Legal Aid South Africa Attention: Bestmed Medical Fund Member

Transcription

1 Legal Aid South Africa Attention: Bestmed Medical Fund Member Dear Bestmed Member, renewal is the one time of the year where you are given the choice to change your medical aid option. It is a change that will directly influences you and your family s health, so make sure you choose the level of cover that best suits your needs effective from 1 January Take some time to understand the changes in your scheme for 2015 so that you have all the information you need to make good choices and enjoy good health. Are you satisfied with your existing medical aid option? Changing your medical aid option is not compulsory, so if you are satisfied with your current option and believe it will continue to meet you and your family s health needs for the coming year, you are welcome to continue with your chosen option. You will not need to complete any forms for this, but you will want to note any changes for 2015 that may apply to your plan. Do you want to change your existing scheme or plan? To change your medical aid option, complete the Scheme option change form in your communication pack, and send it to medicalaid@legal-aid.co.za by no later than 28 November Please note that if you do not notify your HR Department of your plan choice before the deadline, you will stay on your current option and will have your next chance to change no earlier than 1 January What are the Key Questions I need to ask? Was my day to day cover sufficient for this year? How much would I need for next year? Which plan will cover my Chronic medicine needs best?

2 Contribution increases for 2015 Bestmed has announced an overall weighted average increase of 8.59%. However, this does vary per option as follows: Beat 1 Beat 2 Beat 3 Beat 4 Pace 1 Pace 2 Pace 3 Pace 4 Pulse 1 Pulse 2 9.5% 10.84%* 9.5% 10.5% 6.14% 9% 9.5% 9.5% 9.5% 9.5% *Enhanced savings levels have been introduced on Beat 2, which translates into a total contribution increase of 11.8% New benefits for 2015 All the Beat options will each get an efficiency discount sub-option (EDO). The EDOs will differ from the normal options in terms of lower contributions, a network of hospitals and a R5 000 copayment payable on admission should the member choose not to use a network hospital. No copayments will apply to endoscopic procedures that are performed out of hospital on Beat 1, 2 and Beat 3. A preventative care benefit of one dietician consultation per family per year has been introduced on Beat 4, Pace 2, Pace 3 and Pace 4. Members will have access to an electronic list of network GPs, Specialists and Allied Providers on the Bestmed website. The network providers will be linked to Google Maps. Benefit limits and copayments Most of the benefit limits for each option have been increased by the respective risk contribution increase percentage Copayments on endoscopic procedures have increased by 9% Dentistry limits have been increased at rates higher than the respective risk contribution increase for selected options Dentistry limit increase Beat 4 21% Pace 1 16% Pace % Pace % Pace % A benefit limit has been introduced for dual chamber pacemakers and this will be subject to the overall prosthesis limit. Annual limit Beat 1, 2, 3 and Pulse 1 R Beat 4 and Pace 1 R Pace 2, 3 and 4 R Pulse 2 R Benefit enhancements and changes for 2015 HPV vaccination will be covered as part of preventative care benefits for female dependants up to the age of 26 years on all the Pace options as well as on Beat 4 The medical savings account has increased from 17% to 18% on Beat 2 The medical savings account has been reduced from 22% to 21% on Pace 1 The wound care benefit will no longer be subject to the overall day-to-day limit and will have a separate benefit allocation on Beat 4, Pace 1, Pace 2, Pace 3 and Pace 4

