September dimension range 2018

Transcription

1 September 2017 dimension range 2018

2 General disclaimers This brochure is intended for marketing purposes and contains only a summary of Medihelp s benefits. On joining Medihelp, members receive a member guide with detailed information. In case of a dispute, the registered Rules of Medihelp apply, which are available on request. The information in this brochure is subject to approval by the Council for Medical Schemes. The content of this brochure may change from time to time. Please refer to Medihelp s website for an updated brochure or consult Medihelp s Rules for the latest information. We encourage you to seek financial advice about your healthcare cover by speaking to your financial adviser.

3 contents 1 why medihelp 10 benefit option comparison 22 supporting information 3 Summary of benefits 8 Additional insured benefits 9 Added value 10 Essential cover 10 Core benefits 14 Internally implanted prostheses 15 Day-to-day benefits 20 Deductibles 22 Dimension Prime hospital network 24 Our healthcare partners 25 Explanation of terms 26 Summary of exclusions 27 Contact us

4 why medihelp With a value-driven mindset we focus on fulfilling your health and wellness needs and customise our products and services to ensure an individualised experience when interacting with the Scheme in terms of the following four key areas: Products Services Value Engagement 1 A SOUND HEALTHCARE PARTNER SERVICE AND ENGAGEMENT 112 YEARS experience in the medical schemes industry As a SELF-ADMINISTERED medical scheme Medihelp maintains complete control and tightly manages all administration costs LARGE AND RELIABLE Medihelp is one of the five largest open medical schemes in South Africa Our members and advisers service experience is measured at the point of engagement through voice-of-the-customer research, allowing for constant written enquiries average hospital admissions per month calls answered claims processed mobile app users web visits social media followers CLAIMS PAYMENT ABILITY is guaranteed with our AA- rating awarded by Global Credit Rating CONSISTENCY Medihelp s average beneficiary age of 37 years provides a healthy risk pool to contribute to sustainability OUR SOLVENCY LEVEL Medihelp consistently maintains a solvency level well above the industry requirement Member app With an electronic membership card and instant benefit verification Call centre 60 helpful consultants to assist you Secured website An online hub with all your Medihelp service functionalities Educational videos Effortless empowerment on relevant topics mysos emergency This app ensures that you and your loved ones can be located in an emergency

5 products Tailor-made options which differ in price and benefits to suit various lifestyles and health profiles Full cover 270 prescribed minimum benefits 26 chronic conditions No overall limit for hospital cover cover for trauma and emergencies A 30 days post-hospital care benefit Large family Only two children younger than 18 years pay a monthly premium on the Dimension Prime options, the rest receive free cover Kids are grown up Child dependant rates apply until they are 26 years old Ask your adviser about the option specifically for full-time students HOSPITAL PLAN Pay 22% less for the network option SAVINGS 15% savings account Pay 22% less for the network option 25% SAVINGS account /Non- /Non- Unify Additional benefits Certain options offer additional screening, preventive, pregnancy and wellness benefits An individualised, free wellness programme provides relevant health support and value during every life stage INSURED family benefits /Non- s pay less Using a quality network of healthcare providers with a national footprint effects up to a 22% discount in premiums Join Medihelp MultiSport for runners, walkers and cyclists and get access to club gear at a discount and free participation in Medihelp promotional events CHRONIC BENEFITS INCOME-BASED Students and corporate groups Necesse 2

6 summary of benefits 3 /Non- /Non- /Non- The hospital plan is an affordable solution if you are healthy, but want the assurance of cover for private hospitalisation and minor day-to-day medical expenses. You save 22% in monthly premiums when choosing a network of 108 quality private hospitals as an alternative. is ideal for young, healthy couples and provides the value of private hospital cover combined with a 15% savings account and added preventive care and insured benefits, should you plan on starting a family. By choosing the wide network of 108 private hospitals you save 22% in monthly premiums. The popular option delivers insured family cover encompassing comprehensive benefits for hospitalisation, preventive care and day-to-day medical expenses, and the freedom to obtain services at any provider. You can choose a network of quality providers and save 20% in premiums per month. is a top-of-the-range allinclusive healthcare solution if you have more extensive healthcare needs. It offers rich, insured benefits for hospitalisation, chronic medicine and other day-to-day medical expenses.

7 contribution table This table provides a guideline for contributions based on your family s composition. You pay child dependant rates for kids until they are 26 years old and you only pay for the first two children under 18 on the Dimension Prime range. Please note that late-joiner penalties and employer subsidies were not taken into consideration. Speak to your accredited adviser to obtain a more detailed quotation based on your information. Principal member R1 356 R1 728 R1 800 (R270 savings contribution included per month and R3 240 ) R2 310 (R348 savings contribution included per month and R4 176 ) R2 352 R2 940 R4 272 Dependant R1 104 R1 422 R1 476 (R222 savings contribution included per month and R2 664 ) R1 890 (R282 savings contribution included per month and R3 384 ) R1 986 R2 490 R3 996 Child dependant <26 years R408 R522 R534 (R78 savings contribution included per month and R936 ) R690 (R102 savings contribution included per month and R1 224 ) R684 R858 R1 164 R2 460 R3 150 R3 276 (R492 savings contribution included per month and R5 904 ) R4 200 (R630 savings contribution included per month and R7 560 ) R4 338 R5 430 R8 268 R1 764 R2 250 R2 334 (R348 savings contribution included per month and R4 176 ) R3 000 (R450 savings contribution included per month and R5 400 ) R3 036 R3 798 R5 436 R2 172 R2 772 R2 868 (R426 savings contribution included per month and R5 112 ) R3 690 (R552 savings contribution included per month and R6 624 ) R3 720 R4 656 R6 600 R2 868 R3 672 R3 810 (R570 savings contribution included per month and R6 840 ) R4 890 (R732 savings contribution included per month and R8 784 ) R5 022 R6 288 R9 432 R3 276 R4 194 R4 344 (R648 savings contribution included per month and R7 776 ) R5 580 (R834 savings contribution included per month and R ) R5 706 R7 146 R R3 276 R4 194 R4 344 (R648 savings contribution included per month and R7 776 ) R5 580 (R834 savings contribution included per month and R ) R5 706 R7 146 * You only pay for two children younger than 18 years on the Dimension Prime range, after which child dependant rates will apply from the beginning of the year following the year in which they turn 18, until they are 26 years old. If you join after January, your savings amount will be calculated by counting the remaining months in the year. 4

