S A L E S P R E S E N T A T I O N Medical aid control, flexibility - - PowerPoint PPT Presentation

S A L E S P R E S E N T A T I O N

Medical aid control, flexibility and choice like never before.

• Boasting an 83-year track record, Fedhealth has a solvency rate of 31.42% (as

at 31 December 2018) and a Global Credit Rating of AA-, retained for 13 consecutive years

• Moving away from a one-size fits-all approach and embracing customisation.
• Fedhealth pays more benefits from Risk than other schemes.
• Choice, flexibility and control with our flexiFED range with up to 25% discounts
• n contributions and day-to-day funding that puts the member in control.

Customised interaction with members

Fedhealth Website Fedhealth Family Room LiveChat & Chatbot Network GP, Specialist and Hospital locator FedChat

More about Fedhealth’s hospital cover

• All Fedhealth options have unlimited private hospitalisation.
• Any private hospital may be used except on certain options where

members must use a Fedhealth network hospital. Emergency treatment will be covered at any hospital no matter the option.

• The in-hospital benefit covers hospital costs as well as the accounts

for doctors, specialists and other healthcare providers.

• Also unlimited cover for selected procedures performed in day

wards, day clinics and doctors’ rooms.

• Some treatments and procedures may have a co-payment

depending on the option.

Chronic medicine benefit

• Fedhealth provides unlimited chronic medication cover on all
• ptions for the 27 chronic conditions on the Prescribed Minimum

Benefit (PMB) Chronic Disease List (CDL).

• The benefit covers medication for the list of CDL conditions paid

from a formulary and must be obtained from a preferred provider

• r DSP, depending on the option.
• Certain options cover medicine for additional chronic conditions –

up to 72 on the highest option.

Fedhealth is the only scheme that allows option upgrades anytime

• f the year within 30 days of

diagnosis of a dread disease or a life-changing event…

Maternity Benefits

• 2 x 2D antenatal scans
• 8 x ante- and postnatal consultations with a midwife, network GP or

gynaecologist on flexFED2 and 12 consultations on flexiFED3 and 4, maxima EXEC and maxima PLUS

• Antenatal classes up to R1 090
• Amniocentesis
• Fedhealth Baby programme
• Private ward cover for delivery on flexiFED3 and 4, maxima EXEC and

Maxima PLUS

• Doula benefit: R3 000 per delivery
• Postnatal midwifery benefit: 4 consults per delivery in- and out of hospital

Paid from risk and not day-to-day

• benefits. Upgrade anytime of the

year to a higher option – pregnancy included

Great childhood benefits

• 24/7 Pead-IQ parenting hub
• Paediatric consultations without referral from a GP – up to 12 months of

age on flexiFED2 and up to 24 months on flexiFED3 and 4

• Infant hearing screening benefit
• Childhood immunisations
• Trauma treatment in a casualty ward
• Childhood illness specialised drug benefit up to 18 years on flexiFED 2, 3

and 4

• Child rates up to the age of 27
• Only pay for three children

Paid from risk and not day-to-day benefits

A proactive stance on health: screening benefits

Womens Health – all options except on myFED

Cervical cancer screening Women; ages 21 to 65 1 every 3 years Breast cancer screening with mammography All lives; aged 45 and older 1 every 3 years

Men’s Health – all options except

Prostate specific Antigen (PSA) Men; ages 45 - 69 1 every year

Children’s Health – all options except on myFED

Immunisation Programme (as per State EPI) Birth to 12 years Various

Cardiac Health – all options except on myFED

Cholesterol screening (full lipogram) All lives; aged 20 and older 1 every 5 years

A proactive stance on health: screening benefits

Over 45’s – all options except for myFED

Bone densitometry (only available on maxima PLUS and maxima EXEC) Women; aged 65 and older Men; aged 70 and older 1 every 2 years Breast cancer screening with mammography All lives; aged 45 and older 1 every 3 years Colorectal cancer screening All lives; aged 50 – 75 1 every year Pneumococcal vaccination All lives; aged 65 and older 1 per lifetime

