2020 Bonitas Medical Fund and Fedhealth Medical Scheme Induction - - PowerPoint PPT Presentation

▶
2020 bonitas medical fund and fedhealth medical scheme
SMART_READER_LITE
LIVE PREVIEW

2020 Bonitas Medical Fund and Fedhealth Medical Scheme Induction - - PowerPoint PPT Presentation

Nov 23, 2023 488 likes •755 views

2020 Bonitas Medical Fund and Fedhealth Medical Scheme Induction Presentation for Santam Employees Aon South Africa (Pty) Ltd Aon South Africa (Pty) Ltd 1 Proprietary & Confidential Proprietary & Confidential Agenda Section 1 - Five

slide-1
SLIDE 1

Aon South Africa (Pty) Ltd Proprietary & Confidential

1

Aon South Africa (Pty) Ltd Proprietary & Confidential

2020 Bonitas Medical Fund and Fedhealth Medical Scheme

Induction Presentation for Santam Employees

slide-2
SLIDE 2

2

Aon South Africa (Pty) Ltd Proprietary & Confidential

Agenda

Section 1 - Five Key Decisions Section 2 - Sanlam Gap Cover Section 3 - Underwriting: Gap & Medical Scheme Section 4 - 2020 Medical Scheme Offerings Section 5 – Review and the way forward Section 6 - Aon Resolution Centre (ARC) Section 7 - Social Media

slide-3
SLIDE 3

3

Aon South Africa (Pty) Ltd Proprietary & Confidential

Five Key Decisions

Network of hospitals OR freedom of choice? Co-payments OR Annual Limits? Carried over MSA? Depleted MSA? Used less than 50% MSA? Closed SPG? Used up day to day? What rate of hospital reimbursement is appropriate? Do you need additional chronic cover? To what extent do you require Day to Day cover?

Hospitalisation Day-to-Day Expenses Chronic

slide-4
SLIDE 4

4

Aon South Africa (Pty) Ltd Proprietary & Confidential

Sanlam Gap Cover 2020

slide-5
SLIDE 5

5

Aon South Africa (Pty) Ltd Proprietary & Confidential

Sanlam Gap Cover for hospital expenses. The difference between covered and fully covered.

There’s often a difference between what a specialist charges in hospital and what your medical scheme will cover. Sanlam Gap Cover pays for this shortfall up to an Additional 500% so you don’t have to suffer financially due to unexpected medical expenses. This includes co-payment cover and more.

slide-6
SLIDE 6

6

Aon South Africa (Pty) Ltd Proprietary & Confidential

Gap Cover is typically restricted to procedures that take place in a hospital. But some outpatient services are also covered. Anyone belonging to a registered medical scheme is eligible for Sanlam Gap Cover. This cover extends to the principle member or family (Children up to the age of 27).

slide-7
SLIDE 7

7

Aon South Africa (Pty) Ltd Proprietary & Confidential

IN-HOSPITAL TREATMENT – 2020 BENEFITS – R266

Tariff shortfalls Additional 500% of scheme tariff

Unlimited cover for specified procedures* Unlimited cover for specified procedures*

Please refer to the Sanlam Gap Cover insurance policy agreement, for more detailed information. Overall limit of R165 000 per member per year as per regulations.

R40 000 per event/condition 1 per family per annum (maximum R12 000)

Unlimited cover for specified procedures such as MRI & CT Scans, scopes etc Co-payments Deductibles 1 per family per annum (maximum R15 000) or a percentage co-payment that does not exceed 30% Unlimited cover for specified procedures. This is a similar term used for co-payments by Medical aid Schemes Sub-limits R52 100 per event/condition where the medical scheme imposes a limit of in hospital procedures Penalty co-payment

slide-8
SLIDE 8

8

Aon South Africa (Pty) Ltd Proprietary & Confidential

OUT-OF-HOSPITAL TREATMENT – 2020 BENEFITS

Oncology Co-payments Limited to the statutory maximum of R165 000 per insured per annum

