2 0 1 7
play

2 0 1 7 PRODUCT UPDATE CARING AFFORDABLE SIMPLE Over 3 - PowerPoint PPT Presentation

Feb 20, 2024 •204 likes •430 views

2 0 1 7 PRODUCT UPDATE CARING AFFORDABLE SIMPLE Over 3 decades of History Over R1 billion 47% Solvency A+ Global Credit Rating Over 121 954 lives covered 33 Average age ratio Headline CPI inflation (y/y) Bottom

  1. 2 0 1 7 PRODUCT UPDATE

  2. CARING AFFORDABLE SIMPLE · Over 3 decades of History · Over R1 billion · 47% Solvency · A+ Global Credit Rating · Over 121 954 lives covered · 33 Average age ratio

  3. Headline CPI inflation (y/y) Bottom range Upper range 8% Budget Assumptions 7% 6% 5% 4% 3% 2% 1% 0% J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D 2014 2015 2016 CPI 6.5% Hospital Tariffs 6.5% (CPI + 1%) Medicines (SEP) 8.6% (5.7% + 2.9% gazetted increases) Reference price list 6.5% Utilization (plus ageing as well as 2.5% supplier induced demand) Investment return 6.5%

  4. AVERAGE INCREASE 8.9% INCREASES FOR 2017

  5. PRODUCT HIGHLIGHTS BASIC RADIOLOGY AND PATHOLOGY DENTISTRY Basic radiology and pathology Introduction of a sub-limit on basic radiology and pathology out of hospital. Primary Care: M:R1 000 and M+:R1 900 Affordable Care: M:R1 100 and M+:R2 200 Full Benefit: M:R1 300 and M+:R2 750 Dentistry Introduction of the following limits for dentistry.  Primary Care - A limit of R2 800 per family on conservative dentistry.  Affordable Care - A limit of R3 200 per family on conservative dentistry.  Full Benefit - A limit of R3 600 per family on conservative dentistry and R3 600 per family on specialised dentistry (excluding orthodontics). Benefit for plastic dentures covered over a 4 year period, regardless of whether full or partial dentures are provided. Benefit for implants be increased by more than inflation, from R2 350 to R3 500 in 2017.

  6. PRODUCT HIGHLIGHTS PREVENTATIVE CARE HEARING AIDS Preventative care Flu vaccine will be covered within the current Wellness benefit. Pneumococcal vaccine will be covered within the current Wellness benefit. Wellness benefit on Full Benefit be increased to R2 500 per family. Hearing aids 20% increase in the hearing aid benefit on the Primary Care and Affordable Care options 30% increase for Full Benefit. GOMOMO CARE Removal of the two lower income bands on Gomomo Option

  7. PRODUCT HIGHLIGHTS OPTOMETRY Change from a family limit to the following cover per beneficiary Inflationary increases to the following limits  Oncology  Prosthesis  Advanced radiology  Preventative care and wellness  Day to day: Auxiliary services  Day to day: Mental health  Day to day: Chronic conditions  Day to day: Appliances  Day to day: Wheelchairs

  8. GOMOMO CARE 6.5% Average Increase Plan Option Service Type 2017 Limit Gomomo Care -Out of hospital Advanced radiology limited to a combined in and out of hospital 6 770 benefit This is our entry-level option. Gomomo provides Over the counter medication 280 excellent value for money. GPs, specialists and acute Chronic medication 7 450 medicines are accessible through a selected network Optical (M) -subject to 24-month cycle 1 070 provider. Dentistry, radiology and pathology are also Optical (M + 1) -subject to 24-month cycle 1 230 available from a network provider. No overall limit for Optical (M + 2) -subject to 24-month cycle 1 370 in-hospital at selected network hospital Covers the 27 Optical (M + 3) -subject to 24-month cycle 1 970 CDL conditions Dentistry (M) 2 630 Dentistry (M+1) 3 020 Dentistry (M+2) 3 290 Dentistry (M+3) 3 560 Dentistry (M+4) 3 810 Dentistry (M+5) 4 070 Dentistry (M+6) 4 470 Other services (Includes physiotherapists, speech therapists, 2 400 clinical psychologists, podiatrists, equipment and external prostheses) per family subject to PMBs Gomomo Care Option -In-hospital Overall Prosthesis benefit sub-limit- per beneficiary per annum. 26 625