General – all options

Flu vaccination All lives 1 every year HIV finger prick test All lives 1 every year

A proactive stance on health: screening benefits

Health risk assessments – all options

Wellness screening (BMI, blood pressure, finger prick cholesterol & glucose test) Women; aged 65 and older Men; aged 70 and older 1 every 2 years Preventative screening (waist-to-hip ratio, body fat%, flexibility, posture & fitness All lives; aged 45 and older 1 every 3 years

Programmes and wellness initiatives by Fedhealth

• Corporate wellness days
• Health Risk Assessments
• Sisters-on-Site
• Conservative Back and Neck Rehabilitation

Programme

• Mental Health Programme
• Emotional Wellbeing Programme
• Weight Management Programme
• GoSmokeFree Smoking Cessation Programme
• Aid for Aids (HIV Management)
• Paed IQ
• Diabetes Care

What about cancer?

• On myFED and flexiFED1, oncology is covered unlimited at PMB level of

care at the Designated Service Provider (DSP), ICON, subject to Level 1 treatment protocols.

• On flexiFED2 and flexiFED3, oncology is covered up to R290 400 per

family per year at the DSP, ICON, subject to Level 1 treatment protocols.

• On flexiFED4, oncology is covered up to R464 700 per family per year at

the DSP, ICON, subject to Level 1 treatment protocols.

• On maxima EXEC, oncology is covered up to R580 900 per family per

year at a preferred provider, ICON, subject to Level 2 treatment protocols.

• On maxima PLUS, oncology is covered unlimited at a preferred provider,

ICON, subject to Level 3 treatment protocols.

Fedhealth is the only scheme that allows option upgrades anytime

• f the year within 30 days of

diagnosis of a dread disease or a life-changing event…

Fedhealth: We pay more from risk…

The numbers that matter: how much we’re saving our members by covering day-to-day benefits from Risk

What we pay from Risk, rather than Savings

Most other medical schemes will deduct these expenses from a member’s day-to-day benefits

How much we saved our members in the last year MRI and CT Scans R97 875 548 Unlimited GP Consultations R61 794 913 Unlimited cover for certain female contraceptives R 8 101 239 Trauma treatment in a casualty ward R 6 357 678 Take home medication R 5 883 259 Mental Health Programme R 4 066 398 Emotional Wellbeing Programme R 720 000

Fedhealth: We pay more from risk…

The numbers that matter: how much we’re saving our members by covering day-to-day benefits from Risk

What we pay from Risk, rather than Savings

Most other medical schemes will deduct these expenses from a member’s day-to-day benefits

How much we saved our members in the last year Baby Programme R 998 442 Preventative screening and wellness benefits: Cholesterol Screenings R4 469 843 Breast Cancer Screenings R3 193 844 Childhood Immunisations R2 552 207 Flu Vaccinations R 626 242

Fedhealth: We pay more from risk…

• Unlimited network GP visits
• Unlimited post-hospitalisation treatment for up to 30 days
• Unlimited take-home medication for 7 days after discharge from

hospital

• Unlimited cover for certain female contraceptives
• Unlimited trauma treatment in a casualty ward
• Unlimited specialised radiology (MRI/CT scans) whether they are

performed in or out of hospital

• In-hospital dentistry for children under 7

We pay more from Risk so day-to-day benefits last longer

These benefits show we really care

• Upgrades any time of the year

within 30 days of a life changing event

• 24-hour Nurse Line
• Emotional Wellbeing

Programme

• Fedhealth Baby Programme
• Paed-IQ
• SOS Call me
• Emergency Transport

Response

• MediTaxi Service
• Child rates for financially

dependent children up to the age of 27*

• Only pay for three children

Covering just one child at child rates on flexiFED4 will save the member R24 216 per year in contributions

Overview of the Fedhealth option range

On myFED, members enjoy the following benefits:

• In-hospital benefit – No overall annual limit for hospitalisation, at

network hospitals.

