Circular 65 of 2018: Medical Scheme benefit options for open & restricted schemes approved with effect from 01 January 2019
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1 CIRCULAR Reference: Benefit options status for open and restricted schemes 2019 Contact person: Lindiwe Twala Tel: (012) Fax: Date: 19 December 2018 Circular 65 of 2018: Medical Scheme benefit options for open & restricted schemes approved with effect from 01 January 2019 The Council for Medical Schemes (CMS) would hereby like to share information on the status of benefit options applicable to all schemes, for the 2019 benefit year. The table below provides details on the approval status for the different open scheme benefit options. NAME OF MEDICAL BESTMED MEDICAL PACE4 PACE3 PACE2 PACE1 BEAT4 BEAT3 BEAT3 NETWORK BEAT2 BEAT2 NETWORK Page 1
2 BEAT1 BEAT1 NETWORK PULSE2 PULSE1 BONITAS MEDICAL FUND BONCAP BONCOMPREHENSIVE BONSAVE PRIMARY PRIMARY SELECT STANDARD STANDARD SELECT BONESSENTIAL BONESSENTIAL SELECT BONCLASSIC BONFIT BONCOMPLETE PLUS DISCONTINUED WEF 31/12/2018 STANDARD CAPE MEDICAL PLAN HEALTHPACT PREMIUM HEALTHPACT SILVER HEALTHPACT SELECT COMPCARE WELLNESS MEDICAL DYNAMIX DSP NETWORK PINNACLE DSP NETWORK MUMED DSP NETWORK SYMMETRY DSP NETWORK AXIS DSP NETWORK NETWORX Page 2
3 DSP NETWORK UNISAVE DISCOVERY HEALTH MEDICAL CLASSIC COMPREHENSIVE CLASSIC DELTA COMPREHENSIVE CLASSIC CORE CLASSIC DELTA CORE CLASSIC PRIORITY CLASSIC SAVER CLASSIC DELTA SAVER COASTAL CORE COASTAL SAVER ESSENTIAL COMPREHENSIVE ESSENTIAL DELTA COMPREHENSIVE ESSENTIAL CORE ESSENTIAL DELTA CORE ESSENTIAL PRIORITY ESSENTIAL SAVER ESSENTIAL DELTA SAVER EXECUTIVE KEYCARE CORE KEYCARE PLUS KEYCARE START (was KeyCare Access) CLASSIC COMPREHENSIVE ZERO MSA CLASSIC SMART ESSENTIAL SMART Page 3
4 FEDHEALTH MEDICAL MAXIFED 2 (was Maxima Plus) MAXIFED 1 (was Maxima Executive) MAXIFED 1 Grid (new) FLEXIFED 4 (was Maxima Standard) FLEXIFED 4 Grid (new) FLEXIFED 4 Elect (was Maxima Standard Elect) FLEXIFED 3 (was Maxima Core) FLEXIFED 3 Grid (was Maxima Core Grid) FLEXIFED 3 Elect (new) FLEXIFED 2 (was Maxima Saver) FLEXIFED 2 Grid (was Maxima Saver Grid) FLEXIFED 2 Elect (new) FLEXIFED 1 (was Maxima EntrySaver) FLEXIFED 1 Elect (new) MYFED (was Blue Door Plus) MAXIMA ADVANCED DISCONTINUED Merged into Maxima Standard (FlexiFed 4) WEF Page 4
5 MAXIMA BASIS MAXIMA BASIS GRID ULTIMAX MAXIMA ENTRYZONE DISCONTINUED DISCONTINUED DISCONTINUED DISCONTINUED Merged into Maxima Core (FlexiFed 3) WEF Merged into Maxima Core Grid (FlexiFed 3 Grid) WEF Merged into Maxima Plus (MaxiFed 2) WEF Merged into Maxima EntrySaver (FlexiFed 1) WEF GENESIS MEDICAL PRIVATE PRIVATE PLUS PRIVATE COMPREHENSIVE PRIVATE CHOICE HEALTH SQUARED (Was SPECTRAMED) ADVANCE (was Cyan) ASPIRE (was Hospital) COBALT FLEX (was Progressive Flex and merged with Capri) FLEX PLUS (was Progressive Flex Plus) FOUNDATION MILLENNIUM MILLENNIUM SELECT OPTIMUM (was Azure) RISE (was Aqua) ULTIMATE (was Supreme) CAPRI DISCONTINUED Name change after amalgamation with Resolution Health WEF HOSMED MEDICAL AID PLUS ESSENTIAL VALUE VALUE CORE(New) EDO Application Page 5
