2014 Healthcare Arrangements Presented by Nicolette du Toit AGENDA - PowerPoint PPT Presentation

Volkswagen Group South Africa 2014 Healthcare Arrangements Presented by Nicolette du Toit

AGENDA  Who is Alexander Forbes?  FAIS Requirements  2014 VWSA Healthcare Arrangements  General  On-site Assistance  Scheme Administration  Waiting Periods and Penalties  Medical Schemes Options for 2014  Top-up/Gap Cover Insurance offering  Overview of Schemes/Plans  Bonitas Medical Fund  Medihelp Unify  Discovery Health (Managers and Supervisors Only)  Contact Details for Assistance

Alexander Forbes Health’s Commitment to You As Healthcare Consultants to VWSA we provide the following services • On-Site Assistance – Monthly visits • Telephone/E-mail Assistance: Consultant and Member Service Unit. • Assistance in choosing the correct medical scheme option, based on your needs  Monthly Induction sessions upon employment at VWSA; promotion (to supervisor/managerial level).  Annual Helpdesks during the option change period (October – November). • Clarification of benefits and the escalation of any unresolved medical scheme queries. • Liaison with your medical scheme on your behalf to ensure you are treated fairly and correctly, based on your benefit entitlements. • Industry updates that could affect the business and members. • Annual Evaluation of Medical Schemes available in the Market. • Strategic consulting to VWSA as a whole.

FAIS Requirements  Alexander Forbes Health is an approved Financial Services Provider - FSP 33471  Alexander Forbes Health is accredited by Council for Medical Schemes - ORG 3064  General Disclosure and Product Supplier disclosures are available upon request  Alexander Forbes Health are appointed brokers to Administrators and Open Medical Schemes (actuarial and consulting services)  All information provided in this presentation is factual and NO advice is provided  All information provided in this presentation has been customized according to the VWSA Healthcare offering for 2014

2014 HEALTHCARE ARRANGEMENTS General  Medical Aid Compulsory for all VWSA employees  Employer Subsidy – 50% of total contribution  Relatives and Children charged at the Adult Dependant Rates are not subsidised. On-site Assistance (Medical Aid Office in the HR Benefits Department)  Rosalind Lourens - Administration / Applications  Medical Schemes/Service Providers:  Bonitas – 11h00 to 15h00 - Tuesday & Wednesday  Udipa – Every day  Alexander Forbes – 11h00 to 14h00 – Thursday Scheme Administration  All changes in personal status, i.e. marriage, new-borns etc. must be advised within 30 days of the event.  Termination of dependants requires one month’s notice.  Members joining during the year – benefits will be pro-rated.

2014 HEALTHCARE ARRANGEMENTS Waiting Periods & Penalties  No waiting periods will be applied to any new employee and dependants who join a VWSA Scheme at date of employment.  No waiting periods will be applied when changing options within your Scheme or if you change Schemes (at the end of the year). Medical Schemes & Options for 2014 (All Employees)  Bonitas • Standard Option • Primary Option  Medihelp • Unify Option  Discovery Health (Managers & Supervisors only) • Classic Comprehensive • Essential Comprehensive • Classic Priority • Classic Saver • Essential Saver • Coastal Saver

2014 HEALTHCARE ARRANGEMENTS AdmedAdd+* Separate Insurance product – Administered by Guardrisk  Membership is VOLUNTARY  Covers the GAP for in hospital expenses up to a maximum of 5 times the Admed Tariff  Additional benefits:  Stated benefit – R20 000 - can be used for In-hospital deductibles/co-payments on specified procedures - includes Breast cancer & prostate cancer benefit on 1 st diagnosis post policy  Oncology co-payment cover up to R250 000  Personal accident cover  RoadCover  Waiting periods and Exclusions apply  A calendar months notice is required in order to terminate the policy  Admed Gap must be claimed within 6 months of the date of admission to hospital  Cost: R 123 per month – payment via Debit Order *Please refer to the Admed brochure in your induction pack for further detail

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Summary of the 2014 Schemes/Plans PLANS Primary Standard Unify Type of Plan Offers members who do not Provides comprehensive a Managed Care plan need extensive chronic cover with extended chronic where the selected GP medicine benefits, with medicine cover and generous acts as the “gatekeeper” to affordable cover and limited day-to-day benefits. the required health day-to-day benefits. services, and provides primary health benefits for the full year as medically required. Ambulance ER 24 – 084 124 Overall Annual Limit None None None HOSPITALS Unlimited Unlimited Unlimited Private Hospitals 100% of Bonitas Rate 100% of Bonitas Rate 100% of Medihelp Rate Pre-authorisation [at Sub-limits apply & Sub-limits apply Sub-limits apply least 48 hours prior to deductibles on listed Cuyler Clinic: Uithge hospitalisation ] procedures Mercantile: PE & Others