R325 000 per treatment cycle per beneficiary

Provides up to R15 000 per event Cover for all services delivered in the casualty ward relating to an accident (physical injury via an external force that requires immediate medical attention) even if the costs are paid from the Medical Savings Account. Oncology Sub-limits Limited to the statutory maximum of R165 000 per insured per annum

slide-9
SLIDE 9

9

Aon South Africa (Pty) Ltd Proprietary & Confidential

OUT-OF-HOSPITAL TREATMENT/UNIQUE BENEFITS – 2020 BENEFITS

Supplementary Benefits

  • Hospital Cash Benefit (only payable for accidents and

premature births – 6 weeks subject to a maximum of R21 290, per beneficiary per annum) Day 1 to 13, R380 per day Day 14 to 20, R750 per day Day 21 to 30, R1 500 per day

  • Premature Birth (in 34th week )

R14 000 per event

  • Death/Permanent Disability

Accidental – R28 000 per member

  • Medical Scheme and Medical Gap Premium Waiver

6 months – max. R5 500 per month Paid as a lump sum of R33 000 to the claimant

  • Road Accident Fund (RAF) Claims

Assistance for Road Accident Claims where the policy holder was not at fault in the vehicle accident.

slide-10
SLIDE 10

10

Aon South Africa (Pty) Ltd Proprietary & Confidential

The following waiting periods apply:

For more information, please refer to our policy wording document, which can be provided by your Sanlam Gap specialist

A general waiting period of

3 months

  • n all benefits

12 months

for pre-existing conditions, and pregnancy

Gap Cover – Underwriting

slide-11
SLIDE 11

Proprietary & Confidential

11

Medical Scheme – Underwriting Concession

Medical Schemes Waiting Periods Waiting periods Late Joiner Penalty NB! 3 months general waiting period waived 12 months for Pre-Existing conditions waived Applies after age 35 waived

Bonitas Fedhealth

Members and their ordinary dependents will be allowed to move to Fedhealth or Bonitas medical scheme with no underwriting, provided they join within 90 days of being employed by Santam. Special Dependents It is important to note that special dependents (brother, sister, parents, nephew, niece, cousin, grand parents etc) will be fully

  • underwritten. A General waiting period, condition specific waiting period and a late joining penalty fee may therefore be place in

accordance with the Medical Scheme Act. Previous medical scheme cover will be taken into consideration for these dependents.

slide-12
SLIDE 12

Proprietary & Confidential

12

Summary of Medical Schemes

Medical Scheme No of Options Hospital Cover Chronic Day to Day Fedhealth

14 Options 100% or 200% All options have cover for PMB Comprehensive options has access to an additional chronic disease list Network option New Generation without Threshold options New Generation with Threshold options

Bonitas

13 Options 100% or 150% All Options have cover for PMB Comprehensive options has access to an additional chronic disease list Network option Hospital option Hybrid – Savings and Traditional options New Generation with Threshold option Traditional options

slide-13
SLIDE 13

Proprietary & Confidential

13

Hospital Plans

Benefit Option Bonitas Bon Essential Bonitas Bon Essential Select

Risk Contribution R1,877 R1,602 Savings R0 R0 Total Contribution R1,877 R1,602 In-Hospital Cover 100% Any Hospital 100% Network Chronic Cover CDL CDL Additional/ Out of Hospital Benefit Maternity Care Female Contraceptives Wellness Extender Childcare Benefit Maternity Care Female Contraceptives Wellness Extender Childcare Benefit

slide-14
SLIDE 14

Proprietary & Confidential

14

Savings Plans

Benefit Option Bonitas BonSave Bonitas BonFit Select Fedhealth flexiFED 1 Fedhealth flexiFED 1 Elect

Risk Contribution R2,723 R1,722 R1,721 R1,341 Savings R531 R305 R25 R19 Total Contribution R3,254 R2,027 R1,746 R1,360 In-Hospital Cover 100% Any Hospital 100% Network 100% Network 100% Network Chronic Cover CDL CDL CDL CDL Additional/ Out of Hospital Benefit Maternity Care Childcare Benefit Contraceptives Wellness Extender Additional GP visits once savings is depleted Basic Dentistry Wellness Extender Maternity Care Childcare Benefit Contraceptives Wellness Extender Additional GP visits once savings is depleted Basic Dentistry Wellness Extender Unlimited Network GP and Preventative Dentistry once Maximizer reached Wellness screening benefits Female contraceptives Trauma treatment in casualty ward Take-home medicine Specialised Radiology Unlimited Network GP and Preventative Dentistry once Maximizer reached Wellness screening benefits Female contraceptives Trauma treatment in casualty ward Take-home medicine Specialised Radiology

slide-15
SLIDE 15

Proprietary & Confidential

15

Savings Plans

Benefit Option Fedhealth flexiFED 2 Fedhealth flexiFED 2 Grid Fedhealth flexiFED 2 Elect