• Chronic disease benefit – Members are covered for conditions on

the Chronic Disease List (CDL). Covered in full up to the Medicine Price List if the member uses medicine on the basic formulary and

• btains it from one of our DSPs: Clicks, Dis-Chem, MediRite and

Pharmacy Direct.

• Screening benefit – this benefit pays for lifestyle and wellness

screenings.

• Day-to-day benefits – We provide comprehensive day-to-day

benefits like unlimited contracted nominated GP visits.

• Additional benefits – lots of additional valuable benefits like the

myFED Baby Programme, oral and injectable contraceptives and the free Fedhealth Nurse Line.

No overall annual limit Network hospitals only Covered in full Up to the Fedhealth Rate. Limited to R2 300 per beneficiary per year Up to 100% of Fedhealth Rate

Hospitalisation

Network GPs and Specialists Non-network GPs and Specialists Other healthcare professionals R14 000 per beneficiary, paid from an overall limit of R28 300 per family per year Specialised Radiology Limited to R38 100 per maternity event, with a limit

• f R56 400 per family per year. Unlimited at cost at

PMB level of care once limits are reached. Maternity

In-Hospital Benefit

Unlimited cover for the 27 Chronic conditions on the Chronic Disease List (CDL) Basic Formulary MediRite, Clicks, Dis-Chem and Pharmacy Direct

Chronic Disease Benefit

Unlimited GP visits at nominated myFED GPs Utilisation monitoring after 10 visits per beneficiary per year Two “out-of-area” myFED network GP consultations per beneficiary per year

Unlimited prescribed medication at nominated contracted myFED GPs 2 x Specialist visits per family per year paid at cost to a maximum of R1 800 Basic cover for Dentistry and Optometry Unlimited general Radiology and Pathology subject to basic protocols and limited list of tests and procedures

Day-to-day Benefits

myFED 2020 contribution rates

Highest household income per month Member Adult Dependant Child Dependant

R1 – 6 251

R1 023 R893 R492

6 252 – 10 219

R1 297 R1 126 R634

10 220 – 12 622

R1 818 R1 587 R697

12 623 – 14 426

R2 310 R1 904 R903

14 427>

R3 133 R2 854 R1 194

Summary of changes for 2020:

Inflationary increase in benefit limits, procedure co- payments and non-network hospital co-payments. Contracted GP visits remain unlimited and utilisation monitoring will only start after 10 visits per beneficiary per year. Average weighted myFED contribution increase is 10%

By committing to only use Fedhealth’s network

• f more than 100 private

hospitals By choosing to pay a fixed excess (R12 000)

• n all hospital

procedures except emergencies.

Great discounts on contributions

Fund non-network co-pays with Sanlam Gap Cover

In-hospital benefit – No overall annual limit for hospitalisation Chronic Disease benefit – Members are covered for conditions on the CDL. Covered in full up to the Medicine Price List if the member uses medicine on the formulary and obtains it from either one of our Preferred Providers: Clicks, Dis-Chem, Medi-Rite and Pharmacy Direct or DSPs: MediRite and Pharmacy Direct (and Clicks on flexiFED1). Additional conditions are covered on flexiFED3 and 4 Threshold – Pays for limited day-to-day expenses on flexiFED1, 2 and 3 and comprehensive day-to-day expenses on flexiFED4 once claims have accumulated to the Threshold level Day-to-day benefits from Risk – we pride ourselves on paying more from Risk so the members’ day-to-day benefits lasts longer Screening benefit – Pays for lifestyle, wellness and physical screenings Savings – The funds in the Savings Account will be used first for day- to-day expenses

The MediVault & Wallet

Members are allocated funds for day-to-day medical expenses in their personal MediVault How much is in the MediVault flexiFED1 flexiFED2 flexiFED3 flexiFED4 M R9 000 R9 600 R10 800 R14 400 M + 1 R12 600 R15 000 R16 200 R25 800 M + 2 R13 800 R20 400 R21 600 R29 400 M + 2 + R15 000 R24 000 R25 200 R33 000

Available MediVault funds have been standardised within options Available MediVault funds increased significantly

For 2020:

The MediVault & Wallet

How does the MediVault & Wallet work?

