Frequently Asked Questions

Why does Trulogic have a Wellness Centre?

We realized that too many of our clients are not capitalizing on the discounts, cash backs and other rewards that were available to them. The Truwellness Centre is very conveniently situated where our clients can do all their assessments very conveniently in one place.

Employment insurance or Job Insurance, what is it and how do I get it?

Employment Insurance or Job Insurance, better known as Income Protection Cover, is a type of Life Insurance policy that pays a monthly "salary" in the event that you become disabled due to injury or disease and unable to earn an income.

What is a PMB?

PMB is an acronym for Prescribed Minimum Benefits as stipulated by the Council for Medical Schemes.
PMBs are defined by law and deal with the minimum level of diagnosis, treatment and care that your Medical Aid scheme must cover. Your Medical Aid Scheme must pay for these conditions or treatments from its risk pool, (so not from your savings for instance), and it must pay for it in full.

Medical Aid

I am looking for a cheap Medical Aid in South Africa!

Yes, unfortunately this takes too big a bite out of our budgets every month and there is no such thing as a cheap Medical Aid on South Africa!

But, that does not mean that you cannot save! 

The first step is to make sure that the Medical Aid that you are on is suitable for your requirements. You can either have too many benefits that you simply don't use because you are possibly still young or just healthy, or you could be on an option that doesn't provide for your exact requirements and you end up having to pay too much out of your pocket.

Once you are happy that you are on the best and cheapest Medical Aid for your needs, the next step is to look at adding a Gap Cover product so that you don't have to worry about sudden unbudgeted expenses due to excesses and co-payments.

With that taken care of, you need to look at maximizing the rewards, discounts and cash-backs that many Medical Aid Schemes in South Africa offer. This does take a bit of effort on your part, but is really worth it!

The good news is that Trulogic will help you maximize your rewards every step of the way!

We have our own Wellness Centre at our offices where you can do Health, Fitness and Dietitian assessments all conveniently in one place. (and you can book your appointments online by clicking here). We also guide you on the easiest way to quickly earn points based on your lifestyle and preferences which include points for doing online assessments, going to the Gym or wearing a Pedometer. (and many others)

Who is the Best Medical Aid in South Africa?

There is no easy answer to this as there are too many factors that need to be considered before anyone can recommend the best Medical Aid for you.

There are many Medical Aid Schemes in South Africa and each one of them have numerous options to cater for a variety of budgets and needs. To pick the one that is best for you requires in depth knowledge, experience and the right tools.

Typically if you qualify for membership of a closed scheme, the benefits and price would be such that there may be no reason for you to look elsewhere. Often membership to a closed scheme is compulsory when you work for a company that has its own Medical Aid. Making it compulsory for all employees is necessary to ensure that they have high enough volumes to manage the risk and negotiate rates with service providers.

If you look at the open scheme market you have lots of choices! The good news is that the open scheme market is very competitive so you can shop around to your hearts content. Medical Aid Schemes are also highly regulated by the Council for Medical Schemes.

At Trulogic Financial Services we use a Medical Aid comparison tool that puts the different options from different Medical Aid Schemes next to each other so you can compare apples with apples. Contact us today to book an appointment with one of our brokers to discuss this.

What is a PMB?

PMB is an acronym for Prescribed Minimum Benefits as stipulated by the Council for Medical Schemes.

PMBs are defined by law and deal with the minimum level of diagnosis, treatment and care that your Medical Aid scheme must cover. Your Medical Aid Scheme must pay for these conditions or treatments from its risk pool, (so not from your savings for instance), and it must pay for it in full.

But, be aware! The law also makes provision for Designated Service Providers, Managed Care Protocols and Formularies.

What this means for you as a Medical Aid member is that as long as you follow the rules of your Medical Aid Scheme and use their Designated Service Providers they are bound by law to pay PMB claims in full. Should you however decide not to follow their rules, or use a doctor, specialist or other service provider that is not on the Designated Service Provider list of your scheme, you may be liable for excesses or co-payments as specified by your Medical Aid policy.

