The Mzansi Network Option - TBMS

1 The Mzansi Network OptionFront2012 Tiger Brands Medical SchemeThe Mzansi Network Option is an affordable healthcare plan that offers primary cover within the Universal Healthcare Provider PMB CDL- chronic MedicationBenefits above Annual Flexi BenefitAnnual Flexi Benefit (AFB)Major Medical ExpensesAnnual Flexi BenefitR2 000 p/bR3 000 p/f1 Unlimited cover for Prescribed Minimum BenefitsUnlimited Universal Network GP VisitsBasic RadiologyBasic PathologySpecialist ConsultationsDentistryOptometryUnlimited PMB cover100% Agreed TariffUniversal Hospital NetworkAnnual Hospital limit of R250 000 P/B & R500 000 p/fHere s why the Mzansi Network Option offers exceptional value and benefits in 2012 We cover all your clinically necessary, essential day-to-day primary healthcare benefits unlimited GP visits, acute and chronic medication, basic radiology and basic pathology Basic dentistry and optometry benefits Cover for 27 chronic conditions Wellness benefit, including preventative screening for blood pressure, glucose, cholesterol, BMI and waist circumference paid from risk You pay only for the first three child dependants - the rest are free!

2 2 Unlimited Universal Network GP VisitsBasic RadiologyBasic PathologyDay-to-day services are subject to the utilisation of the Universal Healthcare Provider Network . Services rendered by Universal Network will be paid at an agreed tariff up to specified limits. Some benefits are subject to Annual Flexi Benefit (AFB). The AFB will be pro-rated if you join later during the year. AFB Limits:R2 000 p/b and R3 000 p/fDay-to-day BenefitsDay-to-day services paid from the AFBBENEFITSLIMITSS pecialists100% of Agreed Tariff (AT), paid from the AFB2 visits per beneficiary max 3 per family per annum. Two additional ante-natal visits per pregnancy. Specialist visits are subject to referral by a Universal Network GP and pre-authorisation of each specialist visit. Referrals limited to specialists located at Universal Network Hospitals onlyBasic Dentistry100% of AT, paid from the AFBOne consultation per beneficiary per annum. Preventative care, infection control, fillings, extractions and dental x-rays, subject to protocols, list of applicable dental codes and use of Universal Network .

3 No benefit for out-of- Network dental visits/procedures except for PMB emergenciesSpecialised Dentistry100% of ATNo benefit unless PMB, subject to protocolsOptometry100% of AT, paid from the AFBTest - 1 p/b every second yearLenses, frames - Clear plastic single vision (limited to R600) or bi-focal lenses (limited to R750) every second year. No benefit for contact lenses, limited to a range of frames within Universal NetworkHospital emergency room/casualty emergency visits (not requiring admissions excluding facility fees100% of AT, paid from the AFB3 Other BenefitsBENEFITSLIMITSE mergency Assistance and Ambulance TransportationUnlimitedPreferred Provider - ER 24 Wellness, Lifestyle and Preventative CareBlood pressure, blood sugar and cholesterol test, limited to R100 p/b and Universal Network Pharmacy4 Day-to-day services not subject to the AFBBENEFITSLIMITSGP Consultations100% of AT, unlimited, subject to clinical necessity. Each beneficiary must select a contracted Universal Network GP for day-to-day care.)

4 Two out-of-area visits per beneficiary per annum. Member required to pay the out-of-area provider in cash and claim back. Reimbursement of out-of-area visit at 80% of the cost of the claim to a maximum of R750 per event ( for the GP consultation and all related costs)Acute Medication100% of AT, unlimited if prescribed by a Universal Network GP, or by a specialist provided member referred by a Universal Network GP. Subject to formulary. No cover for non-formulary medicines unless otherwise pre-authorised. No cover in cases of voluntary use of non-Universal Network Provider, or voluntary use of a specialist without referral by a Universal Network GPSpecialised Radiology including MRI, CT and PET ScansPMBs only, subject to pre-authorisation and case management within the Universal NetworkBasic Radiology100% of ATUnlimited when clinically appropriate within the Universal Network and subject to referral by a Universal Network GP.

5 Limited to list of codes. Subject to case management. No benefit if not referred by a Universal Network Provider, or by a specialist following referral by a Universal Network GP (except when involuntary)Basic Pathology100% of ATUnlimited when clinically appropriate within Universal Network and subject to referral by a Universal Network GP. Limited to list of codes. Subject to case management. No benefit if not referred by a Universal Network Provider, or by a specialist following referral by a Universal Network GP (except when involuntary)Auxiliary Services No benefit unless PMB, PMB rules apply, subject to protocolsClinical PsychologistNo benefit unless PMB, PMB rules apply, subject to protocolsPsychiatryNo benefit unless PMB, PMB rules apply, subject to protocolsSurgical and Medical Appliances No benefit unless PMB, PMB rules apply, subject to protocols. No benefit for hearing aidsThe Mzansi Network Option offers extensive cover for 27 PMB CDL you suffer from one of the chronic conditions on the list, you need to register with MEDISCOR.