• MediVault can be used to fund all

co-payments

• Determine own payback period to a

maximum of 12 months

• MediVault pro-ration at company/paypoint

level

• Participating paypoints can limit/cap the

MediVault according to company policy

More flexibility in 2020:

An allocated amount based

• n your option and family

composition will be available in your MediVault. If you don’t use it, you don’t pay for it. Transfer funds from the MediVault to the Wallet as and when required Only pay back amounts transferred from the MediVault to the Wallet over a rolling 12 month or shorter period

The MediVault & Wallet

If members prefer the traditional medical savings account system, they can either:

For 2020:

Transfer their chosen amount into their wallet at the beginning of the year, which means they will pay more or less the same amount they did before when Savings was still included in their contribution. Transfer only a portion

• f their MediVault as

and when they need it , meaning they pay less. Make the choice not to use the MediVault facility at all and use the saving to fund their

• wn day-to-day

expenses. OR OR

The MediVault & Wallet

Activating the MediVault and transferring funds into the Wallet

For 2020:

Call the Fedhealth Customer Contact Centre

• n 0860 002 153 for

assistance Log into the Fedhealth Family Room online portal and follow the prompts Call our USSD line on *134*999*memberno# and follow the prompts

IN-HOSPITAL BENEFIT

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Hospitalisation Unlimited.

Network Hospitals

Unlimited.

Hospitals of choice

Network GPs and Specialists Covered unlimited. Paid in full. Non-network GPs, Specialists and all other healthcare professionals Paid up to Fedhealth Rate

Inflationary increases have been applied to all benefit limits, threshold levels, procedure co- payments and non-network hospital co-payments FOR 2020

IN-HOSPITAL BENEFIT

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Maternity

Unlimited at cost with network specialists and GPs Unlimited at cost with network specialists and GPs 2 x 2D scans Antenatal classes up to R1 090 8 antenatal and/or postnatal consults with a midwife, network GP or gynaecologist Amniocentesis Private ward cover for delivery Unlimited at cost with network specialists and GPs 2 x 2D scans Antenatal classes up to R1 090 12 antenatal and/or postnatal consults with a midwife, network GP or gynaecologist Amniocentesis Private Ward cover for delivery Unlimited at cost with network specialists and GPs 2 x 2D scans Antenatal classes up to R1 090 12 antenatal and/or postnatal consults with a midwife, network GP or gynaecologist Amniocentesis Private Ward cover for delivery

The maternity benefits on flexiFED3 paid from Risk have been extended to flexiFED4

FOR 2020

IN-HOSPITAL BENEFIT

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Oncology Unlimited at cost up to PMB level of care at DSP (ICON) R290 400 at DSP (ICON) R290 400 at DSP (ICON) R464 700 at DSP (ICON) Organ Transplant Unlimited at cost up to PMB level of care R290 400 R290 400 R464 700 Renal Dialysis Unlimited at cost up to PMB level of care at DSP R290 400 at DSP R290 400 at DSP R464 700 at DSP Childhood illness specialised drug benefit No benefit

Children up to the age of 18 years Children up to the age of 18 years Children up to the age of 18 years

CHRONIC DISEASE BENEFIT

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Limit

Unlimited cover for conditions on the Chronic Disease List (CDL) Unlimited cover for conditions on the Chronic Disease List (CDL) Unlimited cover for conditions on the Chronic Disease List (CDL). Also includes medicine for allergic rhinitis, acne and eczema. Subject to a limit of R5 900 pb and R11 800 pf @ preferred provider