8 summary of benefits 5 HOSPITAL BENEFITS (NO OAL) HOSPITAL BENEFITS (NO OAL) HOSPITAL BENEFITS (NO OAL) HOSPITAL BENEFITS (NO OAL) 108 network facilities Any hospital 108 network facilities Any hospital 108 network facilities Any hospital Any hospital ESSENTIAL COVER Diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions on the CDL DSPs & specialist network apply ESSENTIAL COVER Diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions on the CDL DSPs & specialist network apply ESSENTIAL COVER Diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions on the CDL DSPs & specialist network apply ESSENTIAL COVER Diagnosis, treatment and care costs of 270 PMB and 26 chronic conditions on the CDL DSPs & specialist network apply Core benefits POST-HOSPITAL CARE Up to 30 days after discharge SPECIALISED RADIOLOGY In and out of hospital Member pays the first R1 550 per examination Balance paid at POST-HOSPITAL CARE Up to 30 days after discharge SPECIALISED RADIOLOGY In and out of hospital Member pays the first R1 550 per examination Balance paid at POST-HOSPITAL CARE Up to 30 days after discharge SPECIALISED RADIOLOGY In and out of hospital Member pays the first R1 550 per examination Balance paid at POST-HOSPITAL CARE Up to 30 days after discharge SPECIALISED RADIOLOGY In and out of hospital Member pays the first R1 050 per examination Balance paid at TRAUMA-RELATED BENEFITS Including post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV TRAUMA-RELATED BENEFITS Including post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV TRAUMA-RELATED BENEFITS Including post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV TRAUMA-RELATED BENEFITS Including post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV EMS ROAD & AIR TRANSPORT (Netcare 911) within RSA 24-hour helpline & trauma counselling ROAD & AIR TRANSPORT (Netcare 911) within RSA 24-hour helpline & trauma counselling ROAD & AIR TRANSPORT (Netcare 911) within RSA 24-hour helpline & trauma counselling ROAD & AIR TRANSPORT (Netcare 911) within RSA 24-hour helpline & trauma counselling

9 summary of benefits Day-to-day benefits INSURED DAY-TO-DAY BENEFITS M = R1 100 M+ = R2 200 GPs, specialists, physiotherapy, contraceptives, acute and self-medication DAY-TO-DAY MEDICAL EXPENSES 15% medical savings account INSURED DAY-TO-DAY POOLED BENEFITS M = R8 600 M+1 = R M+2 = R M+3+ = R GPs & specialists Clinical psychology & physiotherapy Supplementary health services Acute medicine, self-medication and contraceptives Standard radiology and pathology INSURED DENTISTRY BENEFITS INSURED OPTICAL BENEFITS Spectacles/contact lenses INSURED DAY-TO-DAY POOLED BENEFITS M = R2 550 M+1 = R4 300 M+2 = R5 300 M+3+ = R6 400 GPs & specialists Clinical psychology & physiotherapy Supplementary health services CHRONIC MEDICINE BENEFITS (Non-PMB) M = R4 100 M+1 = R6 200 M+2 = R8 300 M+3+ = R8 900 ACUTE MEDICINE BENEFITS M = R3 900 M+1 = R6 550 M+2 = R8 000 M+3+ = R8 600 STANDARD RADIOLOGY BENEFITS R2 550 per family PATHOLOGY BENEFITS R2 550 per family INSURED DENTISTRY BENEFITS INSURED OPTICAL BENEFITS Spectacles/contact lenses M Member CDL Chronic Diseases List GP General practitioner DSP Designated service provider PMB Prescribed minimum benefits EMS Emergency medical services OAL Overall annual limit MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 6