Do not assume these excesses or co-payments will be covered by your Gap CoverClick here to read how you can make sure you are covered.

Medical Aid Schemes make use of Designated Service Providers, Managed Care Protocols and Formularies to manage their costs in providing for PMB claims and in doing so enabling them to offer cheaper premiums.

Click here to read more about Prescribed Minimum Benefits

Gap cover

Will my Gap Cover policy pay for PMB claims?

Your Gap Cover policy will only pay the excess on a PMB, (Prescribed Minimum Benefit), claim if PMB claims are specifically included as a benefit on your policy document.

Don't assume that this is the case. Most Gap Cover policies in fact do not cover accesses on PMB claims. Make sure that you specifically ask your broker to include PMB claims as an option in your quote. Including PMB claims in your Gap Cover policy will typically increase the premium that you will pay.

Make sure that PMB claims are included in your Gap Cover policy by checking the policy document wording or ask your broker to point it out to you.

Can I get Gap Cover without Medical Aid?

There are Gap Cover providers that do allow you to have a Gap Cover policy without Medical Aid. In this case they will use their own internal tariffs to calculate what a typical Medical Aid would have paid out for the treatment you received, and they will then pay you the balance, or excess, over and above that.

For most Gap Cover providers getting a Gap Cover policy without Medical Aid would be meaningless, in fact, most will not allow you to take out a Gap Cover policy without providing your Medical Aid membership number first.

Your Gap Cover is not a Medical Aid and will only pay shortfalls or gaps that your Medical Aid does not cover. Typically if your Medical Aid rejects a claim outright, your Gap Cover policy will also not pay anything because it only pays shortfalls, not an entire medical claim.

Does my TruGap Gap Cover policy pay PMB claims?

Including PMB claims in your Gap Cover policy does make it more expensive. We therefore offer options with and without a PMB claims benefit.

If you are on Momentum Medical Aid you can choose from four TruGap Gap Cover options:

Option 1 - Will only cover PMB claims if you are on the ALTERNATIVE COVER option
Option 2 - Will only cover PMB claims if you are on the ALTERNATIVE COVER option
Option 3 - Does not cover PMB claims
Option 4 - Does include PMB claims

If you are on Profmed Medical Aid you have two TruGap Gap Cover options to choose from but neither of them cover PMB claims at this stage.

Life Insurance

What is the difference between Dread Disease Cover and Critical Illness Cover?

Dread Disease Cover and Critical Illness Cover refers to exactly the same type of Life Insurance cover.

Your Dread Disease or Critical Illness Cover policy will pay a lump sum in the event that you are being diagnosed with a qualifying disease as stipulated in your policy document. Worldwide the probability of anyone being diagnosed with a critical disease is on the increase so including this type of Life Insurance cover as part of our financial planning is important. You should also consider the prevalence of these diseases in your family when prioritizing the type of cover you can afford.

Diseases that are typically covered in a Critical Illness Cover policy include Cancer, Heart Attack, Stroke, Renal Failure, Multiple Sclerosis, Parkinson’s disease and many more.

Do not assume these excesses or co-payments will be covered by your Gap CoverClick here to read how you can make sure you are covered.

Medical Aid Schemes make use of Designated Service Providers, Managed Care Protocols and Formularies to manage their costs in providing for PMB claims and in doing so enabling them to offer cheaper premiums.

Click here to read more about Prescribed Minimum Benefits

Should I consider a Funeral Plan or getting Funeral Cover?

The short answer is that we would probably advise you to first have a good look at the Life Insurance policies you have and specifically any Death Cover benefits that you may have.

Many Death Cover policies include Funeral Cover as a benefit so if you are looking for a Funeral Plan just for yourself you may be covered already. If you are looking for Funeral Cover for someone else then it certainly would be in your best interest to look at the situation carefully first to determine if a Death Cover Policy with a Funeral benefit is the way to go or just a stand alone Funeral Cover policy. For instance, if one person would be left with debt to repay if the other passed away, it may be better to consider a Death Cover policy.

