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 you require hospitals co-payments additional reimbursement Day to Day OR OR chronic cover ? is appropriate? cover? do you prefer Annual Limits? freedom of choice? Aon Employee Benefits I Healthcare Proprietary & Confidential
Medical Scheme – Underwriting Concession Medical Schemes Waiting Periods Waiting periods Late Joiner Penalty 12 months for Pre- 3 months general Applies after age 35 NB! Existing conditions waiting period waived waived 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. Aon Employee Benefits I Healthcare Proprietary & Confidential
2019 Benefits Highlights 2019 Medical Scheme Highlights 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% 100% Any Hospital Network Chronic Cover CDL CDL Additional/ Out of Hospital Benefit Maternity Care Maternity Care Female Contraceptives Female Contraceptives Wellness Extender Wellness Extender 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% 100% Any Hospital Network Chronic Cover CDL CDL Maternity Care Additional/ Out of Hospital Benefit Maternity Care Childcare Childcare Contraceptives Contraceptives Wellness Extender Wellness Extender Additional GP visits once savings is depleted Additional GP visits once savings is depleted Basic Dentistry Basic Dentistry Wellness Extender Wellness Extender Aon Employee Benefits I Healthcare Proprietary & Confidential
Savings Plans Fedhealth Fedhealth Fedhealth Fedhealth Fedhealth Benefit Option flexiFED 1 flexiFED 1 Elect flexiFED 2 flexiFED 2 Grid 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% 100% 100% 100% 100% Network Network Any Hospital Network Network Chronic Cover CDL CDL CDL CDL CDL Additional/ Out of Unlimited Network Unlimited Network Unlimited Network Unlimited Network Unlimited Network Hospital Benefit GP and GP and GP and Basic GP and Basic GP and Basic Preventative Preventative Dentistry once Dentistry once Dentistry once Dentistry once Dentistry once Maximizer reached Maximizer reached Maximizer reached Maximizer reached Maximizer reached Aon Employee Benefits I Healthcare Proprietary & Confidential
Savings Plans Fedhealth flexiFED 3 Fedhealth flexiFED 3 Fedhealth flexiFED 3 Benefit Option Grid 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% 100% 100% Any Hospital Network Network Chronic Cover CDL + 3 ADL CDL + 3 ADL CDL + 3 ADL Additional/ Out of Hospital Benefit Unlimited Network GP and Unlimited Network GP and Unlimited Network GP and preventative/basic Dentistry preventative/basic Dentistry preventative/basic Dentistry once Maximizer reached once Maximizer reached once Maximizer reached Optical benefit payable from Optical benefit payable from Optical benefit payable from Core Benefit Core Benefit Core Benefit Aon Employee Benefits I Healthcare Proprietary & Confidential
New Generation Plans Benefit Option Bonitas Bon Bonitas Bon Classic Bonitas Bon Complete Comprehensive 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% 100% 100% Any Hospital Any Hospital Any Hospital Chronic Cover CDL + 33 ADL CDL + 20 ADL CDL + 4 ADL Female Contraceptives Additional/ Out of Hospital Female Contraceptives Female Contraceptives Maternity Benefit Benefit Maternity Benefit Maternity Benefit Basic/Specialised Dentistry Basic/Specialised Dentistry Hearing Aids/Appliances Hearing Aids/Appliances Childcare & Preventative benefits Childcare & Preventative benefits Childcare & Preventative benefits Wellness Extender Wellness Extender Wellness Extender Aon Employee Benefits I Healthcare Proprietary & Confidential
New Generation Plans Fedhealth Fedhealth Fedhealth Fedhealth Fedhealth Fedhealth Benefit Option flexiFED 4 flexiFED 4 flexiFED 4 Maxima Exec Maxima Exec Maxima Plus Grid Elect Grid 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% 100% 100% 200% 200% 200% Restricted Any Hospital Network Any Hospital Network Any Hospital Network Chronic Cover CDL + 16 CDL + 16 ADL CDL + 16 ADL CDL + 26 ADL CDL + 26 ADL CDL + 40 ADL ADL Unlimited Network Unlimited Network Additional/ Out of Unlimited Network Unlimited Network Unlimited Network Unlimited Network GP Visits once GP Visits once Hospital Benefit GP Visits GP Visits GP Visits GP Visits savings is depleted savings is depleted Aon Employee Benefits I Healthcare Proprietary & Confidential
Traditional Bonitas Primary Bonitas Primary Bonitas Standard Bonitas Standard Benefit Option Select Select Risk Contribution R2, 240 R1904 R3, 556 R3, 080 Savings R0 R0 R0 R0 Total Contribution R3, 556 R2, 240 R1904 R3, 080 In-Hospital Cover 100% 100% 100% 100% Any Hospital Network Any Hospital Network Chronic Cover CDL CDL CDL + 18 ADL CDL + 18 ADL Female Contraceptives Female Contraceptives Additional/ Out of Hospital GP Visits/Day to Day Benefits Nominated GPVisits/ Day to Day Maternity Benefit Maternity Benefit Benefit Basic& Specialised Dentistry Benefits Basic Dentistry Basic Dentistry Optical Benefits Optical Benefits Optical Benefits Optical Benefits Mental Health Basic& Specialised Dentistry Appliances Appliances Appliances Mental Health / Appliances Childcare & Preventative Childcare & Preventative Childcare & Preventative Childcare & Preventative benefits benefits benefits benefits Wellness Extender Wellness Extender Wellness Extender Wellness Extender Aon Employee Benefits I Healthcare Proprietary & Confidential
Managed Care Plans/ Network Plans Bonitas BonCAP Fedhealth MyFED Benefit Option Income R0 – R8 030 IIncome R1 – R5 953 Total Contribution PM R1 009 PM R916 Income R8 031 – R1 3050 Income R5 954 – R9 732 PM R1 226 PM R1 161 Income R1 3051 – R17 830 Income R9 733 – R12 021 PM R2 000 PM R1 627 Income R17 831+ Income R12 022 - R13 739 PM R2 456 PM R2 068 Income R13 740+ PM R2 804 In-Hospital Cover 100% 100% Restricted Network Restricted Network Chronic Cover CDL CDL Restricted Medication Formulary Restricted Medication Formulary Day To Day Out of Hospital Benefits GP Visits at nominated GP – monitoring after 6 th visit Contraceptives Unlimited prescribed formulary medication Unlimited GP Visits at a Network GP Basic x-rays and pathology Limited Over the Counter medication Basic Dentistry Acute Meds/Basic x-rays/pathology benefit One pair of glasses every 24 months Basic Dentistry including dentures Casualty Benefit One pair of glasses/contact lenses (R1 035 pb) every 24 months Maternity Benefit Appliances Benefit Specialist Benefit per referral and annual limit Specialist Benefit per referral and annual limit Female Contraception Casualty Benefit – R570 co-payment R570 per visit for non PMB Aon Employee Benefits I Healthcare Proprietary & Confidential
Sanlam Gap Cover 2019 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. Aon Employee Benefits I Healthcare Proprietary & Confidential
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