthy eating plan should be nutritionally complete.
• Is it proven to counter common lifestyle diseases such as diabetes and cardiovascular diseases?
• Does it sustain a healthy and functioning body in the whole, supporting muscle mass, bone structure and metabolic functions providing sustained energy throughout the day?

"It is my professional opinion that, with the correct planning, the WFPB diet ticks all of these boxes, and that the diet choices the WFPB diet propagates also pose the least negative impact on the environment", Snyman concludes.

The myths

• No, you don’t have to avoid cooked foods.
• You can include frozen fruit and vegetables in your diet, as well as canned food – just look out for low-sodium options.
• Your food does not have to be bland – you’re free to experiment with spices.
• It’s not as expensive as it sounds. Many staples included in a WFPB diet, like beans and potatoes, are very affordable.
• You won’t suffer from insufficient protein intake. According to doctorsthatdo.org, all your daily protein needs can be met by the proteins found in vegetarian sources. On the contrary, animal fat is high in saturated fat, trans fat and dietary cholesterol – the top three risk factors for elevating heart disease.
• No, you won’t feel hungry all the time. Tubers, whole grains and legumes such as peas, lentils and beans help you fill up on fibre, which makes you feel satiated and prevents cravings.

Five tips for a successful transition to a WFPB diet

• If you have any reason to believe that your body will not cope with a WFPB diet, consult your doctor first. Also see a doctor should you experience any discomfort while following a WFPB eating plan.
• Start slowly – identify one meal per day, e.g. breakfast, and make the transition to WFPB options. As soon as you’re used to it, add another meal.
• Start with meals that you have always enjoyed, e.g. pasta with veggie stir fry, jacket potatoes or lentil stew. Then gradually build on these basic options by adding other WFPB eating plan options.
• Ensure that you include enough protein in your diet by eating protein rich plants like tofu, lentils, chick peas and beans.
• Variety and balance is key, as is the case with any eating plan.

So you’re in? Visit the Centre for Nutrition Studies’ handy whole food plant-based diet guide to see exactly what should be included and excluded in your new eating habits. You can also try out forksoverknives.com’s meal planner, or get started with some WFPB recipes. é

Cancer causes more deaths in South Africa than HIV/Aids, tuberculosis and malaria combined. According to the Cancer Association of South Africa (CANSA), 115 000 South Africans are diagnosed with cancer each year with one in six successfully treated. If you are aware of the risk factors, heed early warning signs and make use of the cancer screening and treatment benefits you enjoy as a Medihelp member, you can increase your chances of successful treatment.

Risk factors you can control

Although risk factors for developing cancer such as age and family history are inevitable, you can effectively reduce your risk by making positive lifestyle choices (which seem self-evident but are not always so easy to implement!), through:

• Beating the smoking habit
• Maintaining a healthy weight
• Following a healthy diet which includes a variety of fresh fruit and veggies
• Protecting your skin from the sun
• Staying physically active and exercising regularly
• Avoiding excessive alcohol intake
• Regularly checking your body for warning signs
• Making use of Medihelp’s preventive care benefits and check-ups.

Early detection is key

The earlier cancer is detected, the greater the chance of successful treatment. According to the World Health Organisation (WHO), early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon, rectum and skin. Some early warning signs include:

• Loss of appetite. Cancer can change your metabolism. Stomach, pancreatic, colon and ovarian cancers can put pressure on your stomach, which makes you feel too full to eat and can lead to weight loss.
• A lump in the neck or elsewhere. Most cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands) and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size.
• Changes to your skin. Skin cancers often start as changes to your skin, such as a growth that starts to look different, a mole that changes shape or colour or a sore that doesn’t heal. They can be new growths or precancerous lesions – changes that are not cancer, but could become cancer over time.
• Swelling in lymph nodes that doesn’t go away in a week or so - especially under the arms, which could be an indicator of breast cancer.

Help from Medihelp for early detection

Medihelp offers a range of screening tests such as an annual pap smear for all ladies, while over 40s also qualify for an annual mammogram and men for an annual prostate test (PSA level). Keep in mind that these screens should be requested by a medical doctor.

Treatment

Medihelp provides support through the oncology programme offered in cooperation with the oncologists of the Independent Clinical Oncology Network (ICON) to give you the best possible care and treatment. More than 80% of South Africa’s oncologists belong to this network, which provides the highest quality cancer care based on evidence-based protocols. ICON has a national footprint and uses a combination of treatments at their high-tech chemotherapy and radiotherapy facilities, as well as at private hospitals should surgery be required.