6 chronic medication is subject to the Core formulary, and the Medicine Reference Pricing (MRP). chronic medication is unlimited only if prescribed by a Universal Network Provider. Any voluntary use of chronic medicine prescribed by out-of- Network provider and any non-formulary medicines are for the member s own account, unless pre-authorised by the medical advisor. PMB rules for chronic ConditionsIn-hospital benefits BENEFITSLIMITSO verall Annual Limit (OAL)R250 000 p/b and R500 000 p/fPrivate hospitals and nursing homes100% of AT, subject to pre-authorisation and within Universal Network HospitalTTO Medication (take home medication)Limited to 7 days supply, subject to OALGP and Specialist cost100% of Agreed Tariff, subject to OALS urgical Prosthesis and Electronic Nuclear Devices PMB benefitsSubject to pre-authorisation and protocols and OALR adiology and Pathology100% of AT, subject to OALMRI, CT Scans/PET Scans100% of AT, subject to OAL, pre-authorisation requiredPhysiotherapy in hospital100% of AT, subject to OALO rgan transplants, Renal Dialysis (includes transportation of the organ, surgically related procedures, professional fees and services, as well as immunosuppressant drugs)

7 100% of AT, subject to OAL, PMB s only, subject to pre-authorisation, protocols, and within Universal Network HospitalEmergency room/casualty100% of AT, subject to OAL, for emergency medical conditions and injuries resulting from accidents or trauma5 The following in-hospital procedures are not covered on the Mzansi Network Option , unless it is a PMB:Dentistry, back and neck surgery, hip and knee replacement, cochlear implants, auditory brain implants and internal nerve stimulators, Nissen Fundoplication (reflux surgery), treatment for obesity, skin disorders and functional nasal problems, elective caesarean section, refractive eye surgery, brachytherapy for prostate cancer, Subject to Scheme Protocols Hospitalisation - 100% AT at Universal Network Provider, unlimited Medication - CDL conditions are unlimited subject to a formulary and dispensed by Universal Network Provider Medical Management in and out of hospital - 100% AT, subject to protocols and treatment by Universal Network Provider HIV/AIDS disease management program is available to all HIV positive members.

8 The programme aims to support and assist HIV patients in the management of their conditionPrescribed Minimum Benefits (PMB) chronic diseases that are covered as PMB sAddison s diseaseCrohn s diseaseHyperlipidaemia AsthmaDiabetes mellitus type 1 & 2 HypothyroidismBipolar mood disorderDiabetes insipidusMultiple sclerosisBronchiectasisDysrhythmiasParki nson s diseaseCardiac failureEpilepsyRheumatoid arthritis chronic renal diseaseGlaucomaSchizophreniaChronic obstructive pulmonary disorder HaemophiliaSystemic lupus erythematosusCardiomyopathy diseaseHIVU lcerative colitisCoronary artery diseaseHypertension The Mzansi Network Option offers cover for step down nursing facilities, Hospice and Rehabilitation. Cover is subject to pre-authorisation, protocols and case management, and to hospitalisation6 AbbreviationsAT - Agreed TariffPMB - Prescribed Minimum BenefitAFB - Annual Flexi BenefitCDL - chronic Disease ListP/B - Per BeneficiaryP/F - Per FamilyMRP - Medicine Reference PricingOAL - Overall Annual LimitContribution TableSalary (Rand)

9 PrincipalAdultChild0 3 0003723721083 001 4 0004264261264 001 5 0005345341565 001 6 0005885881746 001 7 0006426421927 001 8 0006906902048001 +1 6021 Waiting periodsProspective members are required to disclose to the Scheme, on the application form, details of any sickness or medical condition for which medical advice, diagnosis, care or treatment was recommended and/or received prior to the 12 month period ending on the date on which application for membership was Scheme may impose upon a person in respect of whom an application is made for membership or admission as a dependant, and who was not a beneficiary of a medical scheme for a period of at least 90 days preceding the date of application: a general waiting period of up to three months a condition-specific waiting period of up to 12 months a concurrent waiting period on PMB s The Scheme may impose upon any person in respect of whom an application is made for membership or admission as a dependant, and who was previously a beneficiary of a medical scheme for a continuous period of up to 24 months, terminating less than 90 days immediately prior to the date of application: a condition specific waiting period of up to 12 months, except in respect of any treatment or diagnostic procedures covered within the prescribed minimum benefits a general waiting period of up to 3 months Membership cardEvery member shall be furnished with a membership card.

10 This card must be exhibited to the supplier of a service on request. It remains the property of the Scheme and must be returned to the Scheme on termination of membership. Members will receive 2 cards. Members may apply for additional membership cards or replacement Rules of the SchemeThe Scheme is governed by a set of Rules submitted to and approved by the Registrar for Medical Schemes. All terms and conditions are set out in detail in the Rules of the Scheme, which can be viewed at the office of the administrator. The Rules of the Scheme always apply during a dispute MembershipMembership is restricted to all eligible Registration of dependantsA member may apply for the registration of his/her dependants at the time of applying for membership. The following persons can qualify as a dependant: A spouse or partner Dependant children under the age of 21 Dependant children over the age of 21 but under the age of 25 and who are full time students at a recognised tertiary educational institution Disabled/Mentally challenged children Students and children older than 21 yearsChildren above the age of 21 years are regarded as dependants if they are studying full-time at a recognised tertiary or educational institution.