Benefits BonCap-Network - 2015 BonEssential - …

1 BenefitsBonCap-Network - 2015 BonEssential - 2015 Primary - 2015 Plan TypeCapitation (Designated Service Providers)Hospital PlanTraditional limitedPlan Operation - Hospitalisation100% of Scheme Tariff (Bonitas Rate)100% of Scheme Tariff (Bonitas Rate)100% of Scheme Tariff (Bonitas Rate)- Day-to-dayBonCap GP networkNo benefit, except for limited Supplementary benefitsBenefit Pool and limited Supplementary benefitsOverall Annual MaximumUnlimitedUnlimitedUnlimitedHospit al Benefit1 Private Hospital CareDesignated Bonitas contracted Network HospitalsAny Private HospitalAny Private Hospital2 Co-paymentNone, except R5350 co-pay at non-network hospitalsCertain procedures and Endoscopies (R1000 - R5000)Certain procedures and Endoscopies (R1000 - R5000)

2 3 OncologyLimited to PMB conditionsR280 800 p/f, no benefit for biological medicineR135 000 p/f, Subject to OAL, no benefit for biological medicine4 Organ TransplantsLimited to PMB'sUnlimitedLimited to PMB conditions at Public Hospitals5 DialysisLimited to PMB conditionsLimited to PMB conditions & State protocolLimited to PMB conditions at Public Hospitals6 Maternity - Natural BirthUnlimited, DSP, Neonatal Care limited to R37 000 p/fUnlimited, subject to authorisationUnlimited, subject to authorisation- Elective CeasareanUnlimited, DSP, Neonatal Care limited to R37 000 p/fUnlimited, subject to authorisationUnlimited, subject to authorisation7 To take home medicationLimited to R310 per beneficiary per admissionR310 per beneficiary per dischargeR310 per beneficiary per discharge8 Psychiatric HospitalisationLimited to PMB'sR26 300 p/f, PMB consultations only, pre-authorisationR12 900 p/f, sublimit of R7800 for consultationsRadiology/Pathology/Prosthe sis1 Basic Radiology100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited2 MRI, CT & PET ScansR9 450 per family100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited3 PathologyR20 700 per family100% of Scheme Rate, Unlimited100% of Scheme Rate.

3 Unlimited4 Internal ProsthesisLimited to PMB'sLimited to PMB'sLimited to PMB's5 External Appliances/ProsthesisGeneral Appliance limit of R4450, otherwise no benefitLimited to PMB'sLimited to PMB's, R7400 for hearing aids x 24 months (10% co-pay)Sub Acute Facilities1 HospiceR11 650 per familyR13 500 per familyR13 500 per family2 NursingCombined with Hospice benefitCombined with Hospice benefitCombined with Hospice benefit3 Ambulance ServicesUnlimited - ER24 Unlimited - ER24 Unlimited - ER24 Chronic Benefit27 CDL chronic conditionsUnlimited - Preferred Provider & Formulary appliesUnlimited - Preferred Provider & Formulary appliesUnlimited - Preferred Provider & Formulary appliesAdditional chronic conditionsNo benefitNo benefitNo benefitDay-to-day BenefitOverall Annual MaximumIndividual limits per service categoryNo benefitGP benefit + Benefit Pool (BP)

4 + Dentistry/Optical benefitsPreferred ProviderYes - Member selected BonCap network GPNo benefitYes - Bonitas GP NetworkMedical Savings AccountN/aN/aN/a, but Benefit Pool M R1700,M1 R3100,M2 R3600,M3 R3900,M+4+ R4250 Annual ThresholdN/aN/aN/aSelf Payment GapN/aN/aN/aAbove Threshold BenefitN/aNo benefitN/aGP's and medication1 General PractitionersDSP, 12 consults p/b. Authorisation required after 12th visit, 2 out-of-network consults p/f, 20% co-pay. R1500 p/f limit for GP referred radiology/pathology & acute medicineNo benefitNetwork GP's: M R1600, M1 R3000, M2 R3500, M3 R3800, M+4+ R4300. Non-network GP's: M R530, M1 R1000, M2 R1150, M3 R1300, M+4+ R14502 SpecialistsSingle R2550/3 visits, Family R3 770/5 visits, GP referral.