Upon diagnosis

Should you be diagnosed with cancer, contact Medihelp at 086 0100 678 and a consultant will assist you to register on the Medihelp Oncology Management Programme, as all oncology treatment requires pre-authorisation. Once registered on the programme, you will be referred to an ICON oncologist, who will provide you with the appropriate treatment plan.

Family history of cancer?

According to the American Cancer Society, about 5% to 10% of cancers are inherited. An interesting fact is that people from the same family sometimes develop the same kind of cancer because they share behaviour that increase their risk, like unhealthy eating habits. Be aware of your family’s cancer history and have regular check-ups for kinds of cancer that seem to run in your family. é

Private medical practitioners may charge considerably more than what your medical aid plan provides for. This then creates a shortfall or “gap” between what your medical aid pays and the rates the treating medical practitioner charges. Gap cover is a medical short-term insurance product designed to cover these shortfalls incurred in and out of hospital. Without gap cover, you would be personally liable to pay the difference in rates.

Gap cover is not a substitute for your medical aid; it’s simply a supplementary product that helps you and your loved ones cover your medical expense shortfalls.

Why choose MedGap?

MedGap, underwritten by Guardrisk, offers affordable gap cover products specifically designed to provide cover for specified medical expense shortfalls if you need surgery or medical treatment in hospital, as well as for certain procedures performed out-of-hospital.

As one of HealthPrint’s partners, MedGap is offering HealthPrint members a special offer on its Primary and Supreme products. Members can get up to 29,06% discount by taking out a gap cover policy through MedGap.

You will be assured of comprehensive cover for medical shortfalls, a seamless claims process and professional and efficient customer service.

For more information or to apply, log in to your HealthPrint profile and click on “MedGap” on the dashboard. If you are not a HealthPrint member yet, click here to register for free and get access to other exclusive discounts, special offers and health programmes which will help you on your health journey. é

Disclaimer: The views, information, or opinions expressed in this publication are solely those of the authors and do not represent those of Medihelp Medical Scheme and its employees. All content provided is for informational purposes only. Medihelp Medical Scheme makes no representations to the accuracy or completeness of any information in this publication or found by following any link in the text.

From a young age we are taught to practise good oral hygiene to help prevent bad breath, tooth decay and gum disease. A healthy mouth is good for your overall health, too, as recent studies suggest there may be a link between oral infections – primarily gum infections – and poorly controlled diabetes, cardiovascular disease and preterm birth.

If you don't brush and floss regularly to keep your teeth clean, plaque can build up along your gum line, creating an environment for bacteria to gather in the space between your gums and your teeth. When this happens, you run the risk of developing gingivitis, a mild form of gum disease that causes irritation, redness and swelling of gums. Left untreated, gingivitis can lead to periodontitis and other conditions such as trench mouth, a serious oral infection characterised by painful, bleeding gums and ulcers in the gums.

Bacteria from your mouth normally don't enter your bloodstream. However, sometimes even just routine brushing and flossing if you have gum disease can provide a port of entry for these microbes. For people with weakened immune systems, the presence of oral bacteria in the bloodstream (bacteraemia) may lead to an infection in another part of your body.

Even if you take excellent care of your teeth and gums, you still need to visit a dentist preferably every six months for a check-up, as this can help identify problems or diseases early enough to treat while still at a manageable stage.

Why DRUM dental insurance?

Dental treatments can be expensive and additional insurance will go a long way in providing for dental expenses if your medical scheme product does not provide cover. DRUM dental insurance processes claims outside of the medical aid environment. You can also use any provider of your choice.

Special rates for HealthPrint members

DRUM offers HealthPrint members 10% discount on all its dental insurance products. Plans range from basic dentistry services – including check-ups, fillings, X-rays and scale and polish treatments – to comprehensive plans offering cover for members with more extensive dental treatments such as crowns, bridge work and dentures. The two top options also include a benefit for dental implants.

For more information or to apply, log in to HealthPrint and select “DRUM” under HealthPrint partners on the dashboard. If you are not a HealthPrint member yet, click here to register free of charge and get access to this offer and other exclusive discounts, special offers and health programmes which will add value to your Medihelp experience.  é

Disclaimer: The views, information, or opinions expressed in this publication are solely those of the authors and do not represent those of Medihelp Medical Scheme and its employees. All content provided is for informational purposes only. Medihelp Medical Scheme makes no representations to the accuracy or completeness of any information in this publication or found by following any link in the text.

