Benefits and Contributions Update Key Decisions Day-to-Day Chronic - - PowerPoint PPT Presentation

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Benefits and Contributions Update Key Decisions Day-to-Day Chronic - - PowerPoint PPT Presentation

Mar 06, 2023 221 likes •442 views

2019 Medical Scheme Benefits and Contributions Update Key Decisions Day-to-Day Chronic Hospitalisation Expenses Would you be prepared to be limited to a Would you What rate of To what extent network of accept Do you need hospital do

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2019 Medical Scheme Benefits and Contributions Update

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Key Decisions Hospitalisation Chronic Day-to-Day Expenses

Would you be prepared to be limited to a network of hospitals OR do you prefer freedom of choice? Would you accept co-payments OR Annual Limits? What rate of hospital reimbursement is appropriate? Do you need additional chronic cover? To what extent do you require Day to Day cover?

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Aon Employee Benefits I Healthcare Proprietary & Confidential

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 able to join Fedhealth or Bonitas medical scheme with no underwriting. 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.

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Aon Employee Benefits I Healthcare Proprietary & Confidential

2019 Benefits Highlights

2019 Medical Scheme Highlights

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Hospital Plans

Benefit Option

Bonitas Bon Essential Bonitas Bon Essential Select Risk Contribution R1,731 R1,477 Savings R0 R0 Total Contribution R 1, 731 R 1, 477 In-Hospital Cover 100% Any Hospital 100% Network Chronic Cover CDL CDL Additional/ Out of Hospital Benefit

Maternity Care Female Contraceptives Wellness Extender Maternity Care Female Contraceptives Wellness Extender

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Savings Plans

Benefit Option

Bonitas BonSave Bonitas BonFit Risk Contribution R2, 088 R1, 722 Savings R398 R305 Total Contribution R2, 486 R2, 027 In-Hospital Cover 150% Any Hospital 100% Network Chronic Cover CDL CDL Additional/ Out of Hospital Benefit

Maternity Care Childcare Contraceptives Wellness Extender Additional GP visits once savings is depleted Basic Dentistry Wellness Extender

Maternity Care Childcare Contraceptives Wellness Extender Additional GP visits once savings is depleted Basic Dentistry Wellness Extender

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Savings Plans

Benefit Option

Fedhealth flexiFED 1 Fedhealth flexiFED 1 Elect Fedhealth flexiFED 2 Fedhealth flexiFED 2 Grid Fedhealth flexiFED 2 Elect Risk Contribution

R1, 586 R1, 189 R2, 061 R1, 834 R1, 546

Savings

R25 R19 R25 R22 R19

Total Contribution

R1, 611 R1, 208 R2, 086 R1, 856 R1, 565

In-Hospital Cover 100% Network 100% Network 100% Any Hospital 100% Network 100% Network Chronic Cover CDL CDL CDL CDL CDL Additional/ Out of Hospital Benefit

Unlimited Network GP and Preventative Dentistry once Maximizer reached Unlimited Network GP and Preventative Dentistry once Maximizer reached Unlimited Network GP and Basic Dentistry once Maximizer reached Unlimited Network GP and Basic Dentistry once Maximizer reached Unlimited Network GP and Basic Dentistry once Maximizer reached

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Savings Plans

Benefit Option

Fedhealth flexiFED 3 Fedhealth flexiFED 3 Grid Fedhealth flexiFED 3 Elect Risk Contribution

R2,269 R2,019 R1,702

Savings

R25 R22 R19

Total Contribution

R2,294 R2,041 R1,721

In-Hospital Cover 100% Any Hospital 100% Network 100% Network Chronic Cover CDL + 3 ADL CDL + 3 ADL CDL + 3 ADL Additional/ Out of Hospital Benefit

Unlimited Network GP and preventative/basic Dentistry

  • nce Maximizer reached

Optical benefit payable from Core Benefit Unlimited Network GP and preventative/basic Dentistry

  • nce Maximizer reached

Optical benefit payable from Core Benefit Unlimited Network GP and preventative/basic Dentistry

  • nce Maximizer reached

Optical benefit payable from Core Benefit

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Aon Employee Benefits I Healthcare Proprietary & Confidential

New Generation Plans

Benefit Option Bonitas Bon Comprehensive Bonitas Bon Classic Bonitas Bon Complete Risk Contribution R 5,224 R 3,838 R 3,045 Savings R 1,214 R 632 R 536 Total Contribution R 6,438 R 4,470 R 3,581 In-Hospital Cover 300% 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

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Aon Employee Benefits I Healthcare Proprietary & Confidential

