2020 Bonitas Medical Fund and Fedhealth Medical Scheme Induction Presentation for Santam Employees Aon South Africa (Pty) Ltd Aon South Africa (Pty) Ltd 1 Proprietary & Confidential Proprietary & Confidential
Agenda Section 1 - Five Key Decisions Section 2 - Sanlam Gap Cover Section 3 - Underwriting: Gap & Medical Scheme Section 4 - 2020 Medical Scheme Offerings Section 5 – Review and the way forward Section 6 - Aon Resolution Centre (ARC) Section 7 - Social Media Aon South Africa (Pty) Ltd 2 Proprietary & Confidential
Five Key Decisions Day-to-Day Hospitalisation Chronic Expenses Carried over Network of MSA? hospitals To what extent Depleted MSA? OR What rate of Do you need do you require Used less than freedom of hospital additional Day to Day 50% MSA? choice? reimbursement chronic cover ? cover? is appropriate? Closed SPG? Co-payments OR Used up day to Annual Limits? day? Aon South Africa (Pty) Ltd 3 Proprietary & Confidential
Sanlam Gap Cover 2020 Aon South Africa (Pty) Ltd 4 Proprietary & Confidential
Sanlam Gap Cover for hospital expenses. The difference between covered and fully covered. There’s often a difference between what a specialist charges in hospital and what your medical scheme will cover. Sanlam Gap Cover pays for this shortfall up to an Additional 500% so you don’t have to suffer financially due to unexpected medical expenses. This includes co-payment cover and more. Aon South Africa (Pty) Ltd 5 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 cover extends to the principle member or family (Children up to the age of 27). Aon South Africa (Pty) Ltd 6 Proprietary & Confidential
IN-HOSPITAL TREATMENT – 2020 BENEFITS – R266 Tariff shortfalls Additional 500% of scheme tariff Unlimited cover for specified procedures Unlimited cover for Co-payments specified procedures* such as MRI & CT Scans, scopes etc Unlimited cover for specified procedures. Unlimited cover for Deductibles This is a similar term used for co-payments by Medical specified procedures* aid Schemes 1 per family per annum Penalty 1 per family per annum (maximum R15 000) or a (maximum R12 000) co-payment percentage co-payment that does not exceed 30% R52 100 per event/condition where the medical R40 000 per event/condition Sub-limits scheme imposes a limit of in hospital procedures Please refer to the Sanlam Gap Cover insurance policy agreement, for more detailed information. Overall limit of R165 000 per member per year as per regulations. Aon South Africa (Pty) Ltd 7 Proprietary & Confidential
OUT-OF-HOSPITAL TREATMENT – 2020 BENEFITS Limited to the statutory maximum of R165 000 per Oncology insured per annum Co-payments Limited to the statutory maximum of Oncology R165 000 per insured per annum R325 000 per treatment cycle Sub-limits per beneficiary Provides up to R15 000 per event Cover for all services delivered in the casualty ward relating to an accident (physical injury via an external force that requires immediate medical attention) even if the costs are paid from the Medical Savings Account. Aon South Africa (Pty) Ltd 8 Proprietary & Confidential
OUT-OF-HOSPITAL TREATMENT/UNIQUE BENEFITS – 2020 BENEFITS • Hospital Cash Benefit (only payable for accidents and premature births – 6 weeks subject to a maximum of R21 290, per beneficiary per annum) Supplementary Benefits Day 1 to 13, R380 per day Day 14 to 20, R750 per day Day 21 to 30, R1 500 per day Premature Birth (in 34 th week ) • R14 000 per event • Death/Permanent Disability Accidental – R28 000 per member • Medical Scheme and Medical Gap Premium Waiver 6 months – max. R5 500 per month Paid as a lump sum of R33 000 to the claimant • Road Accident Fund (RAF) Claims Assistance for Road Accident Claims where the policy holder was not at fault in the vehicle accident. Aon South Africa (Pty) Ltd 9 Proprietary & Confidential
