Circular 68 of 2014: Medical Scheme benefit options for open and restricted schemes approved for 2015

Transcription

1 Circular 68 of 2014: Medical Scheme benefit options for open and restricted schemes approved for The Council for Medical Schemes (CMS) would like to share the status of benefit options in open schemes for the 2015 calendar year. Name of medical scheme Name of benefit option Decision Basis for the decision BESTMED MEDICAL PACE 4 PACE 3 PACE 2 PACE 1 BEAT 4 BEAT 4 NETWORK BEAT 3 BEAT 3 NETWORK BEAT 2 BEAT 2 NETWORK BEAT 1 BEAT 1 NETWORK PULSE 2 PULSE 1 BONITAS MEDICAL FUND BONCAP BONCOMPREHENSIVE BONSAVE NETWORK OPTION pending exemption NETWORK OPTION pending exemption NETWORK OPTION pending exemption NETWORK OPTION pending exemption

2 PRIMARY BONESSENTIAL BONCLASSIC CAPE MEDICAL PLAN HEALTHPACT PREMIUM HEALTHPACT SILVER HEALTHPACT SELECT COMMUNITY MEDICAL AID (COMMED) FUNDAMENTAL DISCONTINUED Discontinued with effect from 31 December 2014 DELUXE ROOTS New with effect from 1 January 2015 COMPCARE WELLNESS MEDICAL DISCOVERY HEALTH MEDICAL DYNAMIX DSP NETWORK PINNACLE DSP NETWORK MUMED DSP NETWORK SYMMETRY DSP NETWORK AXIS DSP NETWORK NETWORX DSP NETWORK 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

3 ESSENTIAL CORE ESSENTIAL DELTA CORE ESSENTIAL PRIORITY ESSENTIAL SAVER ESSENTIAL DELTA SAVER EXECUTIVE KEYCARE CORE KEYCARE PLUS KEYCARE ACCESS CLASSIC COMPREHENSIVE ZERO MSA FEDHEALTH MEDICAL MAXIMA BASIS MAXIMA CORE MAXIMA PLUS MAXIMA MAXIMA NET MAXIMA ENTRYZONE MAXIMA EXECUTIVE ULTIMA 200 ULTIMAX BLUE DOOR PLUS Re-named with effect from 1 January 2015 MAXIMA SAVER MAXIMA ENTRYSAVER GENESIS MEDICAL PRIVATE PRIVATE PLUS PRIVATE COMPREHENSIVE PRIVATE CHOICE HOSMED MEDICAL AID PLUS ESSENTIAL (was Step Medium) Renamed Essential with effect from 1 January 2015 STEP CORE DISCONTINUED Discontinued with effect from 31 December 2014 VALUE ACCESS New with effect from 1 January 2015 KEYHEALTH PLATINUM

4 GOLD SILVER EQUILIBRIUM ESSENCE ORIGIN LIBERTY HEALTH MEDICAL TRADITIONAL ULTIMATE SELECT SAVER SAVER SELECT COMPLETE PLUS PLUS SAVER PLUS TRADITIONAL COMPLETE COMPLETE SELECT TRADITIONAL BASIC MAKOTI MEDICAL COMPREHENSIVE PRIMARY MEDIHELP DIMENSION ELITE DIMENSION PRIME 1 DIMENSION PRIME 1 NETWORK DIMENSION PRIME 2 DIMENSION PRIME 2 NETWORK DIMENSION PRIME 3 DIMENSION PRIME 3 NETWORK MEDIHELP PLUS NECESSE UNIFY MEDIMED MEDICAL ALPHA MEDISAVE ESSENTIAL MEDISAVE - MAX MEDISAVE -

5 MEDSHIELD MEDICAL MEDIBONUS MEDIPLUS MEDIVALUE 80% OPTION DISCONTINUED Discontinued with effect from 31 December 2014 CORE PLUS PREMIUM PLUS MEDIPHILA MOMENTUM HEALTH MEDICAL INGWE PRIMARY CARE/STATE NETWORK PRIMARY CARE/INGWE NETWORK ACTIVE NETWORK/INGWE ANY OPTION CUSTOM STATE/ASSOCIATED STATE/ANY ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY ANY GP & PHARM/ASSOC ANY GP & PHARM/ANY INCENTIVE STATE/ASSOCIATED STATE/ANY ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY

6 ANY GP & PHARM/ASSOC ANY GP & PHARM/ANY EXTENDER STATE/ASSOC STATE/ANY ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY ANY GP & PHARM/ASSOC ANY GP & PHARM/ANY ACCESS SUMMIT RESOLUTION HEALTH MEDICAL PROGRESSIVE FLEX CLASSIC SUPREME MILLENNIUM FOUNDATION PENDING SELFMED MEDICAL MEDXXI MED ELITE SELFMED 80% SELFSURE SELFNET New with effect from 1 January 2015 SIZWE MEDICAL FUND AFFORDABLE CARE OPTION FULL CARE OPTION PRIMARY CARE OPTION SAVINGS CARE OPTION New with effect from 1 January 2015 GOMOMO CARE OPTION (WAS BASIC CARE) Renamed with effect from 1 January 2015

7 SPECTRAMED CYAN AZURE AQUA COBALT CAPRI SUREMED HEALTH CHALLENGER NAVIGATOR SHUTTLE EXPLORER THEBEMED ENERGY CORE MEDIUM OPEN UNIVERSAL TOPMED MEDICAL TOPMED RAINBOW COMPREHENSIVE TOPMED PALADIN COMPREHENSIVE TOPMED PROFESSIONAL OPTION TOPMED SAVINGS OPTION TOPMED ACTIVE SAVER TOPMED PLAN TOPMED NETWORK OPTION TOPMED LIMITED OPTION (WAS TOPMED METHCARE OPTION) Renamed with effect from 1 January 2015

8 2. The Council for Medical Schemes (CMS) would like to share the status of benefit options in restricted schemes for the 2015 calendar year. Name of medical scheme Name of benefit option Decision Basis for the decision AECI MEDICAL AID SOCIETY VALUE OPTION COMPREHENSIVE OPTION (WAS COMPREHENSIVE PLAN) AFROX MEDICAL AID SOCIETY BASE PLAN DISCONTINUED Amalgamated with Discovery Health Medical Scheme; with effect from 1 May 2014 ALLIANCE-MIDMED MEDICAL ALLIANCE-MIDMED MEDICAL Re-named with effect from 1 January 2015 ANGLO MEDICAL MANAGED CARE PLAN 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 PMB PLAN BARLOWORLD MEDICAL BARLOWORLD MEDICAL BMW EMPLOYEES MEDICAL AID SOCIETY BMW EMPLOYEES MEDICAL AID SOCIETY

9 BP MEDICAL AID SOCIETY BP MEDICAL SOCIETY Mid-year contribution increases and annual benefit changes BUILDING &CONSTRUCTION INDUSTRY MEDICAL CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) BASIC OPTION 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 DE BEERS BENEFIT SOCIETY ENGEN MEDICAL BENEFIT FUND ENGEN MEDICAL BENEFIT FUND Mid-year contribution increases and annual benefit changes FISHING INDUSTRY MEDICAL (FISH-MED) FOOD WORKERS MEDICAL BENEFIT FUND PRIMARY FOOD WORKERS MEDICAL BENEFIT FUND N/A No changes for 2015 GLENCORE MEDICAL GLENCORE MEDICAL GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND GOVERNMENT EMPLOYEES MEDICAL (GEMS) GRINTEK ELECTRONICS MEDICAL AID ADVANCE PRIMARY ONYX EMERALD RUBY SAPPHIRE BERYL GRINTEK ELECTRONIC MEDICAL AID PLAN

