AFFINITY HEALTH LEGAL
Important legal notices
DISCLOSURE AND OTHER LEGAL REQUIREMENTS
Affinity Health is committed both under legislation and in terms of our own ethical code, to provide you, our client, with all the information that you need to ensure that you are in possession of all relevant facts about the various parties supplying you with your insurance product.
ABOUT THE INSURER
The insurance company which ultimately underwrites the risk as determined by this policy is Lion of Africa Life Assurance Company Limited (FSP 15283).
Information regarding the Insurer:
Registration Number: 1942/015587/06; FSP Number: 15283; 1st Floor, Block D, The Boulevard Office Park, Searle Street. Woodstock 7925.
PLEASE ADD another dropdown:
About the Intermediary
The intermediary is the company who will sell you the Affinity Health policy. Affinity Health’s mandated intermediary is Independent Risk Distribution South Africa (Pty) Ltd.
Information regarding the Intermediary:
Registration Number: 2012/093979/07; FSP Number: 46861; Postnet Suite 241, Private Bag X1, Northmead 1501; 2 Miles Sharp Street, Rynfield, Benoni 1501; Tel: 0861 22 22 93; Fax: 086 571 0237; Email: email@example.com
ABOUT YOUR FINANCIAL SERVICES PROVIDER
Affinity Health is a product of National Risk Managers (Pty) Ltd, the Underwriting Managing Agency (UMA).
The UMA is a company who attends to all administrative and underwriting matters pertaining to the policy, on behalf of the Insurer. The UMA ensures that the intermediary is properly appointed and oversees the receipt and proper disbursement of premiums.
Information regarding the UMA:
Registration Number: 2016/109644/07; FSP Number: 47132; Postnet Suite 124, Private Bag X101, Farrarmere, Benoni 1518; 1 Dingler Street, Rynfield, Benoni 1501; Tel: 0861 11 16 10; Fax: 086 607 9419; Email: firstname.lastname@example.org
Affinity Health and National Risk Managers are in possession of Professional Indemnity Insurance.
HOW TO LODGE A COMPLAINT
Should you have any complaint about your policy or the service that you have received, please contact Affinity Health.
To lodge a complaint:
Please contact our complaints facilitator on email@example.com . All complaints must be reduced to writing and any of our representatives will be able to provide you with a copy of our complaints policy, on request.
If the complaint is not dealt with satisfactorily, please contact the appropriate Ombudsman listed below.
CONFLICT OF INTEREST
We are pleased to report that there are no Conflicts of Interest or potential Conflicts of Interest identified within our organisation. A copy of our Conflict of Interest management policy is available on our website.
- Do not sign any blank or partially completed application form.
- Complete all forms in ink.
- Keep all documents handed to you.
- Make notes as to what is said to you.
- Ask for a letter of representation from your adviser.
- Do not be pressurised into buying the product.
PARTICULARS OF FAIS OMBUD
PARTICULARS OF LONG-TERM INSURANCE OMBUD
Affinity Health is revolutionizing the health benefits market through innovative and customizable healthcare products. Our CEO, Murray Hewlett, is at the forefront of this innovation.
Why trying to regulate morality is failing the healthcare system in South Africa
You can’t regulate morality – and therein lies the dichotomy. While socialism is admirable in its intention, socialism without a capitalist implementation fails every time. Remember the USSR?
And the reason for this is very simple; it’s down to human nature. In any society there are those that will rise to the top and there are those that will languish at the bottom. Socialism tries to equalize this, which doesn’t work because those at the top get tired of carrying those at the bottom and those at the bottom get indignant because they feel that it is their right to be carried.
Sure, equality is our birthright, but without an equal, or at l east valued effort from all parties to maintain a society, moral degeneration will always be the result. Those who rise to the top will eventually start taking advantage of the rest to increase their power and wealth and those more ethically minded will try and step in to apply justice and fairness. Those at the top will keep their wealth amongst themselves and not distribute said wealth to the others because the others will be considered to not have earned it and are ultimately used as a resource to increase the wealth and power for those at the top.
