Medshield Medical Scheme 2017 Benefits and Contributions

Medshield Medical Scheme 2017 Benefits and Contributions Adjustments

PremiumPlus OPTION  Comprehensive cover  Unlimited In-Hospital benefits  Personal savings account

Premium Plus OPTION General, Medical and Appliances

The limit has been increased to R5 350 per family

Refractive Surgery

Limit increased to R 15 400 per family

Prosthesis and Devices Internal

Increased to R53 500 per family

Specialised Radiology (In and Out of Hospital)


Chronic Medicine Pharmacy Advised Therapy

Limit increased to R11 910 per beneficiary and R23 815 per family Limit increased to R185 per script

Optical Readers

Increased to R140 per beneficiary

Flu Vaccination

Increased to R 85 per beneficiary

Adult Vaccination


Human Papillomavirus (HPV)

1 per female beneficiary

Birth Control

Increased to R140 per female beneficiary

Premium Plus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital

Unlimited. Medshield Private Rates (up to 200%)

Basic Dentistry Out-of-Hospital

Subject to Personal Savings Account. Threshold and Above Threshold apply R15 000 per family per annum

Specialised Dentistry 

Wisdom Teeth and Apicectomy



Dental Implants



Orthodontic Treatment



Subject to the Specialised Dentistry Limit. Medshield Private Rates (up to 200%) Subject to the Specialised Dentistry Limit. Medshield Private Rates (up to 200%) Subject to the Specialised Dentistry Limit.

Crowns, Bridges, Inlays, Mounted Study Models, Subject to Personal Savings Account. Partial Metal Base Dentures and Periodontics Threshold and Above Threshold apply Maxillo-Facial and Oral Surgery R15 900 per family per annum. Extended Benefit Cover (up to 200%)

Premium Plus OPTION Threshold Benefit – Out-ofHospital

Member R12 730 Adult Dependant R11770 Child Dependant R2 350 Member R4 280 Adult Dependant R3 210 Child Dependant R2 140

Above Threshold Benefit

PREMIUM PLUS Principal Member

R4 284

SAVINGS (INCLUDED IN PREMIUM) R1 071

Adult Dependant

R3 909

R978

R792

R198

Child

MONTHLY PREMIUM

MediBonus OPTION  Cover at the Hospital of member’s choice  Comprehensive cover  Range of Out-Of Hospital benefits

MediBonus OPTION Non-PMB Internal Prosthesis and Internal Devices

Reduced co-payment to 20%

General, Medical and Appliances


Refractive Surgery

Limit increased to R 15 400 per family





Chronic Medicine

Limit increased to R11 910 per beneficiary and R23 815 per family M0 R9 300 M+1 R13 040 M+2 R14 460 M+3 R15 930 M+4 R17 240

Day-to-Day Limits

MediBonus OPTION Pharmacy Advised Therapy

Optical Limit

Single member limit R725 Family limit R1 245 Script limit increased to R 185 per script Increased to R2 675 per beneficiary

Optical Readers


Flu Vaccination


Birth Control


Adult Vaccination

Increased to R1280 per family



MediBonus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital

Unlimited


Unlimited

Specialised Dentistry

R15 000 per family per annum.




Subject to the Specialised Dentistry Limit.



Dental Implants








Crowns, Bridges, Inlays, Mounted Study Models, Subject to the Specialised Dentistry Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R15 900 per family per annum. Extended Benefit Cover (up to 200%)

MediBonus OPTION MEDIBONUS

MONTHLY PREMIUM

Principal Member

R4 119

Adult Dependant

R2 829

Child

R819

MediSaver OPTION  Unlimited In-Hospital cover through the Medshield Hospital Network  Freedom to manage their own Personal Savings for Out-of-Hospital benefits

MediSaver OPTION General, Medical and Appliances


Refractive Surgery

Limit increased to R7 500 per family





Pharmacy Advised Therapy

Script limit increased to R185 per script

Optical Readers


Flu Vaccination


Birth Control


Adult Vaccination




MediSaver OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital

Subject to the Specialised Dentistry Limit


Subject to Personal Savings Account


R10 000 per family per annum







Dental Implants





Subject to Personal Savings Account



Crowns, Bridges, Inlays, Mounted Study Models, Subject to Personal Savings Account Partial Metal Base Dentures and Periodontics

Maxillo-Facial and Oral Surgery


MediSaver OPTION MEDISAVER Principal Member

R2 571

SAVINGS (INCLUDED IN PREMIUM) R516

Adult Dependant

R2 151

R432

R615

R123

Child

MONTHLY PREMIUM

MediPlus OPTION  Middle to Upper income earners  Unlimited In-Hospital cover through the Medshield Hospital Network  Comprehensive Out-of-Hospital benefits

MediPlus OPTION Non-PMB Internal Prosthesis and Internal devices

Reduced co-payment to 20%

General, Medical and Appliances


Refractive Surgery



Increased to R31 000 per family and application



Chronic Medicine

Limit increased to R5 385per beneficiary and R10 775 per family M0 R6 750 M+1 R9 420 M+2 R10 600 M+3 R11 910 M+4 R13 050

Day-to-Day Limits

MediPlus OPTION Pharmacy Advised Therapy

Optical Limit

Single member limit R535 Family limit R985 Script limit increased to R185 per script Increased to R1 765 per beneficiary

Optical Readers


Flu Vaccination


Birth Control


Adult Vaccination




MediPlus OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital

Unlimited


Unlimited









Dental Implants








Crowns, Bridges, Inlays, Mounted Study Models, Subject to the Specialised Dentistry Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R12 985 per family per annum.