If you find that your Death Cover policy includes a Funeral benefit, make sure that you are aware of any waiting periods for this. Some schemes require that the Death Cover policy be at least 24 months old before you can claim on the Funeral benefit. If the Funeral Cover is available, payout usually happens within 48 hours of the necessary paperwork being done.

Insurance companies in South Africa, how do I choose?

The short answer to this question is that you may want to leave it up to your broker to advise you on which insurance company in South Africa to put your trust in. But, be aware, make sure that you are talking to an independent broker and not to a an agent that is tied to a specific Life Insurance scheme. (unless you know which insurer you want to support in which case it is fine to get advice from an agent of that scheme)

Go one step further, ask your broker to be specific about which Life Insurance schemes he is registered for as a broker. All Life Insurance brokers have to go through a registration process and complete competency tests for a particular scheme to be able to advise on and sell that schemes products. The broker will have proof of registration of all the schemes that he can legally advise you on.

All Life Insurance companies in South Africa are being kept honest and fair by the FSB, (Financial Services Board), and will have an FSB number. The FSB number must always be displayed clearly on all quotes or documents of advice. If you suspect that your best interests are not being looked after you can make inquiries at the FSB using the FSB number.

Note that this applies to your broker as well who must be registered with and provide you with an FSB number clearly visible on all documentation.

Click here to view registration details for Trulogic Financial Services.

If you want to discuss your needs with a broker, book an appointment here now or simply submit your details here and we will contact you.

Employment insurance or Job Insurance, what is it and how do I get it?

Employment Insurance or Job Insurance, better known as Income Protection Cover, is a type of Life Insurance policy that pays a monthly "salary" in the event that you become disabled due to injury or disease and unable to earn an income.

Most Life Insurance Schemes in South Africa offer some sort of Employment Insurance or Income Protection, so you are spoiled for choice. You should always discuss your requirements with your broker to make sure you get the best advice on which scheme and which options will work best for you.

Income Protection typically offers a benefit up to around 65% of your Gross Monthly Income. This limit is a legal requirement so no scheme can legally offer you more cover than that, and it is illegal to get Income Protection cover from different schemes to get more cover than 65% of your Gross Income. Keep in mind that most schemes will also have a maximum Rand amount that they can offer as a benefit. Should this be less than what you need, and less than 65% of your Gross Monthly Income, you may have to look elsewhere.

You will have to decide on the waiting period before you can claim after a claim event. The waiting period can be anything from a few days to 12 months, depending on the schemes rules. Typically the longer the waiting period the cheaper the premium.

Because Employment Insurance or Income Protection pays out monthly you have to consider opting for a benefit growth while in claim. If you are in a situation where you become unable to earn an income for a long time, inflation may reduce the value of the payouts year after year to a point where you start to struggle financially. To counter this you can choose for the monthly benefit to increase annually by a percentage or by CPI. Opting for this will increase your premium but may be well worth it in the long run.

To discuss this with a broker, book an appointment here or submit your details here and we will contact you.

Rewards

Why does Trulogic have a Wellness Centre?

Trulogic has thousands of Medical Aid clients and many of them belong to some kind of rewards programme.

We realized that too many of them were not capitalizing on the discounts, cash backs and other rewards that were available to them because of the inconvenience of booking Bio, Dietitian and Clinic assessments and travelling to all these different venues.

Our offices are very conveniently situated in Lourensford Road, Somerset West and so we decided to setup a facility where our clients can do all their assessments very conveniently in one place with easy parking.

To book your appointment click on button below. We will confirm your booking or suggest alternative dates and times if needed.

Gym Discounts and Rewards, is it worth it?

It really is possible to gym for free in South Africa, even at the big names like Virgin Active and Planet Fitness.

The main schemes that offer gym discounts include Discovery, Momentum, Liberty and Sanlam.