10 summary of benefits 7 PREGNANCY AND BABY BENEFITS 12 pregnancy consultations Two 2D sonars Two baby consultations (< 1 year) PREGNANCY AND BABY BENEFITS 8 pregnancy consultations Two 2D sonars Two baby consultations (< 1 year) PREGNANCY AND BABY BENEFITS 12 pregnancy consultations Two 2D sonars Two baby consultations (< 1 year) PREGNANCY AND BABY BENEFITS 12 pregnancy consultations Two 2D sonars Two baby consultations (< 1 year) Additional insured benefits HEALTH TESTS 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol tests (Clicks and Dis-Chem clinics)* Dietician consultation for HealthPrint members if BMI test result at wellness provider indicates a BMI > 30 Routine tests, including mammograms, pap smears and prostate tests HIV voluntary counselling and testing (Clicks and Dis-Chem clinics) FOBT IMMUNISATION Flu vaccine Tetanus vaccine HPV vaccine Pneumovax vaccine for beneficiaries registered with asthma or COPD Standard kids immunisation (< 7 years) HEALTH TESTS 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol tests (Clicks and Dis-Chem clinics)* Dietician consultation for HealthPrint members if BMI test result at wellness provider indicates a BMI > 30 Routine tests, including mammograms, pap smears and prostate tests HIV voluntary counselling and testing (Clicks and Dis-Chem clinics) FOBT IMMUNISATION Flu vaccine Tetanus vaccine HPV vaccine Pneumovax vaccine for beneficiaries registered with asthma or COPD Standard kids immunisation (< 7 years) HEALTH TESTS 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol tests (Clicks and Dis-Chem clinics)* Dietician consultation for HealthPrint members if BMI test result at wellness provider indicates a BMI > 30 Routine tests, including mammograms, pap smears and prostate tests HIV voluntary counselling and testing (Clicks and Dis-Chem clinics) FOBT IMMUNISATION Flu vaccine Tetanus vaccine HPV vaccine Pneumovax vaccine for beneficiaries registered with asthma or COPD Standard kids immunisation (< 7 years) HEALTH TESTS 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol tests (Clicks and Dis-Chem clinics)* Dietician consultation for HealthPrint members if BMI test result at wellness provider indicates a BMI > 30 Routine tests, including mammograms, pap smears and prostate tests HIV voluntary counselling and testing (Clicks and Dis-Chem clinics) FOBT IMMUNISATION Flu vaccine Tetanus vaccine HPV vaccine Pneumovax vaccine for beneficiaries registered with asthma or COPD Standard kids immunisation (< 7 years) BACK TREATMENT PROGRAMME BACK TREATMENT PROGRAMME BACK TREATMENT PROGRAMME BACK TREATMENT PROGRAMME HPV Human papilloma virus BMI Body mass index COPD Chronic obstructive pulmonary disease FOBT Faecal occult blood test * These benefits are not available if you have been registered for a chronic/pmb condition, as it can no longer be considered as preventive care.

11 additional insured benefits Additional insured benefits which give you access to pregnancy and baby-related benefits, screenings, preventive and wellness services as well as a back treatment programme. Dimension Prime 1 Dimension Prime 2 Dimension Prime 3 Dimension Elite Description Benefit Benefit Benefit Benefit PREGNANCY AND BABY BENEFITS Pregnancy consultations 12 per family 8 per family 2D sonars 2 per family First two consultations at a GP or specialist 2 per baby < 1 year 12 per family SCREENING AND WELLNESS BENEFITS On request of a medical doctor (Doctor s consultation paid from available day-to-day benefits) Pap smear (item codes 4566/4559) 1 pathology test per beneficiary Prostate test (PSA level) > 40 years (item code 4519) FOBT > 50 years (item code 4351) Mammogram for females > 40 years (item codes 3605/39175/34100/34101) Bone mineral density test (BMD) for females > 50 years (item codes 3604/50120) 1 radiology exam per beneficiary AVAILABLE AT OUR WELLNESS PROVIDERS CLICKS AND DIS-CHEM PHARMACY CLINICS: Voluntary HIV testing and counselling* Dimension Prime 1 Dimension Prime 2 Dimension Prime 3 Dimension Elite Description Benefit Benefit Benefit Benefit DIETICIAN CONSULTATION if BMI test result at wellness provider indicates a BMI > 30 and if registered on HealthPrint IMMUNISATIONS Administering fee at Clicks or Dis-Chem pharmacy clinics included Standard immunisations schedule as published by the Department of Health for beneficiaries < 7 years Flu vaccine Tetanus vaccine 1 consultation per registered HealthPrint beneficiary Standard schedule per beneficiary 1 per beneficiary HPV vaccine protocols apply: years 2 injections per beneficiary years 3 injections per beneficiary PNEUMOVAX VACCINE Patients registered on Medihelp s asthma or COPD 1 vaccine per beneficiary in a 5-year cycle treatment programme (NAPPI code ) > 55 years BACK TREATMENT at a DBC facility subject to protocols and 1 programme per beneficiary pre-authorisation Blood glucose* or total cholesterol* or combination test (blood glucose, total cholesterol, BMI and blood pressure measurements)* 1 per beneficiary GP General practitioner FOBT Faecal occult blood test BMI Body mass index COPD Chronic obstructive pulmonary disease * These benefits are not available if you have been registered for a chronic/pmb condition as it is no longer considered as preventive care. DBC Document-Based Care HPV Human papilloma virus 8

12 added value HealthPrint is a free online health and wellness programme that integrates fully with Medihelp s system. 9 By joining HealthPrint via Medihelp s website you get access to the following: your health profile and claims information your activity tracker data your screening test results a functionality to volunteer and update your health profile data As a HealthPrint user you also get access to health information, lifestage-specific programmes and value such as: Wellness enhancement programmes You can enrol for programmes designed to improve your health and ensure your wellness, including a programme for members with a BMI of 30 and higher. A pregnancy and baby programme This programme will assist you on your journey to becoming a mommy by supporting you with relevant information and delivering value at specific milestones, including during the pregnancy, after giving birth, in the toddler phase and on their fourth and sixth birthday, up to school-going age. Medihelp MultiSport All avid walkers, runners and cyclists who are serious about following a healthy, active lifestyle can join Medihelp MultiSport. Membership is open to anyone, no matter where you reside in South Africa or whether you re a member of Medihelp or not. The annual membership fee is only R250 and you get the following: A starter pack A monthly newsletter An open invitation to visit the MultiSport gazebo at selected events Free entry to Medihelp-sponsored sporting events 50% discount on Medihelp-branded cycling and running gear How to join HealthPrint 1 Visit 2 Go to Login Register 3 Choose HealthPrint 4 Choose Register to join HealthPrint

