- Previous Option 2 Option Z - Previous Option D - Previous Option 3 Benefit options Current benefit structures A detailed description of the benefit options (benefit structure) before the amalgamation, in respect of the individual schemes which will be amalgamated, should be submitted. Please note that the table below merely serves as an example and should be adjusted to be relevant to the schemes to be amalgamated: Scheme A Scheme B Option A Option B Option C Option D Option 1 Option 2 Option 3 Type Traditional New New Capitated Traditional New Capitated – – Fee for generation – generation – – low cost – Fee for generation – low cost service negotiated fee for option service negotiated option fee for service fee for service service In-hospital Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited benefits Rate: Rate: 150% R1m limited R500 000 Rate: Rate: 150% R750 000 (overall limits 300% of of scheme per family per family 300% of of scheme per family & rate) scheme rate per annum per scheme rate per annum rate Rate: 100% annum rate Rate: 100% PMB of scheme Rate: of scheme rate 100% of rate scheme rate Out-hospital Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited benefits Limited to Limited to From Unlimited Limited to Limited to Unlimited (overall limits 200% of 150% of savings only capitated 200% of 150% of capitated & rate) scheme scheme rate scheme scheme rate rate rate PMB Chronic PMB + Formulary Formulary Formulary PMB + Formulary Formulary conditions R50 000 PMB + PMB PMB R50 000 PMB + PMB – per family R20 000 per per family R20 000 per capitated PMB per family per per family per - Non-PMB annum annum annum annum Contributions R3 000 R2 200 R1 100 R500 R2 500 R1 800 R1 000 pmpm R2 000 R1 100 R650 R250 R1 300 R900 R450 pbpm Income < R 1000 No income No income No < R1000 No income No income bands per R 1 000 – bands bands income R1 000 bands bands R3 000 bands 000
- Previous Option 2 Option Z - Previous Option D - Previous Option 3 Benefit options Current benefit structures A detailed description of the benefit options (benefit structure) before the amalgamation, in respect of the individual schemes which will be amalgamated, should be submitted. Please note that the table below merely serves as an example and should be adjusted to be relevant to the schemes to be amalgamated: Scheme A Scheme B Option A Option B Option C Option D Option 1 Option 2 Option 3 Type Traditional – Fee for service New generation – negotiated fee for service New generation – fee for service Capitated – low cost option Traditional – Fee for service New generation – negotiated fee for service Capitated – low cost option In-hospital benefits (overall limits & rate) PMB Unlimited Rate: 300% of scheme rate Unlimited Rate: 150% of scheme rate Unlimited R1m limited per family per annum Rate: 100% of scheme rate Unlimited R500 000 per family per annum Rate: 100% of scheme rate Unlimited Rate: 300% of scheme rate Unlimited Rate: 150% of scheme rate Unlimited R750 000 per family per annum Rate: 100% of scheme rate Out-hospital benefits (overall limits & rate) 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 < R 1000 R 1 000 – R3 000 No income bands No income bands No income bands < R1000 R1 000 000 No income bands No income bands
GudlnSchmAmlgmtn20150319.docx