The GTC Medical Aid Survey. Benefit and cost comparisons

Transcription

1 The GTC Medical Aid Survey Benefit and cost comparisons

2 formerly Grant Thornton Capital Let our 40 years of accredited experience in healthcare consulting guide you to a healthy future Our professional consultants can assist you to select the most appropriate healthcare solutions for you and for your company. Our healthcare consulting services include: An annual review of open schemes in the market An annual review of your scheme with guidance on plan types Co-ordination and management of wellness days Administration escalation and monitoring services A strategic review of your scheme compared with other selections Training of HR on your scheme s benefits and administration Client liaison service provider co-ordination Member guidance regarding queries and options For a personal consultation, please contact: Jillian Larkan Head-Healthcare Consulting t +27 (0) c +27 (0) e [email protected] An Authorised Financial Services Provider FSP No. 731

3 Disclaimer Index Whilst this survey compares open medical aid schemes with one another, it is not a complete medical aid report/analysis. This survey is not intended to flout the conditions set out in the Financial Advisory and Intermediary Services Act s General Code of Conduct for Authorised Financial Services Providers and Representatives. Board Notice 80 of 2003, Part III, Information on Product Suppliers 4 (4), which clearly states: A provider may not, in dealing with a client, compare different financial products, product suppliers, providers or representatives, unless the differing characteristics of each are made clear, and may not make inaccurate, unfair or unsubstantiated criticisms of any financial product, product supplier, provider or representative. The 2015 product information has been supplied by each of the product suppliers considered in this survey, and a copy of this survey has been returned to each of them for their consideration and comment. Detailed fact sheets are available from each Medical Aid Service Provider on their respective website, and have been used in the production of this survey. Please further note that although every effort was made to include all open medical aid plans in this survey, Community Medical Aid, MediMed, Selfmed, and Thebemed had still not released their 2015 benefits and rates as at 24 November We have therefore excluded them from this report. KeyHealth was further not included in our Survey. The following Medical Aid and Service Providers are included in our survey: Bestmed Bonitas Cape Medical Plan Compcare Fedhealth Discovery Genesis Hosmed Liberty Makoti Medihelp MediMed MedShield Momentum Profmed OcsaCare Resolution Sizwe Spectramed Suremed Topmed The purpose of this survey is to highlight the similarities and differences in Medical Aid and Service Providers plans, and their design. These plans have been grouped together (as closely as possible) to enable a better comparison between their biggest cost elements. E&OE Foreword for the GTC Medical Aid Survey 2 Introduction to GTC 3 About the author 4 Glossary 6 Executive summary 8 Introduction 12 Categories analysed 13 History of the GTC Medical Aid Annual Survey 14 Methodology 15 Basic cost comparisons 15 Overall or complete cost comparisons 16 Council for Medical Schemes annual report 17 Categorisation of plans 20 Results and comparison 27 Non-hospital plans 30 Starter beginner plans 32 Core plans 44 Saver plans 56 Comprehensive plans 86 Traditional plans 94 a Thornton, The Wanderers Office Park, 52 Corlett Drive, Illovo, 2196 p P.O. Box 55118, Illovo, 2116 An Authorised Financial Services Provider FSP no. 731 t +27 (0) f +27 (0) w GTC (Pty) Ltd. reg. no. 1996/001488/07 directors: G.K. Mockler, F. Dildar Employee Benefits Consulting Employee Benefits Administration Private Client Wealth Management Healthcare Consulting Short-Term Risk Solutions Stockbroking Derivatives Trading Unit Trust Management Asset Management Fiduciary Services formerly Grant Thornton Capital 1