13 essential cover We offer 100% cover for 270 conditions and the following 26 chronic diseases treated by designated service providers and networks according to treatment protocols. 1. Addison s disease 2. Asthma 3. Bipolar mood disorder 4. Bronchiectasis 5. Cardiac failure 6. Cardiomyopathy 7. Chronic obstructive pulmonary disease (COPD) core benefits Essential cover 8. Chronic renal disease 9. Coronary artery disease 10. Crohn s disease 11. Diabetes insipidus 12. Diabetes mellitus type Diabetes mellitus type Dysrhythmia Description Benefit Benefit Benefit Benefit DIAGNOSIS, TREATMENT AND CARE COSTS OF 270 PMB AND 26 CHRONIC CONDITIONS ON THE CDL Subject to protocols, pre-authorisation and DSPs 100% of the cost 15. Epilepsy 16. Glaucoma 17. Haemophilia A and B 18. Hyperlipidaemia 19. Hypertension 20. Hypothyroidism 21. Multiple sclerosis 100% of the cost 100% of the cost 22. Parkinson s disease 23. Rheumatoid arthritis 24. Schizophrenia 25. Systemic lupus erythematosus (SLE) 26. Ulcerative colitis 100% of the cost Trauma EMS BENEFITS FOR MAJOR TRAUMA THAT NECESSITATES HOSPITALISATION IN THE CASE OF: Motor vehicle accidents Stab wounds Gunshot wounds Head trauma Burns Near drowning Subject to authorisation, PMB protocols and case management POST-EXPOSURE PROPHYLAXIS EMERGENCY TRANSPORT SERVICES (Netcare 911) RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana Subject to pre-authorisation and protocols In beneficiary s country of residence Transport by road Transport by air Outside beneficiary s country of residence Transport by road Transport by air 24-HOUR HELPLINE AND TRAUMA COUNSELLING (Netcare 911) 100% of the cost R1 900 per case R per case 100% of the cost R1 900 per case R per case 100% of the cost R1 900 per case R per case 100% of the cost R1 900 per case R per case Phone Phone Phone Phone PMB Prescribed minimum benefits EMS Emergency medical services CDL Chronic Diseases List MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 10

14 11 core benefits Description Benefit Benefit Benefit Benefit HOSPITALISATION (state and private hospitals and day clinics) Subject to pre-authorisation, protocols and case management Intensive and high-care wards Ward accommodation Theatre fees Treatment and ward medicine Consultations, surgery and anaesthesia POST-HOSPITAL CARE Professional services relating to a Medihelp authorised private hospital admission, required for up to 30 days after discharge Speech therapy Occupational therapy Physiotherapy DSP applies M = R1 700 M+ = R2 300 DSP applies M = R1 700 M+ = R2 300 DSP applies M = R1 700 M+ = R2 300 M = R1 700 M+ = R2 300 PROSTHESES See page 14 See page 14 See page 14 See page 14 CONFINEMENT (childbirth) Subject to pre-authorisation, protocols and case management HOME DELIVERY Subject to pre-authorisation Professional nursing fees Equipment Material and medicine STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICES In hospital Subject to clinical protocols SPECIALISED RADIOLOGY In and out of hospital On request of a specialist and subject to clinical protocols MRI and CT imaging (subject to pre-authorisation) R per event Member pays the first R1 550 per examination Angiography ORGAN TRANSPLANTS Subject to pre-authorisation and clinical protocols Cornea implants 100% of the cost R per implant R per event Member pays the first R1 550 per examination 100% of the cost R per implant R per event Member pays the first R1 550 per examination 100% of the cost R per implant R per event Member pays the first R1 050 per examination 100% of the cost R per implant MRI Magnetic resonance imaging CT Computerised tomography PMB Prescribed minimum benefits DSP Designated service provider M Member MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price

15 core benefits Description Benefit Benefit Benefit Benefit SUPPLEMENTARY HEALTH SERVICES In hospital Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services Physiotherapy on referral by the attending medical doctor OXYGEN In hospital NEUROSTIMULATORS Subject to pre-authorisation and clinical protocols Device and components R per beneficiary R per beneficiary R per beneficiary R per beneficiary RENAL DIALYSIS In and out of hospital Subject to pre-authorisation and clinical protocols APPLICABLE PRESCRIPTION MEDICINE DISPENSED AND CHARGED BY THE HOSPITAL ON DISCHARGE FROM THE HOSPITAL (TTO) (Excluding PMB chronic medicine) R330 per admission R330 per admission R340 per admission PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITION Subject to pre-authorisation, services rendered in an approved/ network hospital/facility and prescribed by a medical doctor Professional services rendered in and out of hospital by a psychiatrist General ward accommodation Medicine supplied during the period of the treatment in the institution Outpatient consultations R per beneficiary (maximum R per family ) R per beneficiary (maximum R per family ) R per beneficiary (maximum R per family ) R per beneficiary (maximum R per family ) PMB Prescribed minimum benefits TTO To take out (medicine) MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 12

16 13 core benefits Description Benefit Benefit Benefit Benefit ONCOLOGY Subject to pre-authorisation and registration on the Medihelp Oncology Management Programme. Protocols, DSP and MORP apply. PMB cases Hospital and related cancer treatments and services, including bone marrow/stem cell transplants (subject to PMB legislation) Non-PMB cases Hospital and related cancer treatments, including radiotherapy, brachytherapy, chemotherapy and associated adjuvant medicine HOSPICE SERVICES AND SUB-ACUTE CARE FACILITIES AS AN ALTERNATIVE TO HOSPITALISATION Subject to pre-authorisation, and services rendered in an approved facility and prescribed by a medical doctor PRIVATE NURSING AS AN ALTERNATIVE TO HOSPITALISATION Subject to pre-authorisation (Excluding general day-to-day care) APPENDECTOMY Subject to pre-authorisation R per family R per family R per family R per family Conventional procedure Laparoscopic procedure Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary PROSTATECTOMY Subject to pre-authorisation Conventional or laparoscopic procedure Robotic assisted laparoscopic procedure Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary Hospitalisation: R per beneficiary MORP Medihelp Oncology Reference Price DSP Designated service provider PMB MT Prescribed minimum benefits Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price