6 ACCESS KEYHEALTH PLATINUM GOLD SILVER EQUILIBRIUM ESSENCE ORIGIN MAKOTI MEDICAL COMPREHENSIVE PRIMARY MEDIHELP ELITE (was Dimension Elite) PRIME 1 (was Dimension Prime 1) PRIME 1 NETWORK (was Dimension Prime 1 Network) PRIME 2 (was Dimension Prime 2) PRIME 2 NETWORK (was Dimension Prime 2 Network) PRIME 3 (was Dimension Prime 3) PRIME 3 NETWORK (was Dimension Prime 3 Network) PLUS (was Medihelp Plus) NECESSE UNIFY MEDIMED MEDICAL ALPHA MEDISAVE ESSENTIAL MEDISAVE - MAX Page 6
7 MEDSHIELD MEDICAL MEDISAVE - STANDARD MEDIBONUS MEDIPLUS MEDIVALUE MEDICORE PREMIUM PLUS MEDISAVER MEDIPHILA MOMENTUM HEALTH MEDICAL INGWE PRIMARY CARE/STATE NETWORK PRIMARY CARE/INGWE NETWORK ACTIVE NETWORK/INGWE ANY OPTION CUSTOM STATE/ASSOCIATE D S STATE/ANY ASSOC GP & PHARM/ASSOC S ASSOC GP & PHARM/ANY Page 7
8 ANY GP & PHARM/ASSOC S ANY GP & PHARM/ANY INCENTIVE STATE/ASSOCIATE D S STATE/ANY ASSOC GP & PHARM/ASSOC S ASSOC GP & PHARM/ANY ANY GP & PHARM/ASSOC S ANY GP & PHARM/ANY EXTENDER STATE/ASSOC S STATE/ANY ASSOC GP & PHARM/ASSOC S ASSOC GP & PHARM/ANY Page 8
9 ANY GP & PHARM/ASSOC S ANY GP & PHARM/ANY IMPACT (was ACCESS) IMPACT EDO SUMMIT RESOLUTION HEALTH MEDICAL ULTIMATE (Was Supreme) MILLENNIUM MILLENNIUM SELECT FLEX PLUS (Was Progressive Flex Plus) PROGRESSIVE FLEX (Merged with Capri and renamed FLEX) ASPIRE (Was Hospital) FOUNDATION CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED CARRIED OVER TO HEALTH SQUARED Amalgamated with Health Squared (was Spectramed) WEF SELFMED MEDICAL SELFMED MEDXXI SELFMED MED ELITE SELFMED 80% SELFMED SELFSURE SELFMED SELFNET Page 9
10 SELFMED SELFNET ESSENTIAL SIZWE MEDICAL FUND ENHANCED CARE PLAN NETWORK PLAN (new EDO) GOMOMO CARE PLAN PRIMARY CARE PLAN PRIMARY NETWORK OPTION (new) AFFORDABLE CARE PLAN AFFORDABLE NETWORK OPTION (new) FULL CARE PLAN REJECTED RENAMED WEF NEW WEF NEW WEF SUREMED HEALTH CHALLENGER NAVIGATOR SHUTTLE EXPLORER THEBEMED TOPMED MEDICAL ENERGY CORE MEDIUM OPEN UNIVERSAL UNIVERSAL EDO FANTASY TOPMED COMPREHENSIVE TOPMED FAMILY TOPMED EXECUTIVE TOPMED SAVINGS TOPMED ACTIVE SAVER TOPMED ESSENTIAL TOPMED NETWORK Page 10
11 WEF with effect from TOPMED LIMITED DISCONTINUED WEF 31/12/2018 The table below provides details on the approval status for the different benefit options for the 2019 benefit year, for restricted schemes. NAME OF MEDICAL AECI MEDICAL AID SOCIETY VALUE OPTION COMPREHENSIVE OPTION ALLIANCE-MIDMED MEDICAL ANGLO MEDICAL ALLIANCE-MIDMED MEDICAL MANAGED CARE PLAN STANDARD CARE PLAN VALUE CARE PLAN ANGLOVAAL GROUP MEDICAL ANGLOVAAL GROUP MEDICAL BANKMED BANKMED BASIC PLAN BANKMED COMPREHENSIVE PLAN BANKMED CORE SAVER PLAN BANKMED PLUS PLAN BANKMED TRADITIONAL PLAN BANKMED ESSENTIAL PLAN BARLOWORLD MEDICAL BMW EMPLOYEES MEDICAL AID SOCIETY BP MEDICAL AID SOCIETY BARLOWORLD MEDICAL BMW EMPLOYEES MEDICAL AID SOCIETY BP MEDICAL SOCIETY Page 11