MediPlus OPTION MEDIPLUS

MONTHLY PREMIUM

Principal Member

R2 544

Adult Dependant

R1 797

Child

R558

MediCore OPTION  Unlimited In-Hospital cover though the Medshield Hospital Network  No Day-to-Day Benefits

MediCore OPTION Prosthesis and Devices Internal


Diagnostic Laparoscopy

Co-payment reduced to R2 000

Flu Vaccination


Birth Control


Adult Vaccination




Basic Dentistry (In-Hospital)

Unlimited


R10 000 per family per annum. Extended Benefit Cover (up to 200%)

MediCore OPTION MEDICORE

MONTHLY PREMIUM

Principal Member

R1 926

Adult Dependant

R1 623

Child

R438

MediValue OPTION  Unlimited In-Hospital cover through the Medshield Hospital Network  Limited Day-to-Day cover

MediValue OPTION General, Medical and Appliances


Specialised Radiology non-PMB co-payment

Co-payment reduced to 8%



Day-to-Day Limits

M0 R4 815 M+1 R5 240 M+2 R5 900 M+3 R6 860 M+4 R7 600 Increased to 3 per family

Specialist Visits Pharmacy Advised Therapy

Single member limit R400 Family limit R600 Script limit increased to R185 per script

MediValue OPTION Optical Limit

Increased to R1 550 per beneficiary

Optical Readers


Flu Vaccination


Birth Control


Adult Vaccination




MediValue OPTION Dentistry benefits restructured as follows for simplicity: Basic Dentistry In-Hospital (only for beneficiaries under the age of 6 years old) Basic Dentistry Out-of-Hospital Specialised Dentistry

R1 360 per family per annum. Subject to the Basic Dentistry Limit. Thereafter subject to Day-to-Day Limit Subject to the Basic Dentistry Limit. Thereafter subject to Day-to-Day Limit R5 000 per family per annum







Dental Implants








Crowns, Bridges, Inlays, Mounted Study Models, Subject to Day-to-Day Limit. Partial Metal Base Dentures and Periodontics Maxillo-Facial and Oral Surgery R6 095 per family per annum.

MediValue OPTION MEDIVALUE

MONTHLY PREMIUM

Principal Member

R1 521

Adult Dependant

R1 323

Child

R414

MediPhila  Low cost Option  Unlimited In-Hospital cover through the MediPhila Hospital Network  Unlimited GP visits

MediPhila OPTION Hospitalisation (Non-PMB Limit) Basic Dentistry

The limit has been increased to R500 000 per beneficiary and R1 000 000 per family Limit increased to R1 135 per family

Day-to-Day Limit

Increased to R2 500

General Practitioner Visits

Unlimited subject to pre-authorisation

Acute Medicine


Pharmacy Advised Therapy

Optical Limit

Single member limit R285 Family limit R395 Script limit increased to R60 per script Increased to R640 per beneficiary

Optical Readers


MediPhila OPTION Flu Vaccination


Birth Control




Basic Dentistry Out-of-Hospital Specialised Dentistry

R1 135 per family per annum Subject to Basic Dentistry R5 000 per family per annum



Subject to Specialised Dentistry Limit



Limited to PMB only

MediPhila OPTION MEDIPHILA

MONTHLY PREMIUM

Principal Member

R1 041

Adult Dependant

R1 041

Child

R261

HIV/AIDS Cover  1 September 2016 - new HIV/AIDS treatment guidelines adopted by government  Medshield has decisively dealt with the accompanying uncertainty regarding ‘test and treat’ approach  Medshield already funds ‘test and treat’ - been factored into our 2017 benefit design

 Contributing positively to a healthy nation  In line with our vision and the Sustainable Development Goals set by the United Nations

Gap Cover  Partnering with all our brokers by promoting GAP Cover products  Assist members in overcoming payment shortfalls  The biggest challenge facing the industry since the 2010 Court Ruling which nullified the Reference Price List  Working hard with you to ensure readiness in 2017

Average Contribution increases for 2017

Portion of High Reserves used to fund part of benefit enhancements

9,6% Weighted Average contribution increase for 2017

Medshield • Complies with all statutory requirements • 50% solvency rate • AA-Global Credit Rating for 10 consecutive years

Thank you

Medshield Medical Scheme 2017 Benefits and Contributions

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