What has this got to do with the healthcare system in South Africa? Quite simply, the regulators and government are trying to impose regulations that create an equal environment for all citizens – which is the right thing to try and do, but unless critical sustainability factors are implemented, it will and is failing.
Through the regulation of the medical aid sector by the Council for Medical Schemes (CMS), they have stopped the schemes from being able to underwrite clients therefore making it very difficult to manage their risk pool. Without being able to segregate their risk pool by ascertaining client exposure and by forcing all schemes to accept all clients, no matter their risk exposure, for the same premiums, they have effectively introduced the death spiral for medical aid.
By equalizing the risk pool, through the introduction of Prescribed Minimum Benefits (PMB’s) forcing schemes to accept all applicants and by not considering the commercial sustainability of the system – or by considering it, but not implementing the legislation or principles to make it work (which do exist) – it has caused the rampant increase in medical aid premiums, which in turn reduces your client base as members either can’t afford the premiums or choose alternatives.
Medical and Health Insurance provides the alternative
Alternatives never really existed until recently with the innovation from insurance companies as they used the gaps created in the medical aid market as a means to reduce costs, to create insurance cover for medical events.
As the insurance industry is not regulated by the CMS but the Financial Services Board (FSB), which implements and governs insurance principles, insurance companies don’t have the difficulty the medical aids do in underwriting their risk pool. Although many people feel that insurance is a grudge purchase and is unethical, it is not the fault of the principles of insurance, but rather the ineffectiveness, whether purposeful or not, of the client facing representatives.
Insurance principles are very simple and work off three basic rules:
- The risk must be an uncertain event – unpredictable and not guaranteed.
- The collective needs to have a big enough exposure to uncertain events.
- There needs to be a means to pool the risks so that the collective can cover the individuals who are affected by the uncertain event.
Taking these 3 rules into account, how then is Medical Insurance revolutionizing the healthcare sector?
Well there are two type of insurance: short term and long term. Short term insurance is also known as indemnity insurance and its aim is to ensure that you are in the same position after an unpredictable event as you were before it. Short term insurance, therefore, covers the costs resultant from the event, within certain stipulations and guidelines.
Long term insurance is insurance that provides a stated benefit or benefits for a member in return for an underwritten premium based on each members risk profile.
If we return to the rules of insurance, we can now see how new insurance products are developed: If there is a need to protect or cover people from an event and there are enough people exposed to that risk, then invariably an insurer will develop a product to meet that need.
And this is precisely where medical insurance stepped into the picture. There are deficiencies in the medical aid market due to legislation and regulation and, as it nears the end of its death spiral, these deficiencies are as exposed as their declining risk pool.
With the ability to underwrite the risk pool and without being forced to prescribe to the same legislation that Medical Aids do, Medical Insurers are able to calculate premiums based on cost of defined benefits versus the exposure of the risk pool and are therefore able to vary premiums for each member.
At Affinity Health, we have taken this a step further and created a network of medical professionals with whom we can negotiate rates and represent both the interests of the medical professional as well as our members through our case managers. This allows us to provide a seamless, managed experience for all parties.
We go to great lengths to explain to our members that we are not a medical aid. We also explain exactly what their premiums give them in terms of cover, so they can adapt their cover to suit their needs or their budget. No one will ever know a persons’ medical history better than themselves, so our members are, through the advice of our representatives, encouraged to ascertain their own risk level and therefore tailor make the benefits on their cover as per our stated benefits and drug formulary.
Medical insurance in South Africa has not only gone a long way to plugging holes in medical aid deficiencies, but it has also opened up private healthcare services to a wider audience due to its affordability, yet it still operates with the understanding that for any project to be sustainable it needs to be implemented with sound economic principles – and it is the ethical and moral code written into the governance manuals that determine the longevity of an insurance company.
You can’t regulate morality, but you can bring morality, ethics and economics together to provide to a need – that is true sustainability.
Murray is the CEO of Affinity Health.