Preferred provider / DSP

DSPs: flexiFED1 Clicks, MediRite & Pharmacy Direct flexiFED1Elect MediRite & Pharmacy Direct Preferred provider: flexiFED2 MediRite, Dis-Chem, Clicks and Pharmacy Direct DSP: flexiFED2GRID flexiFED2Elect MediRite and Pharmacy Direct Preferred provider: MediRite, Dis-Chem, Clicks and Pharmacy Direct Preferred provider: MediRite, Dis-Chem, Clicks and Pharmacy Direct

Formulary

Basic Intermediate Intermediate Intermediate

CHRONIC DISEASE BENEFIT

The Chronic Disease Benefit on flexiFED3 has been extended to include a R3 000 per family per year benefit for the following: ADHD, depression, Generalised Anxiety Disorder and PTSD. This takes the number of chronic conditions covered on flexiFED3 to 34. The unlimited Chronic Disease Benefits on flexiFED3 for acne for child dependants up to the age of 21, allergic rhinitis for child dependants up to the age of 18, and eczema in child dependants up to the age of 18 have now also been extended to flexiFED4.

For 2020:

DAY-TO-DAY BENEFITS AVAILABLE IN THE THRESHOLD BENEFIT

In order to access the Threshold Benefit, , you need to submit all day-to-day claims to accumulate to the pre- determined level. Thereafter certain claims will be paid from the Threshold Benefit

flexiFED1 flexiFED2 flexiFED3

Network GP visits Unlimited @ nominated network GPs

Dentistry

Preventative dental benefit Basic dental benefit at network providers Basic dental benefit at network providers Optometry No benefit No benefit Basic optometry benefit at network providers Threshold level M R 3 900 R4 500 R5 400 Threshold level M + 1 R6 300 R8 400 R10 200 Threshold level M +2 R7 800 R9 600 R11 700 Threshold level M +2 + R9 300 R11 400 R13 800

DAY-TO-DAY BENEFITS AVAILABLE IN THRESHOLD (flexiFED 4 only)

In order to access the Threshold benefit on flexiFED 4, you need to submit all day-to-day claims to accumulate at the Fedhealth Rate to the Threshold level. Limits apply to certain expenses.

flexiFED4

Annual threshold level R14 400 (M) R25 800 (M+1) R29 400 (M+2) R33 000(M+2+) Limits Limits may apply when calculating certain claims for accumulation to Threshold. These limits will also apply for refunds from Threshold. Co-payments A 20% co payment will apply to all claims paid from the Threshold benefit. No co- payment will apply to network GP and Specialist consultations.

CONTRIBUTION RATES 2020 (Risk + nominal Savings)

flexiFED1 flexiFED2 flexiFED3 flexiFED4

M AD C M AD C M AD C M AD C Any hospital

• 2275

1975 675 2545 2296 915 3367 3054 1036 Grid (- 11%) 1721 1349 628 2022 1759 601 2262 2044 814 2988 2718 923 Elect (- 25%) 1341 1048 488 1703 1484 508 1907 1722 687 2521 2335 792 2020 increase: 10.2% 2020 increase: 11.1% 2020 increase: 11.2% 2020 increase: 10.4%

CONTRIBUTION RATE EXAMPLES (Principal Member only)

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Any hospital

R2 275 R2 545 R3 367 Grid* R1 721 R2 022 Save R3 036 p.a. R2 262

Save R3 396 p.a.

R2 988 Save R4 548 p.a. Elect* R1 341 Save R4 560 p.a. R1 703 Save R6 864 p.a. R1 907 Save R7 656 p.a. R2 521 Save R10 152 p.a

* in the case of emergency or accident (unforeseen and life-threatening events), you can still use any

private hospital and you will be covered without any co-payment. The use of network hospitals only applies to planned procedures.

