MEDICAL AID POLICY MARCH 2009

Transcription

1 MEDICAL AID POLICY MARCH 2009

2 PARMALAT SA (PTY) LTD - MEDICAL AID POLICY Item Page 1. INTRODUCTION / OBJECTIVE / EMPLOYER POLICY 3 2. DEFINITION OF TERMS Act 2.2 Adult dependant 2.3 Benefit option 2.4 Child dependant 2.5 Employee 2.6 Employer 2.7 Late Joiner Member 2.9 Partner 2.10 Pensioner member 2.11 Percentage of contribution amount 2.12 Preferred medical scheme/s 2.13 Principal member 2.14 Senior Employees 2.15 Spouse 2.16 Subsidy 2.17 Underwriting Value of the benefit 3. MEMBERSHIP Membership of Employees 3.2 Membership of Dependants Membership of Pensioner members Termination of membership 3.5 General conditions applying to membership of the Medical Scheme SUBSIDY Employer subsidy - medical scheme contributions for in-service members 4.2 Employer subsidy - medical scheme contributions for Pensioner 13 members/contributions after retirement 5. COLLECTION AND PAYMENT OF CONTRIBUTIONS RESERVATION OF RIGHTS ANNEXURE TO MEDICAL AID POLICY 18 Parmalat SA (Pty) Ltd Medical Aid Policy 2

3 1. INTRODUCTION/OBJECTIVE/EMPLOYER POLICY 1.1 The Employer acknowledges the importance of implementing a medical aid policy that contributes towards a productive and healthy workforce. This policy aims to provide a framework in which a health care programme is established and maintained. As a working document, this policy will be continually reviewed by the Employer to incorporate changes to the health care programme and keep abreast of developments that may impact on this policy. 1.2 The terms and conditions contained herein form part of the terms of the Employee s employment contract with the Employer. 1.3 The objective of the medical aid policy is to promote and facilitate the provision of health care arrangements within the Employer, which will provide appropriate, affordable, cost effective and sustainable health care to all Employees. 1.4 Membership of the Preferred medical scheme/s is subject to the Rules of the approved medical scheme. Parmalat SA (Pty) Ltd Medical Aid Policy 3

4 2. DEFINITION OF TERMS 2.1 Act Shall mean the Medical Schemes Act No. 131 of 1998, including the Regulations published from time to time, and any amendments thereto; 2.2 Adult Dependant * Shall mean a person other than the spouse, partner or child dependant of the principal member; 2.3 Benefit Option Means the registered benefit option(s) of the preferred medical scheme(s) and which are selected by the Employer and offered to their employees; 2.4 Child Dependant * The Employer s rules determine that a child dependant means a Natural child, legally adopted child and step children who are either under the age of 21 years or between the ages of 21 and 25 years where the child is proven to be a student at a formally recognized educational institution. Proof to be provided to the Employer s Human Resources Department; Children under the age of 25 years who are mentally and physically disabled and financially dependant on the Employee. To be approved by the Employer s Human Resources Department; The medical scheme contribution is however subject to the Preferred medical scheme/s rule for a Child Dependant; 2.5 Employee Shall mean an employee as defined in terms of the Basic Conditions of Employment Act No 75 of 1997 and who qualifies for medical scheme membership in terms of this policy; Any person appointed on the full time permanent staff of the Employer. 2.6 Employer Means Parmalat SA (Pty) Ltd 2.7 Late Joiner Means an applicant or the Adult Dependant of an applicant who, at the date of application for membership, is 35 years of Parmalat SA (Pty) Ltd Medical Aid Policy 4

5 2. DEFINITION OF TERMS age or older and has not been a member or a dependant of a member of any medical scheme for a period of two years immediately prior to applying for membership; 2.8 Member An Employee participating in the Preferred medical scheme/s 2.9 Partner A person with whom the member has a committed and serious relationship akin to a marriage based on objective criteria of mutual dependency and a shared and common household irrespective of the gender of either party; To be approved by the Employer Human Resources Department Pensioner Member" 2.11 Percentage or contribution amount 2.12 Preferred medical scheme(s) 2.13 Principal member 2.14 Senior Employees A Principal member who has retired on pension from the service of the Employer, or is booked on permanent disability from the employer, or his/her remaining eligible relatives after his/her death, and who is eligible for medical aid subsidy Means the percentage contributed or alternatively the fixed Rand amount paid by the Employer towards an Employee s medical scheme contribution; Means the medical scheme(s) selected by the Employer from time to time; Shall mean the Employee who participates in the Preferred medical scheme/s. Refers to the group of Employees of Parmalat SA who are remunerated on a Cost to Company Basis Spouse Shall mean the spouse of the Principal member married in terms of any law or custom; A Partner 2.16 Subsidy The subsidy arrangements relating to the portion or percentage of medical scheme contribution paid by Employer towards the Medical scheme on behalf of Employees and where applicable certain pensioner members (Refer 4.2); Parmalat SA (Pty) Ltd Medical Aid Policy 5

