BENEFIT YEAR 2020/21 Agenda 01 Profile of the Fund 02 Overview - PowerPoint PPT Presentation

BENEFIT YEAR 2020/21

Agenda 01 Profile of the Fund 02 Overview of the Plans 03 Benefits offered on each Plan 04 Managed Care Programmes 05 Benefits Enhancement for 2020/2021 06 Benefits available for COVID-19 07 Contribution increases for 2020/21 08 Plan changes for 2020/2021 2

Profile of the Fund 18000 Principal Members Selection of 8 Options Financially stable Closed (Restricted) Medical Scheme 3

Overview of the Plans OUT OF HOSPITAL IN HOSPITAL 4

HOSPITAL PLAN An entry-level Plan that offers Hospital benefits, Basic Chronic Benefits and Wellness Screenings Supple lementary Welln ellness Be Benefi efits Ch Chronic ic Be Benefi efits Hospit ital l Be Benefit its Benefi Be efits  27 PMB chronic  R500 000 per beneficiary  Specialised Radiology  Health Risk Assessments conditions per benefit year R14 800  Vaccinations  Additional 5 non-PMB  R1 000 000 per family per  Ultrasound scans (non-  Nutritional Assessments chronic conditions benefit year pregnancy) R5 020  Woman's Health covered up to R5 270  Unlimited Prescribed Screenings Minimum Benefits (PMB)  Assessments for children 5

NETWORK PLAN INCL. SELECT HOSPITAL PLAN A value-for-money Plan that offers Hospital benefits, Primary Care at a Network Provider, and an enhanced benefit to manage chronic conditions, among others…all at an affordable rate for those in lower income groups. Annua ual l Flexi-Benefit it Pr Prim imary Hea ealt lthcare Chronic Ch ic Benefit its Hospit ital l Be Benefit its (AF AFB) B) Be Benefi efits  R500 000 per beneficiary  GP & Specialist  27 PMB chronic  R5 340 per beneficiary per benefit year consultations conditions per benefit year, R8 900  R1 000 000 per family per  Basic Dentistry  Additional 12 non-PMB per family per benefit benefit year  Basic Optometry chronic conditions Year, includes: Basic  Unlimited Prescribed  (All through the Universal pathology, Basic Minimum Benefits (PMB) Health Provider Network) radiology, Optometry, Auxiliary services, subject Supple lementary y Benefi Be efits to: R1 780 per beneficiary per benefit year and R2  Specialised Radiology 980 per family per benefit R14 800 year (via the Universal  Ultrasound scans (non- Health Provider Network) pregnancy) R5 020 6

SAVINGS PLAN A Plan that offers a flexible Day-to-day Benefit, Hospital Benefits, Basic Chronic Benefits and an enhanced Supplementary Benefit that includes maternity. Supple lementary Personal al Med Medical al Sav avings Hospit ital l Be Benefit its Chr Chronic ic Ben Benef efit its Benef Ben efit its Account (PMSA ) Ac  R750 000 per beneficiary  27 PMB chronic  Maternity Benefits:  PMSA is used to pay for Antenatal classes R1 340 per per benefit year conditions Day-to-day medical family per benefit year;  R1 500 000 per family per  Additional 5 non-PMB services such as GPs, Antenatal visits R3 160 per benefit year chronic conditions, dentistry, acute medicine pregnancy  Unlimited Prescribed covered up to R5 270 etc. Ultrasound scans Two 2D Minimum Benefits (PMB)  Unused PMSA carries over scans per beneficiary  Cover for elective to the new benefit year Out-of-hospital pathology procedures such as joint tests R2 610 per family per replacements benefit year, Antenatal vitamins  Specialised Radiology R14 800  Ultrasound scans (non- pregnancy) R5 020 7

TRADITIONAL PLAN Incl. SELECT SAVINGS PLAN HOSPITAL PLAN Offers Comprehensive Benefits for a variety of Healthcare Services including Hospital Benefits, Day- to-day, a wide- range of Chronic conditions, an extensive Supplementary Benefit and more… Pr Primary Ca Care PCB ) Benefit (PC Be Supp pple lementa tary Comprehensive Pe Person onal Medica cal Sa Savings Hospit ital l Be Benefit its Bene Be nefit its Chronic Ben enefits Acc ccount t (PM PMSA SA)  Unlimited Overall Annual  27 PMB chronic conditions  Medical Appliances:  PMSA is used to pay for  Additional 24 non-PMB  Limit (subject to certain Overall limit of R10 100 Day-to-day medical chronic conditions covered  sub-limits) per family per benefit year services such as GPs, up to R12 800  Enhanced in-hospital Foot Orthotics R4 570 per dentistry, acute medicine limits family per benefit year etc.  Cover for elective (subject to overall limit)  Unused PMSA carries over Dental l Impla mplant t & procedures such as joint  Hearing Aids R18 000 per to the new benefit year Ref efractiv ive Surgery replacements ear per beneficiary,  Primary Care Benefit subject to a co-payment (PCB) is used similar to  Dental Implant: R15 200 per of 10%. the PMSA when you’ve family per benefit year  Specialised Radiology run out of PMSA.  Refractive Surgery: Sub-limit R14 800  Any unused PCB does not of R16 000 per beneficiary  Ultrasound scans (non- carry over. per benefit year pregnancy) R5 020 8