Risk Contribution R2,275 R2,022 R1,703 Savings R25 R22 R19 Total Contribution R2,300 R2,044 R1,722 In-Hospital Cover 100% Any Hospital 100% Network 100% Restricted Network Chronic Cover CDL CDL CDL Additional/ Out of Hospital Benefit Unlimited Network GP and Basic Dentistry once Maximizer reached Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology Unlimited Network GP and Basic Dentistry once Maximizer reached Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology Unlimited Network GP and Basic Dentistry

  • nce Maximizer reached

Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology

slide-16
SLIDE 16

Proprietary & Confidential

16

Savings Plans

Benefit Option Fedhealth flexiFED 3 Fedhealth flexiFED 3 Grid Fedhealth flexiFED 3 Elect

Risk Contribution R2,545 R2,262 R1,907 Savings R25 R22 R19 Total Contribution R2,570 R2,284 R1,926 In-Hospital Cover 100% Any Hospital 100% Network 100% Restricted Network Chronic Cover CDL + 3 ADL CDL + 3 ADL CDL + 3 ADL Additional/ Out of Hospital Benefit Unlimited Network GP and preventative/basic Dentistry once Maximizer reached Optical benefit payable from Core Benefit Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology Unlimited Network GP and preventative/basic Dentistry once Maximizer reached Optical benefit payable from Core Benefit Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology Unlimited Network GP and preventative/basic Dentistry once Maximizer reached Optical benefit payable from Core Benefit Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Take-home medicine Specialised Radiology

slide-17
SLIDE 17

Proprietary & Confidential

17

New Generation Plans

Benefit Option Bonitas BonComprehensive Bonitas BonClassic Bonitas BonComplete

Risk Contribution R7,207 R5,003 R4,009 Savings R1,359 R707 R600 Total Contribution R8,566 R5,710 R4,609 In-Hospital Cover 150% Any Hospital 100% Any Hospital 100% Any Hospital Chronic Cover CDL + 33 ADL CDL + 20 ADL CDL + 4 ADL Additional/ Out of Hospital Benefit Female Contraceptives Maternity Benefit Hearing Aids/Appliances Childcare & Preventative benefits Wellness Extender Female Contraceptives Maternity Benefit Basic/Specialised Dentistry Hearing Aids/Appliances Childcare & Preventative benefits Wellness Extender Female Contraceptives Maternity Benefit Basic/Specialised Dentistry Childcare & Preventative benefits Wellness Extender

slide-18
SLIDE 18

Proprietary & Confidential

18

New Generation Plans

Benefit Option Fedhealth flexiFED 4 Fedhealth flexiFED 4 Grid Fedhealth flexiFED 4 Elect

Risk Contribution R3,367 R2,988 R2,521 Savings R25 R22 R19 Total Contribution R3,392 R3,010 R2,540 In-Hospital Cover 100% Any Hospital 100% Network 100% Restricted Network Chronic Cover CDL + 16 ADL CDL + 16 ADL CDL + 16 ADL Additional/ Out of Hospital Benefit Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology

slide-19
SLIDE 19

Proprietary & Confidential

19

New Generation Plans

Benefit Option Fedhealth Maxima Exec Fedhealth Maxima Exec Grid Fedhealth Maxima Plus

Risk Contribution R5,992 R5,336 R9,470 Savings R774 R690 R478 Total Contribution R6,766 R6,026 R9,948 In-Hospital Cover 200% Any Hospital 200% Network 200% Any Hospital Chronic Cover CDL + 29 ADL CDL + 29 ADL CDL + 43 ADL Additional/ Out of Hospital Benefit Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology Unlimited Network GP Visits Maternity benefits Childhood benefits Female contraceptives Wellness screening benefits Trauma treatment in casualty ward Above Threshold benefits available Treatment for 30 days after discharge from hospital Take-home medicine Specialised Radiology

slide-20
SLIDE 20

Proprietary & Confidential

20

Traditional Plans

Benefit Option Bonitas Primary Bonitas Primary Select Bonitas Standard Bonitas Standard Select Risk Contribution R2,429 R2,065 R3,888 R3,368 Savings R0 R0 R0 R0 Total Contribution R2,429 R2,065 R3,888 R3,368 In-Hospital Cover 100% Any Hospital 100% Network 100% Any Hospital 100% Network Chronic Cover CDL CDL CDL + 18 ADL CDL + 18 ADL Additional/ Out of Hospital Benefit