6 2. DEFINITION OF TERMS 2.17 Underwriting The Medical Schemes Act No. 131 of 1998, including the Regulations, allows medical schemes to impose the following waiting periods to medical scheme members joining the medical scheme, i.e. a 3-month general waiting period may be imposed and/or 12-month specific condition waiting periods may be imposed on new applicants; 2.18 Value of the benefit Means the various categories of benefits within a benefit option of the Preferred medical scheme/s. These categories are reviewed and may be amended unilaterally by the Preferred medical scheme/s on an annual basis. For example, the extent of hospitalisation coverage of members. * Please note that these definitions may differ from the Preferred medical scheme(s) definitions for dependants Parmalat SA (Pty) Ltd Medical Aid Policy 6

7 3. MEMBERSHIP 3.1 Membership of employees It is compulsory for all permanent Employees, except for staff specified in paragraph to become members, from the date of entering service, of the medical scheme approved by the Employer Membership of the Preferred medical scheme is not compulsory for the following categories of employees: Employees below the C-Level on the Paterson Grades Staff covered on their spouse s medical scheme and Pensioners The Employer reserves its rights to review and amend, in its sole discretion, the income level/other grading mechanism that will require compulsory membership of the Preferred medical scheme/s. Any such amendment will become effective 30 days from the date the Employer provides written notice to Employees Employees specified in paragraph may apply for membership to the Preferred medical scheme on a voluntary basis Membership of the preferred medical scheme will be with effect from the 1st of a month. In the event that employment occurs during the month or a change in membership occurs during the month, membership of the Preferred medical scheme will only take effect on the first of the following month, provided that notification has been given to the Human Resources division before the 4th of the following month In the event of an Employee and their Spouse both being employed by the Employer, both do not need to register as Principal members of the Preferred medical scheme/s. The family may decide which Employee will be registered with the Preferred medical scheme/s as the Principal member and which as the dependant of the Principal member. Parmalat SA (Pty) Ltd Medical Aid Policy 7

8 3. MEMBERSHIP If a Principal member marries, that person may choose to remain a member of the Preferred medical scheme/s and to register their spouse and children with the Preferred medical scheme/s or to accept membership of the spouse's medical scheme. Documentary evidence of the last-mentioned option must be submitted to the Employer Should the Principal member, including dependants, decide to accept membership of the spouse's medical scheme and then at a later stage voluntarily elect to rejoin the Preferred medical scheme/s of the Employer, the application shall be subject to individual Underwriting by the Preferred medical scheme/s concerned Any change in the Member's dependants must be reported to the Employer in writing or by , within 30 (thirty) days after such change, in order that the membership lists and medical contributions may be adjusted accordingly Should an Employee, who is eligible for medical aid subsidy after retirement, die, the Employee s registered Spouse and if not applicable, the older of the registered dependants, will be regarded as the Principal member of the Preferred medical scheme/s. 3.2 Membership of dependants The registration of dependants is subject to the Rules of the Preferred Medical Scheme/s All Child Dependants, as defined, will qualify for membership Adult Dependants will qualify for membership of the Preferred Medical Scheme subject to the following: - Rules and underwriting of the Preferred Medical Scheme - 100% of the contribution will be payable by the employee - The Employer will continue to effect the deduction Parmalat SA (Pty) Ltd Medical Aid Policy 8