10 HORIZON MEDICAL MAJOR MEDICAL PLAN MAJOR MEDICAL PLUS CARECROSS IMPALA MEDICAL PLAN IMPALA MEDICAL PLAN IMPERIAL GROUP MEDICAL IMPERIALMED HEALTH PLAN Mid-year contribution increases and annual benefit changes. IMPERIALMED BUDGET PLAN Mid-year contribution increases and annual benefit changes. LA-HEALTH ACTIVE COMPREHENSIVE CORE FOCUS KEYPLUS LIBCARE MEDICAL LIBCARE LONMIN MEDICAL LONMIN MEDICAL MALCOR MEDICAL PLAN A PLAN B PLAN C PLAN D MASSMART HEALTH PLAN CHOICE OPTION NETWORK OPTION ESSENTIAL OPTION New with effect from 1 January 2015 MBMED MEDICAL AID FUND PLAN A MEDIPOS MEDICAL OPTION A OPTION B OPTION C METROPOLITAN MEDICAL CLASSIC PREMIER

11 MOTO HEALTHCARE OPTMUM CLASSIC HOSPICARE CUSTOM ESSENTIAL NASPERS MEDICAL FUND M-MED OPTION N OPTION BASIC N OPTION PLUS NEDGROUP MEDICAL AID PLATINUM PLAN TRADITIONAL PLAN TRADITIONAL PLUS PLAN SAVINGS PLAN PLAN NETCARE MEDICAL NETCARE SAVINGS OPTION OLD MUTUAL STAFF MEDICAL AID FUND TRADITIONAL PLUS PLAN Mid-year contribution increases and benefit changes TRADITIONAL PLAN Mid-year contribution increases and benefit changes SAVINGS PLAN Mid-year contribution increases and benefit changes NETWORK PLAN Mid-year contribution increases and benefit changes PLAN Mid-year contribution increases and benefit changes PARMED MEDICAL AID PARMED MEDICAL AID PG GROUP MEDICAL PG GROUP MEDICAL PICK & PAY MEDICAL PICK N PAY MEDICAL PLATINUM HEALTH PLATCOMPREHENSIVE PLATCAP PLATSAVE PROFMED PRO ACTIVE PRO ACTIVE PLUS PRO PINNACLE

12 PRO SECURE PRO SECURE PLUS QUANTUM MEDICAL AID SOCIETY ESSENTIAL COMPREHENSIVE ESSENTIAL SAVER KEYCARE PLUS RAND WATER MEDICAL OPTION A OPTION B PLUS REMEDI MEDICAL AID CLASSIC COMPREHENSIVE RETAIL MEDICAL ESSENTIAL OPTION ESSENTIAL PLUS OPTION RHODES UNIVERSITY MEDICAL S A BREWERIES MEDICAL AID SOCIETY RUMED ESSENTIAL COMPREHENSIVE SABC MEDICAL AID SABC PLAN 009 SOUTH AFRICAN MUNICIPAL OPTION A UNION NATIONAL MEDICAL OPTION B (SAMWUMED) SASOLMED SASOLMED Mid-year contribution increases and annual benefit changes SEDMED SEDMED SISONKE HEALTH MEDICAL SOUTH AFRICAN POLICE SERVICE MEDICAL (POLMED) HERITAGE PLAN PRIDE PLAN HIGHER PLAN LOWER PLAN

13 TFG MEDICAL PLAN A PLAN B TIGER BRANDS MEDICAL OPTION 1 Mid-year contribution increases and annual benefit changes MZANSI NETWORK OPTION Mid-year contribution increases and annual benefit changes TRANSMED MEDICAL FUND GUARDIAN STATE PLUS NETWORK STATE PLUS OWN CHOICE PRIVATE NETWORK TSOGO SUN GROUP MEDICAL CLASSIC COMPREHENSIVE CLASSIC SAVER UMVUZO HEALTH MEDICAL SUPREME ULTRA AFFORDABLE EXTREME New with effect from 1 January 2015 UNIVERSITY OF KWAZULU-NATAL MEDICAL UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG STAFF MEDICAL AID WITBANK COALFIELDS MEDICAL AID PLAN KEYPLUS PLAN UNIVERSITY OF WITWATERSRAND STAFF MEDICAL AID COMPREHENSIVE OPTION YEBOMED DISCONTINUED WOOLTRU HEALTHCARE FUND CORE OPTION EXTENDED OPTION PLUS OPTION