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Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

Dec 13, 2015

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Todd Huckstep
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Page 1: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.
Page 2: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

Who are we?

• We are a registered medical scheme –serving our members since 1961.

• We are a non-profit organisation with our members as our primary stateholders.

• We are truly independent – being a self administered fund.

• Excellent administration system – we process patient claims within 48 hours.

• Our reserves exceed the statutary regulation by 120%. (Current Solvency 150%) – amongst the industries highest.

Page 3: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

When considering a Medical Scheme - we think you need to ask?

• Is in-hospital or out-of-hospital/ Day to Day benefits important to you?

• Can I go to a hospital of my choice and will it be a Government or a Private Hospital? AND can I have a private Ward?

• Can I choose my own doctors?

• How long must I wait for my bills to be paid?

• Do I have a say in how “they” use my money?

• Does your company contribute towards your Medical Aid subscriptions and if so, how much per month? – What's the tax implication to me?

Page 4: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

OPTION 1 - Health Pact Premium aimed at …

• Individuals that require top quality private hospital care.

• Not concerned about day-to-day care, because he/she has disposable cash to cover this.

• Tax efficient product.

Our offer to you.

Chronic Meds: Asthma, Epilepsy, Juvenile Rheumatoid Arthritis

Pediatrics R600 per child

Ante-natal R1600 per family

Unlimited Hospital cover in a hospital of your choice

Full Pathology

MRI / CT R6000 per beneficiary,with co-payment of R1500

Specialists up to 200% of NHRPL/CMP tariff

Emergency ambulance services of your choice

Laparoscopic procedures according to (SASES) SA Society of Endoscopic Surgeons guidelines and pre-authorization

This product is not designed for ongoing chronic usage

PM

B’s

HealthPact Premium

Page 5: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

OPTION 2 - Health Pact Silver aimed at …

• This option is not designed for , “ I want full freedom of choice”, but rather at members that require – Balanced cover at an Affordable cost.

• Families with children, often single parent families.

• Little disposable income – monthly budgeting may be an issue.

• Limited chronic medicine requirements.

• Hospital benefits are important, but secondary to day-to-day

Our offer to you. P

MB

’s

Chronic Meds: Asthma, Epilepsy, Juvenile Rheumatoid Arthritis

2 Visits to GP

Dental R300 per beneficiary

Pediatrics R600 per child

Ante-natal R1600 per family

Acute medication R300 per family

Unlimited Hospital cover in a hospital of your choice

Full Pathology

MRI / CT R6000 per beneficiary, with co-payment of R1500

Specialists up to 111% of NHRPL /CMP tariff

Emergency ambulance services of your choice

No Laparoscopic procedures

Pre-Funded Med Pre-Funded Med Savings R2100 per Savings R2100 per

adultadult

HealthPact Silver

Page 6: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

OPTION 3 - Health Pact Gold aimed at …

• The high income business executive.

• The person who requires significant savings and day-to-day cover, to avoid the hassle factor.

• Who demands seeing top quality medical practitioners – who charge above tariff.

• Who demands top quality hospital cover.

• The person who requires top quality chronic medication.

• Who demands freedom of choice and is not really worried about monthly cost. In most cases these individuals are subsidised.

Our offer to you.

Unlimited Hospital cover in a hospital of your choice. Semi Pvt Wards Included.

Full Pathology

MRI / CT R12000 per beneficiary, with co-payment of R1500

Specialists up to 200% of NHRPL/CMP tariff

Emergency ambulance services of your choice

Laparoscopic procedures according to (SASES) SA Society of Endoscopic Surgeons guidelines and pre-authorization

Dental R1200 per family

Orthodontic R8000 per minor beneficiary per family

4 Visits to GP per beneficiary

Pediatrics R1200 per child

Ante-natal R2400 per family

28 Chronic conditions

Acute medication R1200 per family

Pre-Funded Med Pre-Funded Med Savings R4800 per Savings R4800 per

adult adult

HealthPact Gold

PM

B’s

Page 7: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

Typical Hospital Event

Medicine 10%

Specialist 20%

Hospital 70%

CMP Portion CMP Portion

Medicine Co-Payment

Amount over NHRPL Limit

Amount over NHRPL Limit

Covered by Medical Aid

Co-Payment Procedure

Co-Payment Procedure

2006

New Age Payment of Procedure

2007

New Age Payment of Procedure

CMP Portion

Co-Payment Procedure

Amount over NHRPL Limit

Take Home Tablets

2008

The CMP Difference

CM

P M

an

ag

es

Industy Overview

Paid by member either cash or from savings portion

Work with us and we manage on your behalf

Page 8: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

Rates 2008Beneficiarie

sPremium Silver Gold

Adult R610R805

----------------MSA=R2100

Per adult

R2025---------------MSA=R4800

Per adult

Child R100R115

-----------------MSA=R300

per child

R498----------------

MSA = R1176

per child

Page 9: Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders.

• All claims are processed within 48 hours & paid within two weeks• A positive balance on your MSA earns you 5% pa and your funds are

carried forward.• Financial stability.• No channeling – freedom of choice when going to hospital.• Unlimited pathology (blood tests) via Pathcare or Lancet Laboratories.• 5 Nursing sisters at your disposal. Their job is to manage and PRE

QUOTE all hospital events, remove the stress points in you r time of need and just as important, give you a say in what you are going to be charged, BEFORE YOU ARE CHARGED IT!

• We understand Medical Schemes and we promise listen to you.

What we promise you is :