4 Foreword for the GTC Medical Aid Survey Introduction to the GTC Group It gives me great pleasure to introduce the inaugural GTC Medical Aid Survey a definitive review of products currently on offer, providing guidelines, advice and suggestions on a broad range of medical aid offerings in South Africa, highlighting the most suitable and best-value solutions for members. It is with some excitement that GTC undertakes this exercise. Whilst it is a first for our business, Jill Larkan, the author of the publication, has conducted this survey each year for several years before joining GTC. Under Jill s leadership, the GTC Healthcare division advises clients on the most appropriate healthcare programs for their purposes and thereafter manages the relationship between clients and providers, while keeping clients abreast of legislative changes and compliance, industry trends and other related topical issues. Whilst GTC (formerly Grant Thornton Capital) separated from Grant Thornton in to the extent necessary in terms of international regulations (Grant Thornton Johannesburg remaining a minority shareholder) - the collaboration between the audit practice and GTC on a project such as this is, is a logical one. 21st Century Pay Solution Group and GTC have established a formal joint venture and the communication of this year s Medical Aid Survey is one of the outcomes of this partnership. The relationship is built on the solid foundation of each party being expert in their own distinct areas of business, whilst enjoying a close synergy with the other. These core disciplines are notably remuneration and payroll consulting on the part of 21st Century and the range of employee benefits disciplines on the part of GTC. We both are enjoying the business interaction and the opportunity for aligned engagement through this initiative. GTC has a number of other business units that support and complement the Healthcare division and we would welcome the opportunity to meet with you to introduce our capabilities. If you would like a hard copy of this survey, or if you would like a personal introduction to this year s findings from one of our consultants, please contact Jillian Larkan on or at [email protected]. Regards Gary Mockler GTC Group CEO GTC is a leading, diversified financial services company, which was established 24 years ago. The business is nationally represented with offices in Johannesburg, Cape Town and Durban. Core capabilities, products and services include: Employee benefit consulting and administration Private client wealth management Healthcare consulting Asset management, with specific capabilities in stockbroking, derivatives trading, multi-management, transition management, asset consulting and investment analytics. Short-term risk solutions Unit trust management Fiduciary services Formerly Grant Thornton Capital, GTC was established in 1991 from within the Grant Thornton Johannesburg audit practice, itself part of Grant Thornton International. Effective late 2012 GTC was obliged to separate itself from the audit practice as a result of various international regulations separating the asset management and financial advisory capability of any business from that of Grant Thornton. This regulatory change resulted in the business changing its name from that of Grant Thornton Capital to GTC. Today GTC continues to have Grant Thornton as a shareholder. Gary Mockler, the founder of GTC, remains the Chief Executive Officer. Collectively the Group employs over 100 staff in three national centres. Assets under management total some R26 billion with several more billion rand also being under GTC s administration. There are participating members of retirement funds through some 300 participating employer schemes, most of these structured through one of several GTC umbrella funds. In addition, GTC consults to more than private clients in terms of their wealth management goals. GTC continually aspires to being recognised, in a crowded market place as a benchmark of best practice and innovative thinking. This objective is measured by ensuring that the interests of its clients are protected and placed at the core of all decisions, business practices, company culture and ethics. As testament to its business aspirations, GTC was recently awarded the PMR Golden Arrow award in the 2014 National Survey on Pension Fund Administrators, Consultants, Product Providers and Insurers. GTC participated in the Medium Sized Pension Fund Administrators and Consultants category. GTC was rated excellent in their capabilities of benefit consulting and administration by a random national sample of 200 respondents, comprising principal officers and trustees. The depth of GTC s services, the quality of the staff, the uncompromising stance on integrity and professionalism and the easy accessibility to senior management and shareholders justifies the extraordinary client retention that GTC enjoys. The GTC team lives its corporate brand promise - Consult Partner Manage. 2 3

5 About the author Biography Jillian Larkan Jill Larkan is head of Healthcare Consulting at GTC, an established financial advisory business. Jill has extensive experience of the financial services sector, in which she has worked for more than 30 years. Whilst having been at GTC for some three years, Jill notes business relationships with several of her GTC colleagues for more than 20 years. Prior to joining GTC in 2012, Jill ran her own successful broking and consulting business in the Western Cape, where she provided services to private and corporate clients. Before establishing her own business, Jill gained large corporate experience through a career path that included Old Mutual, Sage Life and Glenrand MIB. Jill is continuously growing and learning and she has attained her Advanced Post Graduate Diploma in Financial Planning from the University of the Free State. She is a Certified Financial Planner, an internationally recognised financial advisory designation, awarded by the Financial Planning Institute. Jill is a member of the Insurance Institute of South Africa and the Financial Planning Institute. Jill s management style is based on knowledge sharing, believing that regular engagement and continuous information sharing creates an informed audience. Jill enthusiastically states I am passionate about people, honesty and integrity, and about helping clients make the best decisions possible for their future. Jill, a mother of three, is an enthusiastic sportsperson, having played soccer and hockey in her earlier years, and still actively participates in a wide variety of outdoor sports including mountain biking, cycling, water skiing, tubing, boating and hiking. Jillian Larkan Head - Healthcare Consulting t +27 (0) c +27 (0) [email protected] 4