17 internally implanted prostheses Description Benefit Benefit Benefit Benefit INTERNALLY IMPLANTED PROSTHESES All hospital admissions and prostheses are subject to pre-authorisation, protocols and case management EVARS prosthesis R per beneficiary R per beneficiary R per beneficiary R per beneficiary Vascular/cardiac prosthesis R per beneficiary R per beneficiary R per beneficiary R per beneficiary Health-essential functional prosthesis R per beneficiary R per beneficiary R per beneficiary R per beneficiary Hip, knee and shoulder replacements (non-pmb) In case of acute injury where replacement is the only clinically appropriate treatment modality Hospitalisation: Prosthesis: Health-essential functional prosthesis benefits apply Hospitalisation: Prosthesis: Health-essential functional prosthesis benefits apply Hospitalisation: Prosthesis: Health-essential functional prosthesis benefits apply Hospitalisation: Prosthesis: Health-essential functional prosthesis benefits apply In case of wear and tear This option does not cover this benefit Intra-occular lenses Sub-limit subject to healthessential functional prosthesis benefit 2 lenses per beneficiary R3 800 per lens This option does not cover this benefit Sub-limit subject to healthessential functional prosthesis benefit 2 lenses per beneficiary R3 800 per lens This option does not cover this benefit Sub-limit subject to healthessential functional prosthesis benefit 2 lenses per beneficiary R3 800 per lens Subject to DSP if patient qualifies in terms of clinical criteria (only hip and knee replacements) If not, a R benefit applies for the hospital account and prosthesis components (combined) Sub-limit subject to healthessential functional prosthesis benefit 2 lenses per beneficiary R3 800 per lens Implantable hearing devices (including devices and components) This option does not cover this benefit This option does not cover this benefit R per beneficiary R per beneficiary Prosthesis with reconstructive or restorative surgery In and out of hospital External breast prostheses In and out of hospital R3 900 per family R8 750 per family R8 750 per family R8 750 per family DSP Designated service provider EVARS Endovascular aortic replacement surgery PMB Prescribed minimum benefits MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 14

18 15 day-to-day benefits Description Benefit Benefit Benefit Benefit GPs AND SPECIALISTS Consultations and follow-up consultations PHYSIOTHERAPY Treatment and material CLINICAL PSYCHOLOGY AND PSYCHIATRIC NURSING SUPPLEMENTARY HEALTH SERVICES Occupational and speech therapy, dietician services, audiometry, podiatry, massage, orthoptic, chiropractic, homeopathic, herbal and naturopathic, osteopathic and biokinetic services PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICES Out of hospital Subject to clinical protocols and requested by a medical doctor M = R1 100 M+ = R2 200 Pooled benefit for GP and specialist consultations, physiotherapy, acute medicine and self-medication This option does not cover these benefits M = R8 600 M+1 = R M+2 = R M+3+ = R * M = R2 550 M+1 = R4 300 M+2 = R5 300 M+3+ = R6 400 R2 550 per family STANDARD RADIOLOGY Out of hospital Subject to clinical protocols and requested by a medical doctor or chiropractor (black and white X-rays only) R2 550 per family MEDICINE Medicine obtained in the Medihelp Preferred Pharmacy and prescribed/dispensed by a medical doctor Acute generic medicine (including medicine dispensed at an emergency unit and self-medication, immunisations, contraceptives and homeopathic, herbal, naturopathic and osteopathic medicine) Please note: Original medicine when no generic equivalent is available 80% of the MT will apply Voluntary use of original medicine when generic equivalent is available 70% of the MMAP will apply 100% of the MMAP Generic medicine M = R1 100 M+ = R2 200 See GP and specialist consultations pooled benefit for acute and self-medication, GP and specialist consultations and physiotherapy 100% of the MMAP Generic medicine 100% of the MMAP Generic medicine M = R3 900 M+1 = R6 550 M+2 = R8 000 M+3+ = R8 600 MMAP Maximum Medical Aid Price GP General practitioner M Member MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price * has no limit for medical and surgical treatment, anaesthesia as well as material and medicines used during a consultation, but consultations are subject to the consultations benefit.

19 day-to-day benefits Description Benefit Benefit Benefit Benefit Non-PMB generic chronic medicine Subject to pre-authorisation and registration on Medihelp s chronic medicine management programme Original medicine when no generic equivalent is available 80% of the MT will apply Voluntary use of original medicine when generic equivalent is available 70% of the MMAP will apply PMB chronic medicine Subject to pre-authorisation and registration on Medihelp s PMB medicine management programme OXYGEN Out of hospital Subject to pre-authorisation, clinical protocols and services prescribed by a medical doctor OPTOMETRY Subject to pre-authorisation by PPN and services should be obtained from a PPN provider Optometric examinations 1 composite consultation, including refraction test, tonometry and visual field test Spectacles or contact lenses Benefits are limited to either spectacles or contact lenses Spectacles Frames and/or lens enhancements This option does not cover this benefit This option does not cover this benefit 100% of the MMAP Generic medicine M = R4 100 M+1 = R6 200 M+2 = R8 300 M+3+ = R % of the MHRP 100% of the MHRP 100% of the MHRP 100% of the MHRP DSP & formulary apply This option does not cover these benefits DSP & formulary apply DSP & formulary apply 1 composite examination per beneficiary per 24-month cycle R600 per beneficiary for a frame and/or lens enhancements per 24-month cycle 1 composite examination per beneficiary per 24-month cycle R750 per beneficiary for a frame and/or lens enhancements per 24-month cycle Lenses (one pair of standard clear Aquity lenses) Single vision, bifocal or multifocal (paid at the cost of bifocal lenses) lenses per beneficiary per 24-month cycle Contact lenses R1 155 per beneficiary per 24-month cycle Single vision, bifocal or multifocal lenses per beneficiary per 24-month cycle R1 620 per beneficiary per 24-month cycle MHRP Medihelp Reference Price MMAP Maximum Medical Aid Price PMB Prescribed minimum benefits M Member PPN Preferred Provider Negotiators MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 16