12 NAME OF MEDICAL BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND ALLIANCE BENEFIT OPTION DOUBLE PLUS BENEFIT OPTION FIRST CHOICE BENEFIT OPTION VITAL BENEFIT OPTION NETWORK CHOICE BENEFIT OPTION ESSENTIAL PLUS BENEFIT OPTION DE BEERS BENEFIT SOCIETY ENGEN MEDICAL BENEFIT FUND FISHING INDUSTRY MEDICAL (FISH-MED) FOOD WORKERS MEDICAL BENEFIT FUND GLENCORE MEDICAL GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND GOVERNMENT EMPLOYEES MEDICAL (GEMS) DE BEERS BENEFIT SOCIETY ENGEN MEDICAL BENEFIT FUND PRIMARY STANDARD FOOD WORKERS MEDICAL BENEFIT FUND GLENCORE MEDICAL ADVANCE PRIMARY STANDARD ONYX EMERALD EMERALD VALUE RUBY BERYL SAPPHIRE Page 12
13 NAME OF MEDICAL GRINTEK ELECTRONICS MEDICAL AID HORIZON MEDICAL GRINTEK ELECTRONIC MEDICAL AID CORE PLAN PLUS NETWORK PLAN PLUS SAVINGS PLAN IMPALA MEDICAL PLAN IMPERIAL GROUP MEDICAL IMPALA MEDICAL PLAN IMPERIALMED HEALTH PLAN IMPERIALMED BUDGET PLAN LA-HEALTH ACTIVE COMPREHENSIVE CORE FOCUS KEYPLUS LIBCARE MEDICAL LONMIN MEDICAL MALCOR MEDICAL MASSMART HEALTH PLAN MBMED MEDICAL AID FUND MEDIPOS MEDICAL LIBCARE LONMIN MEDICAL PLAN A PLAN B PLAN C PLAN D CHOICE OPTION NETWORK OPTION ESSENTIAL OPTION MBMED OPTION A OPTION B OPTION C OPTIMUM Page 13
14 NAME OF MEDICAL MOTO HEALTHCARE CLASSIC CLASSIC NETWORK HOSPICARE HOSPICARE NETWORK CUSTOM ESSENTIAL NASPERS MEDICAL FUND NEDGROUP MEDICAL AID NETCARE MEDICAL OLD MUTUAL STAFF MEDICAL AID FUND PARMED MEDICAL AID PG GROUP MEDICAL PICK & PAY MEDICAL PLATINUM HEALTH PROFMED M-MED OPTION PLATINUM PLAN TRADITIONAL PLAN COMPREHENSIVE PLAN SAVINGS PLAN PLAN NETCARE SAVINGS OPTION TRADITIONAL PLUS PLAN TRADITIONAL PLUS SELECT TRADITIONAL PLAN TRADITIONAL SELECT NETWORK PLAN NETWORK SELECT PLAN SAVINGS PLAN PARMED MEDICAL AID PG GROUP MEDICAL PLUS OPTION PRIMARY OPTION PLAT COMPREHENSIVE PLAT CAP PROACTIVE PROACTIVE SAVVY Page 14
15 NAME OF MEDICAL PROACTIVE PLUS PROACTIVE PLUS SAVVY PROPINNACLE PROPINNACLE SAVVY PROSECURE PROSECURE SAVVY PROSECURE PLUS PROSECURE PLUS SAVVY QUANTUM MEDICAL AID SOCIETY RAND WATER MEDICAL REMEDI MEDICAL AID RETAIL MEDICAL ESSENTIAL COMPREHENSIVE PLAN ESSENTIAL SAVER PLAN KEYCARE PLUS PLAN OPTION A OPTION B PLUS CLASSIC COMPREHENSIVE STANDARD ESSENTIAL OPTION ESSENTIAL PLUS OPTION RHODES UNIVERSITY MEDICAL RHODES UNIVERSITY MEDICAL S A BREWERIES ESSENTIAL MEDICAL AID COMPREHENSIVE SOCIETY SABC MEDICAL SABC AID SOUTH AFRICAN OPTION A MUNICIPAL OPTION B WORKERS UNION NATIONAL MEDICAL (SAMWUMED) SASOLMED SASOLMED Page 15
16 NAME OF MEDICAL SEDMED SEDMED SISONKE HEALTH MEDICAL HERITAGE PLAN PRIDE PLAN SOUTH AFRICAN POLICE SERVICE MEDICAL (POLMED) TFG MEDICAL MARINE AQUARIUM TFG HEALTH PLAN (was Plan A) TFG HEALTH PLUS PLAN (was Plan B) TIGER BRANDS MEDICAL OPTION 1 PRIMARY PLUS OPTION (was Mzanzi Network Option) TRANSMED MEDICAL FUND GUARDIAN LINK PLAN (was State Plus Network) SELECT PLAN (was State Plus Own Choice) PRIME PLAN (was Private Network) TSOGO SUN GROUP MEDICAL UMVUZO HEALTH MEDICAL CLASSIC COMPREHENSIVE PLAN CLASSIC SAVER PLAN STANDARD SUPREME ULTRA AFFORDABLE ULTRA AFFORDABLE VALUE (new) EXTREME ACTIVATOR EDO application Page 16
17 NAME OF MEDICAL UNIVERSITY OF KWAZULU-NATAL MEDICAL STANDARD PLAN WITBANK COALFIELDS MEDICAL AID WOOLTRU HEALTHCARE FUND WEF with effect from COMPREHENSIVE OPTION MIDMAS OPTION NTSIKA OPTION YEBOMED OPTION CORE OPTION EXTENDED OPTION PLUS OPTION Page 17
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