Gap Cover – Underwriting The following waiting periods apply: A general waiting period of 12 months 3 months for pre-existing conditions, and pregnancy on all benefits For more information, please refer to our policy wording document, which can be provided by your Sanlam Gap specialist Aon South Africa (Pty) Ltd 10 Proprietary & Confidential
Medical Scheme – Underwriting Concession Medical Schemes Waiting Periods Waiting periods Late Joiner Penalty 3 months general waiting 12 months for Pre-Existing Applies after age 35 NB! period waived conditions waived waived Bonitas Fedhealth Members and their ordinary dependents will be allowed to move to Fedhealth or Bonitas medical scheme with no underwriting, provided they join within 90 days of being employed by Santam. 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. 11 Proprietary & Confidential
Summary of Medical Schemes Medical No of Options Hospital Cover Chronic Day to Day Scheme Network option All options have cover for PMB 14 Options 100% or 200% New Generation without Threshold options Fedhealth Comprehensive options has access to an New Generation with Threshold options additional chronic disease list Network option All Options have cover for PMB Hospital option Comprehensive options has access to an Bonitas 13 Options 100% or 150% Hybrid – Savings and Traditional options additional chronic disease list New Generation with Threshold option Traditional options 12 Proprietary & Confidential
Hospital Plans Benefit Option Bonitas Bon Essential Bonitas Bon Essential Select Risk Contribution R1,877 R1,602 Savings R0 R0 Total Contribution R1,877 R1,602 100% 100% In-Hospital Cover Any Hospital Network Chronic Cover CDL CDL Maternity Care Maternity Care Female Contraceptives Female Contraceptives Additional/ Out of Hospital Benefit Wellness Extender Wellness Extender Childcare Benefit Childcare Benefit 13 Proprietary & Confidential
Savings Plans Fedhealth flexiFED 1 Benefit Option Bonitas BonSave Bonitas BonFit Select Fedhealth flexiFED 1 Elect Risk Contribution R2,723 R1,722 R1,721 R1,341 Savings R531 R305 R25 R19 Total Contribution R3,254 R2,027 R1,746 R1,360 100% 100% 100% 100% In-Hospital Cover Any Hospital Network Network Network Chronic Cover CDL CDL CDL CDL Unlimited Network GP and Maternity Care Unlimited Network GP and Maternity Care Preventative Dentistry once Childcare Benefit Preventative Dentistry once Childcare Benefit Maximizer reached Contraceptives Maximizer reached Contraceptives Wellness screening benefits Wellness Extender Wellness screening benefits Wellness Extender Female contraceptives Additional/ Out of Hospital Benefit Additional GP visits once Female contraceptives Additional GP visits once Trauma treatment in casualty savings is depleted Trauma treatment in casualty ward savings is depleted ward Basic Dentistry Take-home medicine Basic Dentistry Take-home medicine Wellness Extender Specialised Radiology Wellness Extender Specialised Radiology 14 Proprietary & Confidential
Savings Plans Fedhealth flexiFED 2 Benefit Option Fedhealth flexiFED 2 Fedhealth flexiFED 2 Elect Grid Risk Contribution R2,275 R2,022 R1,703 Savings R25 R22 R19 Total Contribution R2,300 R2,044 R1,722 100% 100% 100% In-Hospital Cover Any Hospital Network Restricted Network Chronic Cover CDL CDL CDL Unlimited Network GP and Unlimited Network GP and Basic Unlimited Network GP and Basic Dentistry Basic Dentistry once Dentistry once Maximizer reached once Maximizer reached Maximizer reached Maternity benefits Maternity benefits Maternity benefits Childhood benefits Childhood benefits Childhood benefits Female contraceptives Additional/ Out of Hospital Benefit Female contraceptives Female contraceptives Wellness screening benefits Wellness screening benefits Wellness screening benefits Trauma treatment in casualty ward Trauma treatment in casualty ward Trauma treatment in casualty Take-home medicine Take-home medicine ward Specialised Radiology Specialised Radiology Take-home medicine Specialised Radiology 15 Proprietary & Confidential
Recommend
More recommend