5 Tests and medicine included in limitsNo benefitSubject to Day-to-day Benefit Pool3 Prescribed MedicationUnlimited at DSP accredited Pharmacy/FormularyNo benefitSubject to Day-to-day Benefit Pool (BP)4 Pharmacy Advised MedicineR75 per script, limited to R215 per annum p/bNo benefitSingle R400, Family R1 170, subject to BPRadiology & Pathology1 Basic RadiologyDSP. Specific list of black & white x-rays, GP referral. R1500 p/f limitNo benefitSubject to Day-to-day Benefit Pool2 MRI, CT & PET ScansNo benefitNo benefitIn and Out-of Hospital: R10 600 per family3 PathologyDSP. Specific list of tests, GP referral. R1500 p/f limit with RadiologyNo benefitSubject to Day-to-day Benefit PoolDental Benefit1 Conservative DentistryUnlimited, subject to protocols and sublimitsNo benefitUnlimited from Risk, subject to protocols and sublimits2 Specialised DentistryNo benefitNo benefitNo benefitOptical Benefit1 ExaminationOne consultation per member per 24 months - DSPNo benefitDSP-R400 per consultation p/b/2 years -Non DSP(R295 limit).

6 Optical OAL : R4120 p/f2 LensesSingle vision or bifocal lens at DSPNo benefit1 pair x 24 months: Single vision-R150. Bifocal-R325, Multifocal-R600 /per lens3 FramesRange of approved frames at DSP onlyNo benefitR300 limit p/b per 24 months at DSP4 Contact LensesNo benefitNo benefitOne set every 24 months, R1150 per lens p/b limitAuxilliary Services1 PhysiotherapyPMB's onlyNo benefitSubject to Day-to-day Benefit Pool2 PsychiatryPMB's only, Subject to BonCap networkConsultations for PMB conditions onlyConsultations: R7800 p/f (In- and out-of-hospital)3 PsychologyPMB's only, Subject to BonCap networkNo benefitCombined with Psychiatry benefitHIV / AIDSS ubject to DSP programme and registrationR24 800 p/b, Aid for AIDS registration requiredR20 200 p/b, Aid for AIDS registrationFinancial and Demographic1 Date of informationDecember 31, 2013 December 31, 2013 December 31, 20132 Principal MembersScheme - 293 700 This Option - 38 082 Scheme - 293 700 This Option - 3 113 Scheme - 293 700 This Option - 58 1543 AdministratorMedscheme Holdings (Pty) LtdMedscheme Holdings (Pty) LtdMedscheme Holdings (Pty) Ltd4 Scheme (Option) age profileAverage age- ( ); Pensioner %- ( )Average age- ( ); Pensioner %- ( )Average age- ( ).

7 Pensioner %- ( )5 Solvency Past Scheme increases2012- , 2013- , 2014- , 2015- , 2013- , 2014- , 2015- , 2013- , 2014- , 2015- BracketsR0 R6100R6101 R9950R9951 R13590R13591+AllAllPrincipal Member6758211338164311911550 Principal Member + Spouse131515972530310621022763 Principal + Spouse + 1 Child163319733037372924513257 Principal + Spouse + 2 Children195123493544435228003751 Principal + Spouse + 3 Children226927254051497531494245E&OE. Although care is taken to represent the Benefits correctly, errors and omissions could occur. In case of any conflict, the Rules of the affected Scheme - 2015 Standard - 2015 BonClassic - 2015 Plan TypeHybrid - Savings and Traditional combinedHybrid - Savings and Traditional combinedHybrid - Savings and Traditional combinedPlan Operation - Hospitalisation150% of Scheme Tariff (Bonitas Rate)100% of Scheme Tariff (Bonitas Rate)100% of Scheme Tariff (Bonitas Rate).