  9. HOSPITAL CARE HOSPITAL CARE OPTION This Hospital plan offers peace of mind knowing that in the event of hospitalisation extensive cover is available at any private hospital. In addition the hospital care option provides cover for 26 chronic disease list conditions. Medicines given to a patient to take home limited to a supply of seven (7) days only

  10. HOSPITAL CARE PREVENTATIVE CARE Subject to the family limit of R 1 920 per annum Limited to one test per beneficiary per annum where not otherwise specified Wellness screening Includes the following tests: Blood sugar, Cholesterol, Blood pressure, Body Mass Index, HIV testing; One screening test per beneficiary per annum covered; Limited to R 300 per beneficiary per annum at a Preferred Provider facility; Other screening tests Cover limited to the following tests: Females: Mammogram every 2 years for women above age 40 years, Pap smear every 2 years for women above 21 years Males above 40 years: Prostate Specific Antigen test Vaccinations  Flu Vaccine  Pneumococcal Vaccine

  11. SAVINGS CARE Plan Option Service Type 2017 Limit Savings Care Option - Out of Hospital Specialised Radiology (Combined limit in and out of hospital per family per 23 960 annum) Private nursing (per family per annum) 5 750 This is our new generation option. Appliances (Memb without a dependant) 1 230 Comprehensive in- hospital benefits. Appliances (Member with one or more dependant) 2 160 Out-of-hospital benefits paid from a 15% savings portion available up front for the Prosthesis (per family per annum) 35 950 year. No overall in-hospital limit with the freedom to go to any private hospital. Mental Health (per family per annum) 7 190 Preventative care 1 920 Wellness screening (per beneficiary per annum at a Preferred Provider 300 facility; Preauthorisation required) Pre-authorisation required. Savings Care Option - In-Hospital Blood transfusions and blood replacement products 75 350 Prosthesis (Surgical and non-surgical prosthesis) 35 950 Oncology 121 920 Specialised Radiology (MRI/CAT scan/Angiogram) subject to an overall 23 960 combined in and out of hospital limit Organ Transplant and Renal Dialysis (per family per annum) 190 420

  12. PRIMARY CARE Plan Option Service Type 2017 Limit Primary Care Option -Out of hospital Specialised Radiology (MRI/CAT scan/Angiogram) subject to an overall combined in and out of 17 710 hospital limit) per family per annum Primary Care option offers good value Private nursing (per family per annum) 4 310 for money with unlimited Auxiliary services ( Member without dependant ) 960 hospitalisation at any private Auxiliary services ( Member with 1 or more dependant ) 1 550 hospital. This traditional option has Acute meds ( M) 1 680 generous day-to-day benefits which Acute meds (M+1) 3 030 cover acute medicines, GP s, Acute meds (M+2) 3 370 specialists, radiology, pathology and Acute meds ( M+3) 3 820 more to meet the needs of any family. Acute meds ( M+4) 3 930 Acute meds ( M+5) 4 150 Acute meds(M+6 and more) 4 490 Appliances(Member with one or more dependant ) 960 Mental Health ( per family per annum) 1 560 Wellness screening (per beneficiary per annum at a Preferred Provider facility; Preauthorisation 255 required) Pre-authorisation required. Other screening tests (Mammogram, pap smear, PSA (Limited to one test per beneficiary per 1 920 annum) subject to family limit as stated here Female Contraceptives (per family per annum subject to Managed Care protocols and formulary 2 490 Hearing Aids ( per family ) every 4 years 5 500 Non-motorised wheelchairs (Member with or without dependants) 1 790 Primary Care In- hospital Prosthesis (per family within hospital limit as stipulated) 24 270 Specialised Radiology ((MRI/CAT scan/Angiogram) per family per annum, pre-authorisation and 17 710 managed care protocols Oncology 106 500

Recommend

More recommend