3 The maternity benefit of 2 ultrasounds and 12 antenatal consultations is no longer subject to the overall day-to-day limits on all Pace options as well as on Pulse 2 The day-to-day benefit has been restructured on Pace 1 and Pace 2. Members will be allocated their full annual medical savings account in January 2015 and benefits will first pay from annual savings and then from risk. The medical aids, apparatus and appliances benefit has been replaced by three individual benefits (appliances, wheelchairs and hearing aids) and the limits have been adjusted accordingly for each option The benefit for hearing aids will be available every 24 months and the benefit limit has increased as follows: Pace 2 Pace 3 Pace 4 Pulse 2 Limit on hearing aids every two years R per beneficiary R per beneficiary R per beneficiary R per beneficiary On Pace 3, basic dentistry will also be subject to benefit limits of R for a single member and R per family and will no longer subject to medical saving account only A benefit of R1 500 per family per year for female contraceptives has been introduced on Pulse 2. Closing Our SERVE model drives the way we at Alexander Forbes do business. We strive to deliver Simple and Expert innovative solutions that build long-lasting Relationships founded on the Value of trust all this in the service of Enriching people s lives by providing them with impactful service. As an Alexander Forbes Health client, you can be assured of our unwaivering commitment to help you make good choices and enjoy good health in Get more information here: Browsing the website Alexander Forbes/company medical aid website: Brochure sent by Bestmed Bestmed Call Center Sandton (011) or hcclientservices@aforbes.co.za National walk-in centres Alexander Forbes Complaints: Online contactus@aforbes.co.za Tel Fax Send a letter by post to: Complaints Office P O Box Sandton 2146 Alexander Forbes Health is available to help your employees make good choices and enjoy good health in Yours in health Alexander Forbes Health To keep your finger on the pulse of the medical scheme industry finds us on Twitter Disclaimer: While all reasonable care has been taken in compiling this communication, we have relied upon the accuracy and completeness of the information made available to us by the respective Schemes and Product Suppliers. Consequently we cannot accept any liability for any errors or omissions that may arise as a result of the reliance on such information. Further please note that the Bestmed Medical Fund changes are still subject to approval by the Council for Medical Schemes. Alexander Forbes Health will keep you informed as to further information or changes that may become aware of..

4 Monthly contributions for 2015 Plan Principal member Adult dependant* Child dependant* Beat 1 R1 046 R812 R440 Beat 1 Network R941 R731 R396 Beat 2 R1 287 R1 000 R542 Beat 2 Network R1 158 R900 R488 Beat 3 R1 963 R1 394 R758 Beat 3 Network R1 766 R1 255 R682 Beat 4 R2 934 R2 423 R726 Beat 4 Network R2 640 R2 180 R654 Pace 1 R2 524 R1 772 R637 Pace 2 R3 529 R3 459 R778 Pace 3 ( R p.a) R3 467 R2 774 R643 Pace 3 ( R p.a) R4 165 R3 322 R697 Pace 4 R4 849 R4 849 R1 136 Pulse 1 (R0- R5 500 p.m) R1 029 R978 R618 Pulse 1 (R5 501 R8 500) R1 235 R1 174 R741 Pulse 1 ( R8 501) R1 483 R1 334 R741 Pulse 2 R3 551 R3 551 R844 *Contributions are charged up to a maximum of four children; dependants 21 years and older are considered adult dependants Child dependant rates will apply to children who are registered as students up to the age of 26 years old, documentation required. *all children are charged for on Pulse Medical Savings Account (included in the above monthly contribution, where applicable) Plan Principal member Adult dependant Child dependant* Annual Monthly Annual Monthly Annual Monthly Beat 2 R R 232 R R 180 R R 98 Beat 2 Network R R 208 R R 162 R R 88 Beat 3 R R 334 R R 237 R R 129 Beat 3 Network R R 300 R R 213 R R 116 Beat 4 R R 587 R R 485 R R 145 Beat 4 Network R R 528 R R 436 R R 131 Pace 1 R R 530 R R 372 R R 134 Pace 2 R R 529 R R 519 R R 117 Pace 3 ( R p.a) R R 624 R R 499 R R 116 Pace 3 ( R p.a) R R 750 R R 598 R R 125 Pace 4 R R 145 R R 145 R 408 R 34 * A maximum of four children are counted when calculating the annual savings Late joiner penalties Please note these rates are the standard Bestmed rates and do not take into account any late joiner penalties (LJP) that may be applied to an applicant or to the adult dependant of an applicant older than age 35. Depending on the number of years they have not belonged to a registered South African medical scheme, an additional penalty (a percentage of the contribution) may be added to the member's monthly contribution, as shown in the table below:

5 Penalty bands Maximum penalty 1 4 years 0,05 contributions 5 14 years 0,25 contributions years 0,5 contributions 25+ years 0,75 contributions The LJP is calculated as follows: A = B minus (35 + C) Where: A = the number of years in the first column B = the age of the applicant at the time of application C = the number of years of creditable cover