New Generation Plans

Benefit Option

Fedhealth flexiFED 4 Fedhealth flexiFED 4 Grid Fedhealth flexiFED 4 Elect Fedhealth Maxima Exec Fedhealth Maxima Exec Grid Fedhealth Maxima Plus Risk Contribution R3, 006 R2, 676 R2, 255 R4, 584 R4 080 R7 894 Savings R25 R22 R19 R752 R670 R460 Total Contribution R3, 031 R2, 698 R2 274 R5 336 R4 750 R8 354 In-Hospital Cover 100% Any Hospital 100% Network 100% Restricted Network 200% Any Hospital 200% Network 200% Any Hospital Chronic Cover CDL + 16 ADL CDL + 16 ADL CDL + 16 ADL CDL + 26 ADL CDL + 26 ADL CDL + 40 ADL Additional/ Out of Hospital Benefit

Unlimited Network GP Visits Unlimited Network GP Visits Unlimited Network GP Visits Unlimited Network GP Visits once savings is depleted Unlimited Network GP Visits once savings is depleted Unlimited Network GP Visits

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Traditional

Benefit Option

Bonitas Primary Bonitas Primary Select Bonitas Standard Bonitas Standard Select Risk Contribution R2, 240 R1904 R3, 556 R3, 080 Savings R0 R0 R0 R0 Total Contribution R2, 240 R1904 R3, 556 R3, 080 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

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Managed Care Plans/ Network Plans Benefit Option

Bonitas BonCAP Fedhealth MyFED

Total Contribution Income R0 – R8 030 PM R1 009 Income R8 031 – R1 3050 PM R1 226 Income R1 3051 – R17 830 PM R2 000 Income R17 831+ PM R2 456 IIncome R1 – R5 953 PM R916 Income R5 954 – R9 732 PM R1 161 Income R9 733 – R12 021 PM R1 627 Income R12 022 - R13 739 PM R2 068 Income R13 740+ PM R2 804 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

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Sanlam Gap Cover 2019

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Aon Employee Benefits I Healthcare 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 extends to the principle member’s spouse and children, up to the age of 27.

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Aon Employee Benefits I Healthcare Proprietary & Confidential

IN-HOSPITAL TREATMENT – 2019 BENEFITS : R241

Tariff shortfalls Additional 500% of scheme tariff

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

*Premiums are the same for single members and members with dependants.

**Please refer to the Sanlam Gap Cover insurance policy agreement, Section F BENEFIT SCHEDULE. ***Overall limit of R157 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** Co-payments Deductibles 1 per family per annum (maximum R14 000) Unlimited cover for specified procedures** Sub-limits R48 500 per event/condition Penalty co-payment

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Aon Employee Benefits I Healthcare Proprietary & Confidential

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OUT-OF-HOSPITAL TREATMENT – 2019 BENEFITS

Oncology Co-payments Limited to the statutory maximum of R157 000 per insured per annum

R325 000 per treatment cycle per beneficiary

Casualty Benefit Out Patient

  • Co-payments – MRI/CT

scans, unlimited

  • 500% tariff cover
  • Emergency Casualty

Benefit (accidental only) Up to R14 000 ( max 1 event per annum ) Oncology Sub-limits Limited to the statutory maximum of R157 000 per insured per annum

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Aon Employee Benefits I Healthcare Proprietary & Confidential

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OUT-OF-HOSPITAL TREATMENT – 2019 BENEFITS

Supplementary Benefits

  • Hospital Cash Benefit (only payable for accidents and

premature births – 6 weeks subject to a maximum of R30 000, per beneficiary per annum) Day 1 to 13, R350 per day Day 14 to 20, R700 per day Day 21 to 30, R1 400 per day

  • Premature Birth (in 34th week )

R13 200 per event

  • Death/Permanent Disability

Illness – R13 000 per member Accidental – R26 000 per member

  • Medical Scheme and Medical Gap Premium Waiver

6 months – max. R5 000 per month

  • Road Accident Fund (RAF) Claims

End-to-end legal assistance in RAF Claims (100% RAF Benefit Allocation to Claimant)

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Aon Employee Benefits I Healthcare 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

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Aon Employee Benefits I Healthcare Proprietary & Confidential

Aon Resolution Centre

Aon Resolution Centre

  • Advice on Medical Scheme option

selection

  • Advice on Gap cover option

selection

  • Clarification on benefits and annual

changes

  • Claims queries and payments
  • Explanation of admin procedures
  • Unresolved queries

Contact details:

  • Step 1
  • Contact your medical scheme for

a reference number

  • Step 2
  • If not resolved, contact the ARC
  • Step 3
  • If still not satisfied with the

service, contact the ARC Team leader elaine.broodryk@aon.co.za 086 083 5272 086 586 4218 arc@aon.co.za

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Aon Employee Benefits I Healthcare Proprietary & Confidential

http://www.aon.co.za/SantamHealthca reAndMedicalAid.aspx http://twitter.com/Aonhealthcare http://www.facebook.com/Aonhealthcare

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