20 day-to-day benefits Description Benefit Benefit Benefit Benefit EXTERNAL PROSTHESES, MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCES Services in and out of hospital Artificial eyes R4 300 per family per 3-year cycle Speech and hearing aids R4 300 per family per 3-year cycle Artificial limbs R4 300 per family per 3-year cycle Wheelchairs R4 300 per family per 3-year cycle Medical appliances Hyperbaric oxygen treatment In and out of hospital Stoma components Incontinence products/supplies CPAP apparatus Prescribed by a medical doctor This option does not cover these benefits R8 850 per beneficiary per 24-month cycle R580 per family R4 300 per family per 3-year cycle R4 300 per family per 3-year cycle R4 300 per family per 3-year cycle R4 300 per family per 3-year cycle R1 150 per family R8 850 per beneficiary per 24-month cycle R7 150 per beneficiary per 3-year cycle R7 150 per beneficiary per 3-year cycle R5 750 per beneficiary per 3-year cycle R5 750 per beneficiary per 3-year cycle R1 400 per beneficiary R8 850 per beneficiary per 24-month cycle 17 CPAP Continuous positive airway pressure MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price

21 day-to-day benefits Description Benefit Benefit Benefit Benefit DENTAL SERVICES Subject to DSP s managed care protocols Conservative dental services Routine check-ups 2 per beneficiary (once in 6 months) 2 per beneficiary (once in 6 months) 2 per beneficiary (once in 6 months) Oral hygiene Fluoride treatment for children > 5 and < 13 years Fissure sealants for children younger than 16 years only This option does not cover these benefits 2 scale and polish treatments per beneficiary (once in 6 months) 2 scale and polish treatments per beneficiary (once in 6 months) 2 scale and polish treatments per beneficiary (once in 6 months) Fillings (treatment plans and X-rays may be requested for multiple fillings) 1 filling per tooth in 365 days 1 filling per tooth in 365 days 1 filling per tooth in 365 days Tooth extractions and root canal treatment in the dentist s chair Laughing gas (in the dentist s chair) Dental procedures under conscious sedation in the dentist s chair (sedation cost) Subject to pre-authorisation and managed care protocols Removal of impacted teeth only (Dentist s account only for item codes 8941/8943/8945) Removal of impacted teeth only (Dentist s account only for item codes 8941/8943/8945) Extensive dental treatment and the removal of impacted teeth only Extensive dental treatment and the removal of impacted teeth only Plastic dentures This option does not cover these benefits 1 set (upper and lower jaw) per beneficiary in a 4-year period 1 set (upper and lower jaw) per beneficiary in a 4-year period X-rays Intra-oral X-rays Extra-oral X-rays 1 per beneficiary in a 3-year period 1 per beneficiary in a 3-year period 1 per beneficiary in a 3-year period DSP Designated service provider MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price 18

22 day-to-day benefits Description Benefit Benefit Benefit Benefit Specialised dental services Subject to pre-authorisation and DSP s managed care protocols Partial metal frame dentures This option does not cover these benefits 1 partial frame (upper or lower jaw) per beneficiary in a 5-year period 2 partial frames (upper and lower jaw) per beneficiary in a 5-year period 19 Maxillofacial surgery and oral pathology Surgery in the dentist s chair Benefits for temporomandibular joint (TMJ) therapy are limited to non-surgical interventions/treatment Crowns and bridges Subject to pre-authorisation Once per tooth in a 5-year period 1 crown per family, once per tooth in a 5-year period 2 crowns per family, once per tooth in a 5-year period Implants Subject to pre-authorisation This option does not cover this benefit This option does not cover this benefit Orthodontic treatment (only one beneficiary per family may begin orthodontic treatment per calendar year) Subject to pre-authorisation and orthodontic needs analysis For beneficiaries > 9 and < 18 years old per lifetime Payment from date of authorisation R8 230 per beneficiary > 9 and < 18 years old per lifetime Payment from date of authorisation R per beneficiary > 9 and < 18 years old per lifetime Payment from date of authorisation Periodontal treatment (conservative non-surgical therapy only) Subject to pre-authorisation and a treatment plan DSP Designated service provider MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price This is a summary of benefits. In the event of a dispute, the registered Rules of Medihelp will apply (which are subject to approval by the Council for Medical Schemes). If a beneficiary joins during the course of a financial year, the benefits are calculated pro rata according to the remaining number of months.