Affinity Health is the leading provider of affordable tried and tested medical and health insurance products in the South African Market.
Why do we love to hate our Insurance?
Every time I sit down for a coffee with a colleague, friend or associate, the conversation invariably leads to a mutual distrust and dislike of the insurance industry – ok not every time, but pretty often. I have often wondered why we feel so hard done by when it comes to insurance and the multitude of products that are sold to us…
I have often wondered why we feel so hard done by when it comes to insurance and the multitude of products that are sold to us as a way to protect us from the perils of daily life – we humans really do battle, how we survive is anyone’s guess…
I sat down with Murray Hewlett, CEO of Affinity Health and asked him some hard questions about the insurance industry…
MH: We created Affinity Health to fix problems in the medical aid and medical insurance industries.
Medical aid is seen as too expensive in South Africa and medical insurance has a problem as it is an agreement between an insurer and the policyholder which doesn’t guarantee you admission into a medical facility. Generally you can’t claim until you know an amount, and you don’t know an amount until you have spent the time in the facility – this creates an ethical dilemma and a gap in the market between medical aid’s expensiveness and medical or health insurance’s inability to accept a claim. This is where Affinity Health stepped in providing medical aid service through the health insurance model.
MH: Medical aid is indemnity cover against medical expenses. In theory they cover you for all your medical expenses, but in practice they don’t. Medical insurance in a defined benefit cover, example, if you go for a appendectomy, we’ll pay R 30 000.00, if the cost is R 25 000.00 you score, if it’s R 40 000.00, you have to find the difference.
All the benefits are pre-defined whether it is a surgical procedure or days in hospital, which means that the member knows what they are going to get and can then manage those expenses accordingly and can even negotiate with the facility based on those pre-defined amounts and in fact we’ll negotiate with the facilities on their behalf through our case managers.
Medical Insurance silo?
MH: Customer service, great premiums, having the ability to have our members admitted into a medical facility and having a national network of Doctors, Dentists, Pharmacists, Radiologists, Pathologists and Optometrists.
MH: I don’t think there is lack of trust, I think that it is just indicative of a market that is hyper competitive. We have seen the same for the cell phone companies, the banks and the same in the insurance space over the last 20 years. Churn is important because it allows insurance companies to compete with better and better products. If you look at South Africa’s insurance environment versus global insurance markets, due to our competition our products are first world and better. The competition is good for the consumer because it drives prices down and benefits up.
MH: We spend a lot of time educating our customers about how the product works and why it works. This creates realistic expectations. One of the biggest reasons for insurance policy cancellations is people buying products that they don’t understand, creating unreal expectations, so when the product doesn’t deliver on those expectations, the customer cancels the policy blaming the service or product provider.
http://www.popi-compliance.co.za/ has gone quiet. Everyone, especially the public seemed so excited by its sign off in parliament; finally the public had a way to get back at these spammers and hold them accountable; but an age seems to have passed since then and it feels like its business as usual for the corporate culprits – how will the POPI Act affect insurance companies like yourselves if at all?
MH: The POPI act is designed to protect the consumer against unsolicited marketing from a digital perspective. We’ve seen from overseas cases that opt-in regimens do not offer the consumer more protection, all they do is increase the price of marketing which is then passed down to the consumer with more expensive products, so we don’t see POPI having any effect in digital marketing in the country in the long term.
MH: POPI is designed to protect the information from getting into criminal hands rather than to stop people from receiving marketing information.
Every time the DMA advertises the OPT out list, they don’t receive an increase in opt out requests, it makes humans feel disconnected. Most people would want to be able to choose which types of messages they receive as opposed to being completely opted out, so knowing which people want which type of information is key, of course, though, how do you know that unless you ask?
MH: We ensure that all complaints are answered no matter where they come from: Hello Peter, Facebook, e-mail etc…we do spend a vast amount of time and energy ensuring that our customer service goes above and beyond expectations.
Affinity Health is the leading provider of affordable tried and tested medical and health insurance products in the South African Market.