Medihelp’s Member Zone is an online self-service portal which gives you access to your Medihelp profile, claims and benefits in a secure environment, 24 hours a day, seven days a week.

Manage your personal information. You can update your personal information and contact details on the Member Zone. For security reasons, details such as your full name or ID number may not be changed online, so send email to membership@medihelp.co.za or phone our Customer Care centre at 086 0100 678 to update this information.

Register a dependant. An e-application form is available on the Member Zone to register or deregister your dependants. Simply complete the form, attach the relevant documentation and submit. You also have the option to save the form and complete it at a later stage.

View what medical services are covered by your plan. See a breakdown of the services that are covered by your plan, including the following:

• A detailed description of the benefit for each medical service you may need;
• The annual limit or maximum amount available for each benefit (if applicable);
• A record of the services you have already used; and
• The remaining benefits available for the rest of the year.

If your product includes a savings plan, you can also view the funds available in your savings account.

Check if your claims have been paid, and submit claims. View your processed claims and check your claims statements to ensure that claims have been submitted to Medihelp within the prescribed deadline. You can also submit your Medihelp claims online.

Download your tax certificate. You can download your annual Medihelp Medical Scheme tax certificate on the Member Zone to submit to SARS.

Request pre-authorisation. You can request pre-authorisation online for the following benefits:

• Hospitalisation
• PMB services
• Oncology
• Specialised radiology
• Chronic/PMB medicine
• Oxygen
• Necesse referrals
• Medicine for more than 30 days
• Specialised medicine

Search for a network provider. You can do a quick online search on the Member Zone to find details of your nearest network provider.

A detailed list of these providers is also available to view or download.

View your Medihelp monthly contributions. View a history of your Medihelp contributions to date, how your monthly Medihelp contribution is calculated, the funds available in your savings account (for members of Prime 2 and Unify) and any applicable late-joiner penalties.

View or request your Medihelp membership card. Download or email a pdf version of your membership card to share with your healthcare provider, or request a new printed membership card which we will send to you via post. é

Medihelp began 2019 with a running start when a combined total of more than 10 000 runners and cyclists participated in two Medihelp-sponsored events, the Medihelp Stellenbosch Cycle Tour and the Medihelp Sunrise Monster held in January and March respectively. These events promote a healthy lifestyle and provide value to Medihelp members through free entries to participate in these events.

Cycling

The Medihelp Stellenbosch Cycle Tour took place on Sunday, 20 January in Franschoek, Western Cape in near perfect weather conditions. The 102 km route included a major climb of the new Helshoogte Pass (some 1 285 m of total ascent) about 65 km into the race. Upon reaching the top, the participants enjoyed a pedal-free descent into Pniel and had some time to recover before tackling the last, quick 30 km to the finish line. The winner in the men’s category, Byron Munton (20), finished the race in just over two hours, while Cherise Willeit (29), winner in the women’s category, crossed the finish line in two hours and 35 minutes.

The event was the final premier seeding event for the 2019 Cape Town Cycle Tour and had a total of 4 213 participants.

Running

The 42nd annual Medihelp Sunrise Monster took place a few weeks later on Saturday, 2 March in Pretoria. 6 759 runners tested their mental and physical strengths in one of four distances: The 32 km Monster, 10 km Mini Monster, 5 km Baby Monster and a new 21 km distance called the Half Monster.

The routes contoured through the leafy residential areas of Waterkloof, Monument Park, Muckleneuk and Groenkloof in Pretoria East. Fort Klapperkop proved to be the biggest challenge for the Monster and Half Monster runners, who braved the gradual uphill climb approximately 10 km after the starting point. Medihelp volunteers offered refreshments at water points along the routes and joined spectators in cheering participants on as they made their way towards the finish line.

It was a proud day for Medihelp MultiSport, a social club for runners and cyclists sponsored by Medihelp, when three of the club’s members took podium spots in their respective distances. Velaphi Sibanyoni (40) won the veteran’s category in the 21 km Half Monster, with Brian Montsho (41) taking second place. Justice Ramaliyhana (40) was the winner in the veteran’s category for the 10 km Mini Monster.

Apart from being an excellent Comrades conditioner for serious runners, the Medihelp Sunrise Monster is also a popular event for families and friends who enjoy casual running. é