2014 In Hospital Deductibles applicable on the Primary plan Colonoscopy, Conservative back treatment, Cystoscopy, Facet joint injections, Flexible sigmoidoscopy, Functional nasal surgery, Gastroscopy, Umbilical hernia R1 000 repair, Hysteroscopy (not Endometrial ablation), Myringotomy, Tonsillectomy and Adenoidectomy (except PMB’s), Varicose vein surgery Arthroscopy, Diagnostic laparoscopy, Hysterectomy (except cancer and PMB’s), R2 500 Perutaneous Radiofrequency ablations, Percutaneous rhizotomies, Laparoscopic Appendectomy, Laparscopic Nephrectomy Nissan Fundoplication (reflux surgery), Back surgery including spinal fusion, Joint R5 000 replacements e.g. hip & knee replacements (except PMB’s)Laparoscopic Pyeloplasty, Laparoscpic Radical Prostatectomy

Summary of the 2014 Schemes/Plans PLANS Primary Standard Unify CHRONIC MEDICATION BENEFITS Chronic 26 PMB conditions 26 PMB conditions 26 PMB conditions Medication unlimited cover for PMB’s 16 Additional conditions Subject to chosen GP or from DSP: Pharmacy Paid from benefit limit referred specialist and Direct of R7 400 pb /R14 800 pf Network formulary at ANY Provider Additional conditions (comprehensive formulary) Subject to chosen GP or thereafter referred specialist and unlimited cover for PMB’s Network formulary up to an from DSP: Pharmacy Direct Annual limit of R 6 600 pb Telephonic Application Telephonic Application All Chronic Medication must Clinical Entry Criteria Clinical Entry Criteria be obtained from Udipa’s Chronic Disease and Wellness Centre.

Summary of the 2014 Schemes/Plans PLANS Primary Standard Unify TYPE OF COVER OUT OF HOSPITAL Day-to-Day non-hospital Specialists consultations (referral The member must use the selected Network GP for all Day- required), Acute medication, PAT(limits apply), Radiology, COVER to-Day Doctors’ visits , Pathology and certain auxiliary services are paid from the Day- Acute medication, to-Day fund. Referral to Specialists , The funds belong to the Scheme Radiology and Pathology . No roll over/accumulation takes place Preffered Providers: GP Network – Udipa/Ecipa Benefit limits applies to other disciplines Radiology – Visser & Erasmus Pathology - Pathcare Day-to-Day fund Day-to-Day fund If requirements are met , above Single Member : R1 600 Single Member : R3 600 services will be covered for the full Member+1 : R2 900 Member+1 : R5 500 year. Member+2: R3 400 Member+2: R5 900 OTC Medication up to R250 pfpa available from Udipa’s Chronic Member+3: R3 700 Member+3: R6 400 Disease and Wellness Centre. Member+4: R4 000 Member+4: R6 950 Benefit limits applies to other disciplines

Summary of the 2014 Schemes/Plans PLANS Primary Standard Unify DAY-TO-DAY/OUT OF HOSPITAL LIMITS GP Consultations GP Network Benefit Limit GP Network Benefit Limit Required benefits for the full year from chosen GP & procedures PM : R1 500; M+1 : R2 850; PM : R3 200; M+1 : R4 400; M+2: R3 300; M+3: R3 600; M+2: R5 200; M+3: R5 500; Emergency Out of Network M+4+: R4 000 M+4+: R5 900 Benefit: Non-Network Sub-Limit Non-Network Sub-Limit 4 visits per family & R600 per PM : R500; M+1 : R950; PM : R1 050; M+1 : R1 600; family for medication M+2: R1 100; M+3: R1 200; M+2: R1 750; M+3: R1 850; M+4+: R1 350 M+4+: R2 000 Member to pay and claim back from fund Also for 2 nd Opinion Specialist Subject to Day-to-Day fund limit Required benefits for full year; Subject to referral by chosen Consultations & Specialist referral Management in all instances except: GP procedures Gynaecologist: 1 visit per annum – female beneficiaries. Paediatrician visits: no referral required for children < 2 yr Oncologist visits Ophthalmologist visits