9 3. MEMBERSHIP 3.3 Membership of pensioner members Pensioner members, who are in receipt of a post retirement subsidy, may continue with their membership of the Preferred medical scheme/s. Other pensioner members, may continue their membership in their private capacity? Should a Pensioner member, who is in receipt of a post retirement medical aid subsidy, die, the pensioner's registered Spouse and if not applicable, the oldest of the registered Child Dependants, will be regarded as the Principal member of the Preferred medical scheme/s Employees who are on permanent disability will be treated as Employees until their retirement on pension from the service of the Employer, after which time the rules applying to Pensioner members will apply (Refer to and 3.3.2). 3.4 Termination of membership Once an employee has joined the Preferred medical scheme, membership may only be terminated on the following basis: On permanent service termination from the Employer In order to join the Spouse s medical scheme, proof of membership to the spouse s scheme must be provided within 30 (thirty) days of the commencement of membership and annually thereafter, to the Regional Human Resources Department Where the principal member cancels the membership of a Child Dependant, the reregistration of the dependant concerned will take place in terms of the rules of the Preferred medical scheme/s. Parmalat SA (Pty) Ltd Medical Aid Policy 9

10 3. MEMBERSHIP Where the Principal member has cancelled membership to transfer to their spouse s medical scheme and reregister at a later stage whilst still employed, the Employer will allow the employee to re-register on the Preferred medical scheme, subject to any underwriting that the Preferred Medical scheme may impose Written request by an employee to terminate membership of the Preferred medical scheme other than for reasons above shall be determined by the Head of Human Resources at his/her sole discretion Pensioner members who previously was in receipt of a post retirement subsidy and subsequently terminate membership of the Preferred medical scheme, will be able to re-register as a member of the Preferred medical scheme/s, subject to approval by the Head of Human Resources and to any underwriting that the Preferred Medical Scheme may impose. 3.5 General conditions applying to membership of the Medical Scheme A Member or any of the dependants may not simultaneously be a member of the Preferred medical scheme/s and of another registered medical scheme or submit a claim for the same service to two medical schemes No waiting periods or late joiner penalties will be applied by the scheme if the Employee joins the scheme within 90 days of starting employment with the Employer or if employees join the Preferred medical scheme/s within 90-days of being promoted to C-Level on the Paterson Grade and the Employer having confirmed the promotion in the relevant section on the applicable medical scheme application form Applications for persons specified in paragraph will be subject to full Underwriting as determined by the Medical Schemes Act and Preferred medical scheme rules. Parmalat SA (Pty) Ltd Medical Aid Policy 10

11 3. MEMBERSHIP A newborn child must be registered with the Preferred medical scheme/s within 30 days of birth to be accepted free of Underwriting Principal members and their dependants are bound by the Rules of the Preferred medical scheme. Parmalat SA (Pty) Ltd Medical Aid Policy 11

12 4. SUBSIDY 4.1 Employer subsidy medical scheme contributions for in-service members The subsidy arrangements relating to the portion or percentage of medical scheme contribution paid by the Employer towards the Preferred Medical scheme/s on behalf of Employees, are set out below: Until otherwise notified in writing, in the case of an Employee, other than a Senior Employee, the Employer subsidy is based on a percentage of the total medical scheme contribution of the selected option up to maximum of the benchmark option as selected by Employer and as amended from time to time. Should the Employee select a different option than that currently subsidized by the Employer, then any additional contribution payable to the Preferred medical scheme shall be borne in full by the Employee. If an Employee selects a lower cost option than the benchmark option, the Employer s subsidy will be based on a percentage of the total medical scheme contribution of the lower cost option and the Employee shall not be entitled to any compensation for the difference in the cost In the case of Senior Employees the Employer subsidy forms part of an employee s total cost to company package and no additional subsidy is given by the Employer with respect to medical scheme contributions. In all circumstances, the Employer will deduct the medical scheme contribution from the Employee s monthly salary; Should the contribution payable be increased or decreased by the Preferred medical scheme, the subsidy by the Employer will be adjusted accordingly, subject to the benchmark option, without amending either the contract of employment or notice being furnished to the affected Employee; The Employer will subsidize the spouse and eligible dependants of an Employee on the same basis as the subsidy arrangement of the Employee. The Employee, upon request, must furnish satisfactory motivation as defined under Partner prior to the Employer agreeing to subsidizing the Partner of an Employee; Parmalat SA (Pty) Ltd Medical Aid Policy 12

