Rate: 100% Rate: Rate: 100% of scheme 100% of of scheme rate scheme rate rate Out-hospital benefits (overall limits & rate) Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited PMB Limited to 200% Limited to From Unlimited Limited to Limited to Unlimited Non-PMB of scheme rate 150% of savings capitated 200% of 150% of capitated scheme rate only scheme rate scheme rate Chronic PMB + R50 000 Formulary Formulary Formulary PMB + Formulary Formulary conditions per family per PMB + PMB PMB R50 000 per PMB + PMB – annum R20 000 per family per R20 000 capitated PMB family per annum per family - Non-PMB annum per annum Contributions pmpm R3 000 R2 200 R1 100 R500 R2 500 R1 800 R1 000 pbpm R2 000 R1 100 R650 R250 R1 300 R900 R450 Income bands < R 1000 No income No income No income < R1000 No income No income per current R 1 000 – bands bands bands R1 000 bands bands membership R3 000 000 R3 001 – R3 001 R5 000 000 > R5 000 >R5 000 Personal No PMSA 15% of total 20% of total No PMSA No PMSA 15% of total 25% of total Medical contributions contributions Savings Accounts (PMSA) Average 3.4 2.7 2.1 2.6 2.6 2.3 2.1 family size Average age 34.8 years 32.5 years 28.0 years 29.3 years 31.8 years 29.3 years 28.1 years Ave. 7.4% 3.2% 2.2% 1.9% 8.4% 2.7% 3.4% pensioner ratio (65+ yrs) 2.6.2 Benefit design of amalgamated scheme A detailed description of the benefit options (benefit structure) of the amalgamated scheme should be provided. For example: Option X Option Y Option Z No overall hospital limit No overall hospital limit R750 000 overall hospital limit per family 200% of scheme rate 150% of scheme rate
Rate: 100% of scheme rate Rate: 100% of scheme rate Rate: 100% of scheme rate Out-hospital benefits (overall limits & rate) PMB Non-PMB Unlimited Limited to 200% of scheme rate Unlimited Limited to 150% of scheme rate Unlimited From savings only Unlimited Unlimited capitated Unlimited Limited to 200% of scheme rate Unlimited Limited to 150% of scheme rate Unlimited Unlimited capitated Chronic conditions PMB - Non-PMB PMB + R50 000 per family per annum Formulary PMB + R20 000 per family per annum Formulary PMB Formulary PMB PMB + R50 000 per family per annum Formulary PMB + R20 000 per family per annum Formulary PMB – capitated Contributions pmpm pbpm R3 000 R2 000 R2 200 R1 100 R1 100 R650 R500 R250 R2 500 R1 300 R1 800 R900 R1 000 R450 Income bands per current membership < R 1000 R 1 000 – R3 000 R3 001 – R5 000 > R5 000 No income bands No income bands No income bands < R1000 R1 000 000 R3 001 000 >R5 000 No income bands No income bands Personal Medical Savings Accounts (PMSA) No PMSA 15% of total contributions 20% of total No PMSA No PMSA 15% of total 25% of total contributions Average family size 3.4 2.7 2.1 2.6 2.6 2.3 2.1 Average age 34.8 years 32.5 years 28.0 years 29.3 years 31.8 years 29.3 years 28.1 years Ave. pensioner ratio (65+ yrs) 7.4% 3.2% 2.2% 1.9% 8.4% 2.7% 3.4% 2.6.2 Benefit design of amalgamated scheme A detailed description of the benefit options (benefit structure) of the amalgamated scheme should be provided. For example: Option X Option Y Option Z No overall hospital limit 200% of scheme rate No overall hospital limit 150% of scheme rate R750 000 overall hospital limit per family