8 - Day-to-daySavings and limited Supplementary benefitsSavings Account plus set Benefits per service categorySavings Account plus set Benefits per service categoryOverall Annual Maximum150% of Bonitas Rate, UnlimitedUnlimitedUnlimitedHospital Benefit1 Private Hospital CareAny Private HospitalAny Private HospitalAny Private Hospital2 Co-paymentCertain procedures and Endoscopies (R1000 - R5000)NoneNone3 OncologyR280 000 p/f, no benefit for biological medicineR280 800 p/f, DSP apply, no benefit for biological medicineR334 500 p/f at DSP, , R100 000 for biological medicine4 Organ TransplantsUnlimitedUnlimited while in hospitalUnlimited, subject to pre-authorisation5 DialysisLimited to PMB conditionsLimited to PMB conditionsLimited to PMB conditions6 Maternity - Natural BirthUnlimited, subject to authorisationUnlimited, subject to authorisationUnlimited, subject to authorisation- Elective CeasareanUnlimited, subject to authorisationUnlimited, subject to authorisationUnlimited.

9 Subject to authorisation7 To take home medicationR310 per beneficiary per dischargeR380 per beneficiary per dischargeLimited to R380 per beneficiary per admission8 Psychiatric HospitalisationR26 300 p/f, sublimit of R12 900 for consultationsR33 100 p/f, sublimit of R12 900 for consultationsR33 600 p/f, R13 150 sublimit for consultationsRadiology/Pathology/Prosthe sis1 Basic Radiology100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited2 MRI, CT & PET Scans100% of Scheme Rate, UnlimitedLimited to R21 300 p/fR23 600 per family3 Pathology100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited100% of Scheme Rate, Unlimited4 Internal ProsthesisLimited to PMB'sLimited to R36 000 p/f, R167 800 for cochlear transplantsR44 500 p/f, Subject to pre-authorisation, R168 000 for cochlear implants5 External Appliances/ProsthesisLimited to PMB'sIncluded in Internal Prosthesis limit, sublimits applyIncluded in Internal Prosthesis limit, sublimits applySub Acute Facilities1 HospiceR13 500 per familyR13 500 per familyR13 500 per family2 NursingCombined with Hospice benefitCombined with Hospice benefitCombined with Hospice benefit3 Ambulance ServicesUnlimited - ER24 Unlimited - ER24 Unlimited - ER24 Chronic Benefit27 CDL chronic conditionsUnlimited - Preferred Provider & Formulary appliesUnlimited - Any provider.

10 Comprehensive formularyUnlimited - DSP (Pharmacy Direct) & Restrictive FormularyAdditional chronic conditionsNo benefitSingle R7850, Family R15 700 - 17 Conditions, restrictive formulary if benefit exceeded for PMB's37 Conditions - R9200 p/b and R19 100 p/f. 40% co-payment for non-formularyDay-to-day BenefitOverall Annual MaximumAvailable Savings and additional Scheme Benefits4% Savings Account + Benefit Pool + Supplementary benefitsSavings(GP's, Specialists, Medicine) + Supplementary benefitsPreferred ProviderYes - Bonitas GP NetworkYes - Bonitas GP NetworkAny GP, SpecialistMedical Savings Account17% - PM: R3492, AD: R2700, C: R10564% - PM: R1 152, AD: R996, C: R33615% - PM: R5256, AD: R4524, C: R1296 Annual ThresholdN/aN/aN/aSelf Payment GapN/aN/aN/aAbove Threshold BenefitN/aBenefit Pool - M R8375,M1 R12 640,M2 R14 000,M3 R15 335,M+4+ R16 845N/aGP's and medication1 General PractitionersSubject to MSA, 3 additional visits p/b up to 6 p/fSavings + GP sublimits: Network GP's: M R3400, M1 R5000, M2 R5500, M3 R5800, M+4+ R6300.