CONTRIBUTION RATE EXAMPLES (Principal Member + Adult Dependant)

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Any hospital R4 250 R4 841 R6 421 Grid* R3 070 R3 781

Save R5 628 p.a.

R4 306

Save R6 420 p.a.

R5 706

Save R8 580 p.a.

Elect* R2 389

Save R8 172 p.a.

R3 187

Save R12 756 p.a.

R3 629

Save R14 544 p.a.

R4 856

Save R18 780 p.a. * in the case of emergency or accident (unforeseen and life-threatening events), you can still use any

private hospital and you will be covered without any co-payment. The use of network hospitals only applies to planned procedures.

CONTRIBUTION RATE EXAMPLES (Principal member + adult dependant + 1 child )

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Any hospital R4 925 R5 756 R7 457 Grid* R3 698 R4 382

Save R6 840 p.a.

R5 120

Save R7 632 p.a.

R6 629

Save R9 936 p.a.

Elect* R2 877

Save R9 852 p.a.

R3 695

Save R14 760 p.a.

R4 316

Save R17 280 p.a.

R5 648

Save R21 708 p.a. * in the case of emergency or accident (unforeseen and life-threatening events), you can still use any

private hospital and you will be covered without any co-payment. The use of network hospitals only applies to planned procedures.

CONTRIBUTION RATE EXAMPLES (Principal member + adult dependant + 2 children )

flexiFED1 flexiFED2 flexiFED3 flexiFED4

Any hospital R5 600 R6 671 R8 493 Grid* R4 326 R4 983

Save R7 404 p.a.

R5 934

Save R8 844 p.a.

R7 552

Save R11 292 p.a.

Elect* R3 365

Save R11 532p.a.

R4 203

Save R16 764 p.a.

R5 003

Save R20 016 p.a.

R6 440

Save R24 636 p.a. * in the case of emergency or accident (unforeseen and life-threatening events), you can still use any

private hospital and you will be covered without any co-payment. The use of network hospitals only applies to planned procedures.

Per Month Per Annum Risk R6 606 R79 272 Savings R 65 R 780 TOTAL R6 671 R80 052 Total MediVault available for a family of 4 = R25 200

Below some repayment examples

R5 400 Activated R8 400 Activated R13 200 Activated R25 200 Activated TOTAL MEDIVAULT REPAYMENT TO THE SCHEME OVER 12 MONTHS R450 p.m. R700 p.m. R1 100 p.m. R2 100 p.m. TOTAL PAYMENT TO THE SCHEME (Total contribution + MediVault repayment) R7 121 p.m. R7 371 p.m. R7 771 p.m. R8 771 p.m.

CASE STUDY flexiFED3 PM+AD+2C

Per Month Per Annum Risk R5 876 R70 512 Savings R 58 R 696 TOTAL R5 934 R71 208 Amount you will save on annual contribution R 8 844 Total MediVault available for a family of 4 = R25 200

Below some repayment examples

R5 400 Activated R8 400 Activated R11 700 Activated R25 200 Activated TOTAL MEDIVAULT REPAYMENT TO THE SCHEME OVER 12 MONTHS R450 p.m. R700 p.m. R975 p.m. R2 100 p.m. TOTAL PAYMENT TO THE SCHEME (Total contribution + MediVault repayment) R6 384 p.m. R6 634 p.m. R6 909 p.m. R8 034 p.m.

CASE STUDY flexiFED3GRID PM+AD+2C

Per Month Per Annum Risk R4 954 R59 448 Savings R 49 R 588 TOTAL R5 003 R60 036 Amount you will save on annual contribution R 20 016 Total MediVault available for a family of 4 = R25 200

Below some repayment examples

R3 000 Activated R6 000 Activated R9 900 Activated R25 200 Activated TOTAL MEDIVAULT REPAYMENT TO THE SCHEME OVER 12 MONTHS R250 p.m. R500 p.m. R825 p.m. R2 100 p.m. TOTAL PAYMENT TO THE SCHEME (Total contribution + MediVault repayment) R5 253 p.m. R5 503 p.m. R5 828 p.m. R7 103 p.m.

