EFFICIENCY DISCOUNTED OPTIONS GUIDE 2013 - …

1 2013 EFFICIENCY DISCOUNTEDOPTIONS GUIDEP referred ProviderNetcareDis-chemPharmacists who careYou re in safe handsPinnacleMumedNetworXSymmetryDynamix Axisfrom the pen of the principal officerWith our focus on providing affordable healthcare to members, we are proud to announce that we have partnered with Netcare and Dis-chem whereby contributions are substantially DISCOUNTED if members select Netcare as their designated service provider for in-hospital services and Dis-chem to obtain their chronic our focus on providing affordable healthcare to members, we are proud to announce that we have partnered with Netcare and Dis-chem whereby contributions are substantially DISCOUNTED if members select Netcare as their designated service provider for in-hospital services and Dis-chem to obtain their chronic range up to 25%!

2 Those who are new to the Scheme will find that CompCare is sensitive to both healthcare needs and budgetary requirements with no less than six benefit OPTIONS to choose from. These include new generation OPTIONS , a hospital option and a network trust that this booklet will demonstrate this whileproviding you with relevant information on the benefit OPTIONS that we offer. Please take the time to read this booklet carefully and select an option that will best suit the needs of you and your loved name CompCare Wellness Medical Scheme has become synonymous with the word trust and there is a very good reason for that. For over three decades we have made it our business to be a medical scheme that our members can rely on, year-in and year-out, and 2013 is no is stronger than ever this year with a solvency level of 43%, considerably higher than the 25% minimum required by the Council for Medical Schemes.

3 This figure has steadily improved over the last three years an indication of the Scheme s financial we continue to make a concerted effort to ensure the stability of the Scheme, we have not neglected our duty to provide members with meaningful benefit increases and innovative product enhancementsCompCare has implemented overall benefit and limit enhancements across all OPTIONS for 2013 whilst limiting contribution increases to on all you require any further information please do not hesitate to contact us on (011) 208 1010 wish you health and happiness in HallowellPrincipal OfficerCompCare Wellness Medical Scheme1. From the Pen of the Principal Officer 2. Product overview3. Benefits for 2013A. In-hospital benefitsB. Day-to-day benefitC. Wellness benefitsD.

4 Co-paymentsE. Surgical prostheses limitsF. Appliance limitsG. Chronic conditions H. Exclusions4. Contribution tables per Managed Care Contact Member of contentsTel: 086 122 2777 Fax: 011 208 1028 E-mail: House, 15 Tambach Road Sunninghill Park, SandtonPO Box 1411, Rivonia, 2128 Administered by Universal Healthcare Administrators (Pty) Ltdp. 1p. 3p. 7p. 8p. 9p. 10p. 11p. 12p. 13p. 14p. 15p. 16 PinnacleThe Pinnacle option offers comprehensive cover for the discerning achiever, with exceptional hospital and superior day-to-day benefits comprising a combination of savings account, traditional risk cover and very competitive above threshold Dynamix option is an attractive new generation plan that offers comprehensive private hospital cover, a savings account and traditional risk benefits with above threshold benefits for day-to-day healthcare Symmetry option provides unlimited cover in a Netcare Private of your choice and comprehensive day-to-day benefits comprising of a medical savings account and traditional risk cover.

5 For complete peace of Mumed option is an affordable plan with traditional benefits combined with a medical savings account for young members and families who want the freedom to see a healthcare provider of choice when Axis option is a premium comprehensive private hospital benefit plan with post-operative rehabilitation benefits for complete peace of mind. The networx option is an affordable healthcare plan with exceptional value for students and low-income employees in the corporate sector, and offers essential cover within the Universal Healthcare Provider overviewAxis(Lims Option)Section A: In-hospital benEfitsBENEFIT SCHEDULEPINNACLEDYNAMIX SYMMETRYMUMEDAXISNETWORX HOSPITALISATION (100% of AT in a Netcare facility and nursing homes)Voluntary use of a non-Netcare facility will attract a co-payment of 30% with a minimum of R5000100% of AT in a Public facility and nursing home.