Female Contraceptives Maternity Benefit Basic Dentistry Optical Benefits Appliances Childcare & Preventative benefits Wellness Extender Female Contraceptives Maternity Benefit Basic Dentistry Optical Benefits Appliances Childcare & Preventative benefits Wellness Extender GP Visits/Day to Day Benefits Basic& Specialised Dentistry Optical Benefits Mental Health Appliances Childcare & Preventative benefits Wellness Extender Nominated GPVisits/ Day to Day Benefits Optical Benefits Basic& Specialised Dentistry Mental Health / Appliances Childcare & Preventative benefits Wellness Extender

slide-21
SLIDE 21

Proprietary & Confidential

21

Managed Care Plans/ Network Plans

Benefit Option Bonitas BonCAP Fedhealth MyFED

Total Contribution

Income R0 – R8 520 PM R1, 159 Income R8 521 – R13 840 PM R1, 372 Income R13 841 – R18 900 PM R2, 210 Income R18 901+ PM R2, 714 Income R1 – R6 251 PM R1, 023 Income R6 252 – R10 219 PM R1, 297 Income R10 220– R12 622 PM R1, 818 Income R12 623 - R14 426 PM R2, 310 Income R14 427+ PM R3, 133

In-Hospital Cover

100% Restricted Network 100% Restricted Network

Chronic Cover

CDL Restricted Medication Formulary CDL Restricted Medication Formulary

Day To Day Out of Hospital Benefits

Contraceptives Unlimited GP Visits at a Network GP Limited Over the Counter medication Acute Meds/Basic x-rays/pathology benefit Basic Dentistry including dentures One pair of glasses/contact lenses (R1 035 pb) every 24 months Appliances Benefit Specialist Benefit per referral and annual limit GP Visits at nominated GP – monitoring after 6th visit Unlimited prescribed formulary medication Basic x-rays and pathology Basic Dentistry One pair of glasses every 24 months Casualty Benefit Maternity Benefit Specialist Benefit per referral and annual limit Female Contraception Casualty Benefit –R570 co-payment R570 per visit for non PMB

slide-22
SLIDE 22

Proprietary & Confidential

22

Aon Resolution Centre (ARC)

086 083 5272 086 586 4218 arc@aon.co.za

  • Advice on Medical Scheme option based on

needs analysis

  • Advice on Gap cover option selection
  • Clarification on benefits and annual changes
  • Escalated claims queries and payments
  • Explanation of admin procedures
  • Pre Authorisation for hospitalisation
  • Chronic condition registrations
  • Billing reconciliation

Send your first time query to your Medical Schemes and request reference number If not resolved, contact the ARC If still not satisfied with the service, contact the ARC Team leader elaine.broodryk@aon.co.za

1 2 3

Follow these steps…

slide-23
SLIDE 23

Proprietary & Confidential

23

Aon – Regional Consultants

Should you have difficulty choosing a medical scheme option, please contact an Aon Consultant in your region: Region Aon Consultant Email Address

Gauteng

Gerda van der Ryst gerda.van.der.ryst@aon.co.za

Free State

Anilia Boshoff anilia.boshoff@aon.co.za

Kwazula-Natal

Marianet Breytenbach marianet.breytenbach@aon.co.za

Eastern Cape

Areesh Sataar areesh.sataar@aon.co.za

Western Cape

Valentino Young valentino.young@aon.co.za

slide-24
SLIDE 24

Aon South Africa (Pty) Ltd Proprietary & Confidential

24

Follow us

http://www.aon.co.za/SantamHealt hcareAndMedicalAid.aspx http://twitter.com/Aon_South Africa http://www.facebook.com/Aon healthcare

slide-25
SLIDE 25

Aon South Africa (Pty) Ltd Proprietary & Confidential

25

Aon South Africa (Pty) Ltd Proprietary & Confidential

Thank You