CASE STUDY flexiFED3Elect PM+AD+2C

In-hospital benefit – no overall annual limit for hospitalisation Chronic disease benefit – Members are covered in full for condition on the

• CDL. Covered in full up to the Medicine Price List if the member uses

medicine on the comprehensive formulary and obtains it from one of our Preferred Providers: Clicks, Dis-Chem, MediRite and Pharmacy Direct Threshold – Pays for comprehensive day-to-day benefits once claims have accumulated to the Threshold level Day-to-day benefits from Risk – we provide comprehensive day-to-day benefits like unlimited GP visits once Savings is depleted Screening benefit – Pays for lifestyle, wellness and physical screenings OHEB – Covers day-to-day expenses after the Savings Account has run out of funds. Savings – The funds in the Savings Account will be used first for day-to-day expenses Additional benefits – Lots of additional benefits like free Fedhealth Nurse Line, emotional wellbeing programme, etc.

maxima EXEC

No overall annual limit Covered unlimited. Paid in full Up to 300% of Fedhealth Rate Up to Fedheath Rate Up to 200% of Fedhealth Rate

maxima PLUS

Up to Fedhealth Rate Hospitalisation Network GPs and Specialists Other healthcare providers Non-network Specialists Non-network GPs

In-Hospital Benefit

maxima EXEC

R580 900 R580 900 R580 900

maxima PLUS

R181 200 Oncology Organ Transplant Renal Dialysis Specialised Medication Unlimited Unlimited Unlimited R363 500

Inflationary increases have been applied to all benefit limits, threshold levels, procedure co-payments and non-network hospital co-payments

In-Hospital Benefit

FOR 2020

56 Conditions. R7 400 per beneficiary,R13 600 per family Preferred Provider: MediRite, Dis-Chem, Clicks & Pharmacy Direct Comprehensive formulary 70 Conditions. R15 600 per beneficiary,R29 300 per family Preferred Provider: MediRite, Dis-Chem, Clicks & Pharmacy Direct Comprehensive formulary

maxima EXEC maxima PLUS

Chronic Disease Benefit

The unlimited Chronic Disease Benefits for acne for child dependants up to the age of 21, allergic rhinitis for child dependants up to the age of 18, and eczema in child dependants up to the age of 18 have now also been extended to maxima EXEC and maxima PLUS. The number of chronic conditions covered on Maxima EXEC is now 56 and on maxima PLUS 70.

Chronic Disease Benefit

Chronic Disease Benefit

FOR 2020

A 10% co-payment will apply to all claims paid from the Threshold Benefit. No co-payments on GP and Specialist consultations in- network

Co-payments R14 256 Principal member R10 954 Adult dependent R3 669 Children up to max of 3 Annual Threshold levels

No co-payment will apply to claims paid from the Threshold Benefit

R16 530 Principal member R12 713 Adult dependent R4 409 Children up to max of 3

maxima EXEC maxima PLUS

Threshold Benefit

R8 992 R7 762 R2 860 Member Adult dependent Child R478 R412 R152 R9 470 R8 174 R3 012 R16 530 R12 713 R4 409 R9 116 R6 578 R2 021 Risk Savings Total Annual Threshold Annual OHEB

maxima PLUS

R5 218 R4 530 R1 660 Member Adult dependent Child R774 R672 R246 R5 992 R5 202 R1 906 R14 265 R10 954 R3 669 Risk Savings Total Annual Threshold R4 646 R4 032 R1 476 Member Adult dependent Child R690 R599 R219 R5 336 R4 631 R1 695 R14 265 R10 954 R3 669

maxima EXEC maxima EXECGRID