current R3 001 – R3 001 membership 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 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 31.8 years 29.3 years 28.1 years years Ave. 7.4% 3.2% 2.2% 1.9% 8.4% 2.7% 3.4% pensioner ratio (65+ yrs) 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 100% scheme rate within a sub limits applicable sub limits applicable network hospitals R750 deductible is payable for certain procedures. No Threshold Threshold: No Threshold B = R5 300 F = R8 000 Chronic conditions: PMB + Chronic conditions: Formulary Chronic conditions: Formulary R50 000 per family per annum PMB + R20 000 per family per PMB – capitated annum. Personal medical savings Personal medical savings Personal medical savings account: N/A account: 15% of GC account: 25% of GC General practitioners - Unlimited General practitioners – Limited General practitioners – limited to to 20 visits per beneficiary network of doctors
current membership R3 001 – R5 000 > R5 000 R3 001 000 >R5 000 Personal Medical Savings Accounts (PMSA) No PMSA 15% of total contributions 20% of total contributions No PMSA No PMSA 15% of total contributions 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% 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 sub limits applicable No overall hospital limit 150% of scheme rate sub limits applicable R750 000 overall hospital limit per family 100% scheme rate within a network hospitals R750 deductible is payable for certain procedures. No Threshold Threshold: B = R5 300 F = R8 000 No Threshold Chronic conditions: PMB + R50 000 per family per annum Chronic conditions: Formulary PMB + R20 000 per family per annum. Chronic conditions: Formulary PMB – capitated Personal medical savings account: N/A Personal medical savings account: 15% of GC Personal medical savings account: 25% of GC General practitioners - Unlimited General practitioners – Limited to 20 visits per beneficiary General practitioners – limited to network of doctors
GudlnSchmAmlgmtn20150319.docx