23 deductibles Visiting network service providers, following the correct pre-authorisation process and negotiating tariffs with your doctor are just some of the ways you can manage or reduce out-of-pocket medical expenses Procedure-specific deductibles There are a limited number of low-incidence procedures that require a procedure-specific payment. Back and neck fusion / Member pays the first R Balance paid at 100% of the MT / Member pays the first R9 500 Balance paid at 100% of the MT / Member pays the first R8 250 Balance paid at 100% of the MT Member pays the first R7 050 Balance paid at 100% of the MT Endoscopic procedures There are only four endoscopic procedures where a member is required to contribute to the cost. If the procedure is performed in the doctor s rooms or a day clinic it will significantly reduce or eliminate that expense. These benefits apply to non-network and network options. Endoscopic procedures Gastroscopy Colonoscopy Gastroscopy Colonoscopy Arthroscopy Sigmoidoscopy Facility Doctor s rooms Day clinic Hospital Dimension Prime 1 / Member pays the first R1 950 per admission Member pays the first R2 950 per admission Dimension Prime 2 / Member pays the first R2 550 per admission Member pays the first R3 550 per admission Dimension Prime 3 / Member pays the first R1 950 per admission Member pays the first R2 950 per admission Dimension Elite Member pays the first R1 950 per admission Member pays the first R2 950 per admission Dental procedures under general anaesthesia These benefits rendered in hospital are subject to pre-authorisation and the DSP s managed care protocols. Procedures are paid at 100% of the Medihelp tariff (MT). These benefits apply to non-network and network options. / Member pays the first R2 900 per admission Balance paid at 100% of the MT Removal of impacted teeth (Dentist s account covered for item codes 8941, 8943 and 8945) Extensive dental treatment for children younger than 5 years once per lifetime (Dentist s account: for member s account) / Member pays the first R2 900 per admission Balance paid at Removal of impacted teeth (Dentist s account covered for item codes 8941, 8943 and 8945) Extensive dental treatment for children younger than 5 years once per lifetime (Dentist s account: available funds in savings account) / Member pays the first R840 per admission Balanced paid at Removal of impacted teeth Extensive dental treatment for children younger than 5 years once per lifetime DSP Designated service provider MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price Dimension Elite Member pays the first R790 per admission Balanced paid at Removal of impacted teeth Extensive dental treatment for children younger than 5 years once per lifetime 20

24 deductibles options Members of the Dimension Prime network options should use network hospitals for all planned admissions. A 65% benefit applies when an out-of-network hospital is used by choice. 40% of the Medihelp Reference Price is paid if PMB chronic medicine is obtained outside the formulary and/or DSP on the network options. It is advisable for chronic medicine users to rather choose the alternative non-network options. Pre-authorisation is important Medicine benefits Ask your pharmacist for the generic equivalent of prescribed medicine to avoid unnecessary out-of-pocket expenses. The only difference between an original medicine item and its generic equivalent is the price. Medicine benefits are applied as follows: Generic medicine 100% of the MMAP Original medicine if no generic equivalent is available 80% of the MT Original medicine if a generic equivalent is available 70% of the MMAP Specialised radiology Services rendered in and out of hospital must be requested by a specialist. Benefits are subject to clinical protocols and the deductibles below. 21 The following services and procedures are paid at 100% of the Medihelp tariff if pre-authorised: All planned hospital admissions (protocols and case management apply) Oxygen for out-of-hospital use (protocols and case management apply) Dental procedures under conscious sedation (sedation cost) in the dentist s chair (managed care protocols apply) Specialised dental services Crowns and bridges Implants Periodontal treatment (conservative non-surgical therapy only and subject to registration on the Perio Programme) Should these services not be pre-authorised, an 80% benefit will apply. Description MRI and CT imaging (subject to preauthorisation) / Member pays the first R1 550 per examination Balance paid at 100% of the MT / Member pays the first R1 550 per examination Balance paid at 100% of the MT / Member pays the first R1 550 per examination Balance paid at 100% of the MT Dimension Elite Member pays the first R1 050 per examination Balance paid at 100% of the MT Emergency transport services (Netcare 911) in and outside the country of residence (air and road transport) should be pre-authorised to qualify for the applicable benefit. If not pre-authorised, 50% of the benefit applies except in the case of emergency medical conditions. CT Computerised tomography MRI Magnetic resonance imaging MMAP Maximum Medical Aid Price PMB Prescribed minimum benefits MT Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit price Oncology is subject to pre-authorisation and registration on the Medihelp Oncology Management Programme, use of the designated service provider and treatment protocols to avoid deductibles. The Medihelp Oncology Reference Price applies to oncology medicine.

25 supporting information Dimension Prime hospital network Members of the Dimension Prime network benefit options must be admitted to one of the network hospitals or day clinics below when they need to undergo planned procedures. Gauteng Our website lists all the network hospitals. Visit You can also phone *120*6364# on your cell phone, or download our Medihelp member app, which is available on ios, Android and Windows devices. City/town Name Practice No Alberton Clinton Clinic Alberton Union Hospital Benoni Linmed Hospital Florida Mayo Clinic Johannesburg Garden City Clinic Johannesburg Mulbarton Hospital Johannesburg Park Lane Clinic Johannesburg Rand Clinic Kempton Park Birchmed Surgical Centre Krugersdorp Bellstreet Hospital Krugersdorp Krugersdorp Private Hospital Krugersdorp Pinehaven Hospital Midrand Cure Day Clinics (Midstream) Pretoria Akasia Hospital Pretoria Brooklyn Surgical Centre Pretoria Cure Day Clinics (Erasmuskloof) Pretoria Intercare Day Hospital (Hazeldean) Pretoria Jakaranda Hospital Pretoria Louis Pasteur Hospital Pretoria Medkin Clinic Pretoria Montana Private Hospital Pretoria Pretoria East Private Hospital Pretoria Unitas Hospital Pretoria Zuid-Afrikaans Hospital Gauteng City/town Name Practice No Springs East Rand N17 Private Hospital Vanderbijlpark Cormed Clinic Vanderbijlpark Mediclinic Emfuleni Vanderbijlpark PJ Schutte Theatre Unit (Dental procedures only) Vereeniging Mediclinic Vereeniging Vereeniging Midvaal Private Hospital KwaZulu-Natal City/town Name Practice No Amanzimtoti Kingsway Hospital Ballito Alberlito Hospital Durban Chatsmed Garden Hospital Durban Hillcrest Private Hospital Durban Nu-Shifa Hospital Durban St Augustine s Hospital Howick Mediclinic Howick Ladysmith La Verna Hospital Newcastle Mediclinic Newcastle Pietermaritzburg Mediclinic Pietermaritzburg Pietermaritzburg St Anne s Hospital Pinetown The Crompton Hospital Port Shepstone Hibiscus Hospital Richards Bay The Bay Hospital Shelly Beach Shelly Beach Day Clinic Umhlanga Umhlanga Hospital Umhlanga KZN Day Clinic Limpopo City/town Name Practice No Bela-Bela St Vincent s Hospital Lephalale Marapong Private Hospital Makhado Zoutpansberg Private Hospital Polokwane Mediclinic Limpopo Polokwane Mediclinic Limpopo Day Clinic Tzaneen Mediclinic Tzaneen