13 4. SUBSIDY Employees and their dependants referred to in paragraph will be subsidized; until their retirement on pension In the event that the Employee, other than a Senior Employee, is divorced from their Spouse, the Employer will no longer subsidize towards the contribution payable by the Spouse. The Employer will subsidies the new Spouse if the Employee remarries. The Employee must inform the Employer of such a divorce within 30 days of date of divorce. The member can elect to retain membership in respect of the previous spouse as an adult dependant and will be responsible for 100% of the contribution Applicants may qualify as late joiners as defined in the Medical Schemes Act. If the Preferred medical scheme imposes a penalty on the monthly contribution payable, the Employer shall not be liable to subsidise or incur any cost associated with the late joiner penalty. Accordingly, the Employer will only subsidize that part of the contribution as determined prior to the imposition of late joiner penalties; Where the Principal member has cancelled membership to transfer to their spouse s medical scheme and re-register at a later stage whilst still employed, the Employer will subsidize the contribution if applicable The Employer does not make any provisions for loans relating to medical expenses; The Employer does not subsidize ancillary medical scheme products such as loyalty programmes, additional medical insurance plans, funeral policies other than the group policy in place; 4.2 Employer subsidy medical scheme contributions for pensioner members / contributions after retirement Parmalat SA (Pty) Ltd Medical Aid Policy 13

14 4. SUBSIDY Members who were permanently employed before 1 January 1999 and joined the medical scheme before 1 January 1999 and who have not waived their retirement subsidy are eligible for a retirement subsidy Should the number of dependants of a Pensioner member decrease after retirement, the subsidy of the medical contributions will be adjusted accordingly Where a subsidy is provided, after retirement, the particular benchmark option decided upon by the Employer as the basis for calculating its maximum contribution and the particular option of the medical scheme in which the Principal member is participating at the date of retirement, as well as the Spouse and Child Dependants, will determine the maximum monthly contributions the Employer will make to the pensioner with regard to the medical scheme Should a change in the marital status of the Principal member after retirement result in an increase of dependants, such additional dependants may be accepted by the medical scheme for membership, but will not qualify for any subsidy by Employer to the member's medical contributions As per paragraph 3.3.2, the principal member will in such cases qualify for the appropriate contribution by the Employer. Should a Spouse who has become a Principal member in this manner, re-marry, the Employer will not contribute toward any dependant/s of the new marriage. The contribution of the Employer with regards to the other existing dependants will in such cases be maintained The Employer does not make any provisions for loans relating to medical expenses The Employer does not subsidize ancillary medical scheme products such as loyalty programme, additional medical insurance plans, funeral policies other than the group policy in place. Parmalat SA (Pty) Ltd Medical Aid Policy 14

15 4. SUBSIDY The Employer does not subsidize any Pensioner member who does not participate in the Employers Preferred medical scheme. Parmalat SA (Pty) Ltd Medical Aid Policy 15

16 5. COLLECTION AND PAYMENT OF CONTRIBUTIONS 5.1 The Employer pays the medical scheme contributions to the Preferred medical scheme/s. 5.2 The Employer will make provision for the deduction of ancillary products which are health care related and offered on a group basis to employees, via payroll and make payments to the applicable third parties, e.g. loyalty programmes. 5.3 Any contribution by a Pensioner member due to the Preferred medical scheme/s must be paid by the Pensioner member to the Preferred medical scheme/s by means of an individual debit order. 5.4 The onus will be on the Pensioner member to inform the Employer or the appointed Health care Consultants or the Preferred medical scheme of any changes of address or of bank account details. Parmalat SA (Pty) Ltd Medical Aid Policy 16

17 6. RESERVATION OF RIGHTS 6.1 The Employer endeavours to provide a comprehensive health care programme that meets the needs of individual Employees. However, this objective must be viewed in the light of financial constraints, administrative capacity and personnel resources available to the Employer together with the best interests of Employees on a collective basis. 6.2 The Employer reserves the right in its sole discretion to change the: Preferred medical scheme/s; Benchmark option(s); Value of the benefit subsidised; or Percentage or amount that the Employer subsidies on behalf of each Employee s medical scheme contributions. 6.3 Any changes or amendments by the Employer may be implemented without prior negotiation or consultation with Employees and Pensioner members. Written notice of such changes will be provided to Employees and Pensioner Members prior to the effective date of the change. Parmalat SA (Pty) Ltd Medical Aid Policy 17

18 7. ANNEXURE TO MEDICAL AID POLICY Updated: 1 March 2009 The following terminology refers to the below mentioned: Preferred Medical Scheme : Discovery Health Medical Scheme Benchmark option: Classic Priority Subsidy percentage 50% Parmalat SA (Pty) Ltd Medical Aid Policy PARMALAT Health care policy final -12 Mar2009.doc 18