6 Voluntary use of a non-Public facility will attract a co-payment of 30% with a minium of R5000 (not applicable to emergencies)AuthorisationTreatment subject to pre-authorization, case management and Scheme protocols Netcare Hospitals onlyTreatment subject to pre-authorisation, case management and scheme protocolsOverall Annual Hospital Limit (OHL)UnlimitedUnlimitedUnlimitedR600 000 p/bR1 200 000 p/fUnlimitedR285 000 p/b, R585 000 p/f Co-payments (see section D for a list of co-payments)Co-payments as per Pinnacle list. Co-payments can be paid from savings without accumulation to member s thresholdCo-payments as per Dynamix list. Co-payments can be paid from savings without accumulation to member s thresholdCo-payments as per Symmetry listCo-payments as per Mumed listCo-payments as per Axis listCo-payments as per networx exclusions listVisits by GP and SpecialistUnlimitedSpecialist paid at 200% of ATGP paid at 100% AT100% ATUnlimited100% ATUnlimited100% ATSubject to AHL100% ATUnlimited100% ATSubject to AHLM edication whilste in hospital100% of costAll Specialised Radiology including MRI, CT and PET ScansUnlimited.

7 Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No benefit for unauthorised scans. No benefit for screening purposes. The first R2 000 paid from available savings and AFB accumulates to thresholdUnlimited. Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No benefit for unauthorised scans. No benefit for screening purposes. The first R2 000 paid from available savings and AFB accumulates to thresholdLimited to R13 500 p/f unless otherwise pre-authorised. Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation.

8 No benefit for unauthorised scans. No benefit for screening purposesLimited to R11 660 p/f unless otherwise preauthorised. Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No benefit for unauthorised scans. No benefit for screening purposes. Subject to AHL Limited to R13 500 p/f Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No benefit for unauthorised scans. No benefit for screening purposes Subject to protocols. Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No benefit for unauthorised scans.

9 No benefit for screening purposes. Subject to AHLB asic Radiology (X-rays) including black and white X-rays and UltrasoundUnlimited subject to Scheme protocolsUnlimited subject to Scheme protocolsUnlimited subject to Scheme protocolsLimited to R23 000 p/f. Subject AHL and Scheme protocolsUnlimited subject to Scheme protocolsSubject to AHL, case management and protocolsPathologyUnlimitedUnlimitedLimi ted to R22 400 p/f unless otherwise pre-authorisedLimited to R17 400 p/f unless otherwise pre-authorised. Subject to AHLL imited to R22 400 p/f unless otherwise pre-authorisedSubject to AHL, case management and protocolsMedication on discharge from hospital (subject to MRP and Formularies)TTO limited to 7 days per discharge, subject to MRP and formularyTTO limited to 7 days per discharge, subject to MRP and formularyTTO limited to 7 days per discharge, subject to MRP and formularyTTO limited to 7 days per discharge, subject to MRP and formularyTTO limited to 7 days per discharge, subject to MRP and formulary100% of AT at Designated Hospital Network.

10 TTO limited to R250 per discharge, subject to MRP and formularyOncology including Chemotherapy and RadiotherapyUnlimited. Subject to pre-authorisation and protocolsUnlimited. Subject to pre-authorisation and protocolsUnlimited. Subject to pre-authorisation and protocolsSubject to AHL. Subject to pre-authorisation and Subject to pre-authorisation and protocols. Subject to AHL. Subject to pre-authorisation and protocols. Biological agents (pre-authorisation and protocols apply)R200 000 R150 000 25% co-payment R100 00025% co-paymentR100 00025% co-paymentR100 00025% co-paymentPMB only. Subject to protocols Section A: In-hospital benefits 1 BENEFIT SCHEDULEPINNACLEDYNAMIX SYMMETRYMUMEDAXISNETWORX Step-down nursing facilities, Hospice and rehabilitationUnlimited, subject to pre-authorisation and clinical guidelinesUnlimited, subject to pre-authorisation and clinical guidelinesUnlimited, subject to pre-authorisation and clinical guidelinesSubject to AHL, pre-authorisation and clinical guidelinesUnlimited, subject to pre-authorisation and clinical guidelinesSubject to AHL, pre-authorisation and clinical guidelinesSurgical procedures out-of-hospitalUnlimited.