TRADITIONAL PLUS PLAN Incl. SELECT The most comprehensive Plan on offer that covers a variety of Healthcare Services including Hospital Benefits, more day-to-day cover with consultations at private rates*, a wide-range of Chronic conditions, an extensive Supplementary Benefit and more… Prima mary Care CB ) Benefit (PCB Be Supp pple lementa tary Comprehensive Pe Person onal Medica cal Sa Savings Hospit ital l Be Benefit its Bene Be nefit its Acc ccount t (PM PMSA SA) Chronic Ben enefits  27 PMB chronic conditions  Unlimited Overall Annual  Medical Appliances: Overall  PMSA is used to pay for Day-  Additional 24 non-PMB Limit (subject to certain limit of R10 100 per family to-day medical services. chronic conditions covered sub-limits) per benefit year Foot Unused PMSA carries over up to R15 300  Enhanced in-hospital Orthotics R4 570 per family to the new benefit year limits per benefit year (subject to  Primary Care Benefit (PCB)  Cover for elective overall limit) is used similar to a PMSA procedures such as joint  Hearing Aids R18 000 per when you’ve run out of Dental Den l Impla plant t & Ref efractiv ive Surgery replacements ear per beneficiary, subject PMSA.. Any unused PCB to a co-payment of 10%. does not carry over.  Dental Implant: R15 200 per  Specialised Radiology R14  Pays up to 300% of Medical family per benefit year 800 Scheme Rate for out-of-  Refractive Surgery: Sub-limit  Ultrasound scans (non- hospital consults (e.g. GP, of R16 000 per beneficiary pregnancy) R5 020 Specialist, Dentist etc) per benefit year *Up to 300% Medical Scheme Rate 9

Managed Care Programmes As part of the Fund’s aim of identifying and managing beneficiaries’ disease risks in good time, there are a number of programmes offered across Plans that form part of the Fund’s Managed Care approach. Chronic Medicine Benefit HIV/AIDS Management Programme Active Disease Risk Management Mental Health Programme Programme Back and Neck Mother and Baby Care Programme Rehabilitation Programme (only offered on Savings and Traditional Plans) Oncology Programme 10

Benefit Enhancements for 2020/2021 Childhood immunisations benefit - for children up to the age of 12 years, as per recommendation of the Department of Health Nutritional assessment and healthy eating plan (through the Universal Healthcare network of dieticians) An additional assessment for pregnant beneficiaries Pre-school eye and hearing screening for children aged 5 and 6. A Doula (birthing coach) benefit limited to R2 500 per pregnancy. Wellness Benefits  Health Risk Assessments Wearable device with a valid NAPPI code (from Accumulated PMSA)  Vaccinations  Nutritional Assessments Oncology Social Worker Benefit extended to all terminally ill  Woman's Health Screenings members  Assessments for children 11

Benefits available for COVID-19 #1 Cover the diagnostic pathology test from the risk benefit for confirmed cases only. #2 Pay for 2 GP consultations from the risk benefit during the quarantine period. Upon doctor’s recommendation only, the Fund will cover the claims (as specified above) #3 from the risk benefit for the following high risk beneficiaries:  Beneficiaries who travelled to high risk areas  Beneficiaries who have had contact with a confirmed case.  Beneficiaries who are HIV+  Beneficiaries older than 70 years of age 12

Contribution increases for 2020/21 Medical scheme contribution increases are necessary as costs from service providers such as doctors and hospitals increases annually, and are generally higher than inflation. The trustees have endeavoured to keep the increase as low as possible, without reducing benefits. Benefit limits will be increased by 4.7% along with the benefit enhancements mentioned earlier. Medical Scheme Average 2020 increases Medihelp 11.9% Fedhealth 10.6% MedShield 9.9% Bonitas 9.9% Health Squared (Resolution Health & Spectramed) 9.8% Profmed 9.7% Discovery 9.5% Momentum 8.2% CompCare 8.1% GEMS 7.7% OMSMAF 5.7% 13

Plan Changes for 2020/2021 By sending an email with your option selection to membership@omsmaf.co.za By calling the call centre on 0860 100 076 NOTE: Closing date for Plan Changes is Friday 12 June 2020 14

THANK YOU Old Mutual is a Licensed Financial Services Provider