26 Mpumalanga City/town Name Practice No emalahleni emalahleni Day Hospital emalahleni emalahleni Private Hospital Ermelo Mediclinic Ermelo Middelburg Middelburg Private Hospital Nelspruit Kiaat Private Hospital Nelspruit Lowveld Hospital Nelspruit Mediclinic Nelspruit Secunda Mediclinic Secunda North West City/town Name Practice No Klerksdorp Sunningdale Hospital Klerksdorp Wilmed Park Private Hospital Potchefstroom Potchefstroom Medical and Dental Centre Rustenburg Ferncrest Hospital Vryburg Vryburg Private Hospital Northern Cape City/town Name Practice No Kimberley Mediclinic Kimberley Upington Mediclinic Upington Western Cape City/town Name Practice No Cape Town Christiaan Barnard Memorial Hospital Cape Town Kuilsriver Private Hospital Cape Town Mediclinic Cape Gate Cape Town Mediclinic Durbanville Cape Town Mediclinic Durbanville Day Hospital Cape Town Mediclinic Louis Leipoldt Cape Town Mediclinic Milnerton Cape Town Melomed Bellville Cape Town Melomed Gatesville Cape Town N1 City Hospital Medihelp may change the information contained in this document from time to time and will publish any changes on our website at Western Cape City/town Name Practice No Cape Town Vincent Pallotti Hospital George Mediclinic Geneva George Mediclinic George Hermanus Mediclinic Hermanus Mossel Bay Bayview Hospital Oudtshoorn Mediclinic Klein Karoo Paarl Cure Day Clinics (St Stephen s Paarl) Paarl Mediclinic Paarl Plettenberg Bay Mediclinic Plettenberg Bay Somerset West Mediclinic Vergelegen Stellenbosch Mediclinic Stellenbosch Vredenburg West Coast Private Hospital Worcester Mediclinic Worcester Eastern Cape City/town Name Practice No East London Life Beacon Bay Hospital East London St Dominic s Hospital East London St James Operating Theatres Grahamstown Settlers Hospital Humansdorp Isivivana Private Hospital Port Alfred Port Alfred Hospital Port Elizabeth Greenacres Hospital Port Elizabeth Medical Forum Theatre Queenstown Life Queenstown Private Hospital Uitenhage Cuyler Clinic Free State City/town Name Practice No Bethlehem Bethlehem Medical Centre Bloemfontein Citymed Theatre Bloemfontein Horizon Eye Care Centre Bloemfontein Mediclinic Bloemfontein Bloemfontein Universitas Private Hospital Kroonstad Kroon Hospital Welkom Welkom Medical Centre

27 our healthcare partners We partner with preferred providers and networks to give you access to affordable, quality care. All options Dental Risk Company (DRC) Dental Risk Company (DRC) specialises in offering effective dental managed care solutions and provides Medihelp s dental benefits in partnership with dentists across South Africa. Members may visit any dentist of their choice, but benefits are managed by DRC and granted in accordance with DRC protocols. Medihelp Preferred Pharmacy Medihelp s Preferred Pharmacy consists of more than pharmacies who offer Medihelp members the most cost-effective professional fee structure for prescribed medicine. This means that members who visit network pharmacies will not have to pay any excess amounts for higher professional fees which non-network pharmacies charge to dispense medicine items. Halocare, Dis-Chem Direct and Medipost Halocare is the managed healthcare partner for HIV/Aids-related services and post-exposure prophylaxis while Dis-Chem Direct and Medipost are the designated service providers (DSPs) for HIV/Aids medicine. Specialist networks Two specialist networks (for Medihelp s non-network range and the Dimension Prime network range) effectively manage any PMB specialist care that our members may require, while reducing their out-of-pocket expenses. For members of our network options, specific specialist networks also ensure streamlined care between the specialist and the network hospital, especially with regard to PMB services. options DSP DSPs for Dimension Prime network range only PMB chronic medicine Members must obtain their PMB chronic medicine from a designated service provider (DSP) to avoid a 60% deductible. Order authorised PMB chronic medicine from MobileMeds. Oncology medicine Dis-Chem Oncology and Medipost are the DSPs for oncology PMB medicine. and PPN The Preferred Provider Negotiators (PPN) provide Medihelp s optical benefits in partnership with more than optometrists across South Africa. Medihelp members may visit any optometrist and benefits are paid according to PPN tariffs. Netcare 911 Netcare 911 is our partner in providing emergency medical services, including emergency medical transport, emergency assistance and trauma counselling. ICON ICON is the Independent Clinical Oncology to which more than 80% of the country s oncologists belong. They provide the highest quality cancer care through a countrywide footprint of high-tech chemotherapy and radiotherapy facilities. ICON is Medihelp s designated service provider for oncology treatment. DBC Medihelp s back treatment programme is offered in cooperation with Document-Based Care (DBC). Each programme is developed by a multidisciplinary medical team according to the individual s clinical profile. Preventive care Clicks and Dis-Chem are Medihelp s designated service providers for preventive care health assessment tests. PMB Prescribed minimum benefits 24