Each of them have slightly different criteria and rewards, but all of them have a vested interested in making it as easy as possible for you to get active and be healthy.

Apart from the discounts that you can earn, up to 80% with Discovery and Momentum, and 100% with Liberty, you can also earn cash rewards, so much so that not only do you end up paying nothing for you gym membership, but you actually get money back in your pocket for doing so!

We have a dedicated page just for gym discounts where you can find much more info on this. Have a look at the table comparing the different options to see which one is most suited to your needs.

Dental Cover

Does a principal member have to join or can they opt to only insure their children, for example?

Principal Member has to join

Does the client have to always pre-authorise an upcoming procedure or can they just submit invoices thereafter?

A policyholder must always pre authorise the specialised dentistry benefits. These are the benefits with a six
month waiting period. We need to authorise them for a couple of reasons:
· That the procedure is functional and not cosmetic in nature
· Fraudulent activities etc
· That all exclusions according to the policy document are adhered too.

Does the cover include any dental work in-hospital or is it only for procedures performed in a dentist’s chair?

Dental work in-hospital only applies to Wisdom Teeth and the dentist has to motivate why a hospital needs to
be used and not the dentist’s chair

Please can you clarify whether the pre-existing condition exclusion on the Basic Dentistry Plan excludes for e.g. an existing crown that needs to be replaced?

No, the existing crown cannot be replaced

Confirm that there is no limit on the amount of children covered under the parent’s policy?

No limit is correct

Can a family consisting of husband, spouse and children take out different plans on the same Specialised Dentistry Policy, e.g. Husband on Gold, spouse on Silver and child on Bronze?

No, they must all be on the same plan

Will the Dental Risk Company (DRC) cover a child who needs to have extractions done in hospital? If yes, what is the maximum age limit?

It is a stated benefit. The registered child will get a fixed amount irrespective if it is done in a dentist’s chair or in-hospital

What is the time frame we can expect to get called back when we sms the call centre?

The sms will be responded to within three hours, within working hours

When can a client upgrade their policy?

They can only upgrade (the new upgraded options waiting periods will then apply) or downgrade at the end
of each 12 month period

Implants – is this benefit only for any existing tooth that is removed and replaced with an implant, during the period of insurance?

Yes

Exclusions – Does this include any filling-type that is removed during the period of insurance?

Yes

Exclusions – Impacted teeth, is there a definition of impacted teeth that is different to wisdom teeth that are impacted?

Yes, we only cover impacted wisdom teeth

Exclusions – Severely decayed or damaged tooth, is there a definition that determines the extent of the decay?

Yes, there is a definition. Clause 6 of the policy wording – at least two thirds of the tooth is decayed then we don’t cover

Pre-existing conditions – Other than the stated waiting periods – please clarify at what stage will any preexisting condition be excluded from cover?

On submission of a claim, to determine whether the claim is fraudulent or not

The 65 age limit – Do you need to come on before you are 65 or can you be 65 and does the policy stop at age 65?

The client needs to be 65 or younger to join and the policy does not stop after the age of 65, it carries on until the person resigns or passes away

Can the clients pay annual premiums upfront?

The client can pay upfront but the waiting period still applies

If a member takes the policy in July 2014 for example, all the cover that requires 3 months payments will be available to the member in October 2014, is that correct?

Correct

The implants require 6 months payments (joining date, July 2014), so January 2015 the member would be able to have 2 implants?

Correct

Because the member takes out the policy mid year (July 2014), would the member only be eligible for the next 2 implants the next January regardless of the fact that the member took out the policy in July 2014?

The benefits are allocated for a 12 month period. Only once the initial 12 months have expired, the member qualifies again for the same benefits

If the member wants to change from Platinum to Silver at a later stage, can they and under what conditions?

The member can upgrade at any time during the year but can only buy down once a year in January

Can a member add a child at a later stage and under what conditions?

The member can add a child at any time; they will have to do the waiting periods from scratch