6 Glossary In Hospital % This refers to the amount of cover that your medical aid will pay for In-Hospital procedures and events. This percentage is based upon the previously accepted National Health Reference Price List. NHRPL - National Health Reference Price List This was a list of all medical procedures and events. This list included a monetary amount per procedure or event, and this was referred to as the 100% rate. This was generally the amount which government hospitals and doctors charged. Medical aids have developed their own derivatives of this list, upon which they base their benefits. OAL - Overall Annual Limit The overall limit that the medical aid is prepared to cover for the year, inclusive of all medical procedures events and costs. ATB - Above-Threshold Benefit A threshold amount set by the plan every year. A prescribed limit of Out-of-Hospital medical expenses that must be reached before your medical aid starts to assist with medical expenses again. The accumulation of benefits, up to this limit, is done at 100% of NHRPL, and once in the ATB, benefits are only payable at between 80% and 100% of NHRPL. SPG - Self Payment Gap A gap that exists between the amount of money that is provided in your savings account and/ or OHEB, and the threshold set by your plan. You will be expected to cover all your own Out-of- Hospital medical expenses while you are in the Self Payment Gap. Basic Costs These are the costs of the In-Hospital Benefit, stripping out the savings element and/or any Out-of- Hospital Benefit provided by the scheme and reducing the premium to its Basic Cost, revealing the In-Hospital rate. Overall/Complete Cost This is the overall cost of having this scheme. This cost is the Overall cost which the member will be asked to bear in a year, to cover the premium, and the Self Payment Gap and extend the Outof-Hospital cover into the Above Threshold Benefit. This excludes any additional costs that the member may have to bear for hospital procedures, excesses above sub-limits set by the scheme, co-payments or for Out-of-Hospital treatment costs that exceeds 100% of NHRPL and assumes that all expenses are charged and covered at 100% of NHRPL only. Hybrid This plan range simulates a standard plan, however it offers additional benefits over and above those of a standard plan. e.g. A savings plan would limit its benefits to allow members to use their full savings account no more, whilst the hybrid plan offers additional benefits over and above the savings account limit. Such additional benefit as wellness programmes, dentistry, a number of or unlimited GP visits, etc. may be provided by medical aids. Network A selected network of hospitals, doctors, specialists or pharmacies chosen by your plan. Your service provider has negotiated favourable rates with them and would prefer that you confine your visits and services to these facilities only. Emergencies will be treated separately and allowed outside of the network. MSA - Medical Savings Account An amount of money set aside by your plan for your Out-of-Hospital expenses. This account is funded by your premiums. This annual amount is allocated for the calendar year, in advance, in January of every year. All Out-of-Hospital expenses are funded from this account until it is exhausted. OHEB - Out-of-Hospital Expenses Benefit Like a Savings Account provided by our plan. Also used to fund Out-of-Hospital expenses for the year, and made available in January of every year. 6 7

7 Executive summary 1. No shortage of choice It is hardly news that consumers have a vast range of medical schemes and plans to choose from. As always, the correct decision demands that all factors be considered, especially one s personal circumstances and needs, which outweigh all other factors. 2. Top-up or lose out Top-Up insurance is imperative in today s market, and we strongly recommend that this inexpensive additional benefit is made use of. In all our comparisons we acknowledge the need to enhance the In-Hospital cover to 500% to enable a fair comparison of benefits. According to the Council for Medical Schemes in an October 2014 report, 35.5% of all medical aid costs are In-Hospital followed by medical specialists (24.5%), most of whom earn their revenue from hospital-related procedures. Overview of the findings Below is a summary of the research findings into the most competitive service providers for 2015 for single members, married couples (member and spouse) and families (member, spouse and 2 children): Choosing a medical aid that provides the right mixture of cover, peace of mind and value for money is a task that every South African can relate to. With all the providers choosing to promote and position their offering in unique ways, it is incredibly difficult to compare apples with apples. The GTC Medical Aid Annual survey attempts to provide some clarity for medical aid members who have to make critical decisions while mired in both marketing and technical jargon that does little to ease the decision-making. The 2015 edition of this survey has made some headway in alleviating this burden by separating hybrid plans and presenting its findings on the best medical cover according to distinct groups of plan types. This process has been eased somewhat by many of the medical aid schemes realigning their product offerings along similar lines, with most of them identifiable as hybrid schemes. Plan Range Starter Comprehensive - No Network Starter Comprehensive - Network Starter Comprehensive State Network Starter Core - Network Non-Hospital Plans Core Network Preferred Cost vs Benefit provider for 2015 Per family Liberty Traditional Standard CompCare NetworX CompCare NetworX State Discovery KeyCare Core Unable to make a finding BestMed Beat 1N The 2015 survey has therefore grouped hybrid and standard schemes together and rated them accordingly. We still reflect this in a special division for each hybrid range, as these plans offer additional benefits over and above the Savings Account. This has also had the effect that all In- Hospital costs are not strictly accurate, given that many of the additional, special Out-of-Hospital benefits relating to the hybrid plans particularly, are funded from this risk portion. All of that said, there are some key findings in this year s edition of the survey that medical aid members need to bear in mind. Core No Network Genesis Private Choice Saver - Network CompCare MuMed NN R 501 R Saver No Network Profmed ProActive R 0 R 5000 Comprehensive - Network Fedhealth Maxima Standard Net Comprehensive No Network Fedhealth Maxima Basis Traditional Unable to make a finding 8 9

8 Reason says: Reason Reason admire says: admire says: the the admire difference. admire difference. the the difference. difference. Instinct says: cherish Instinct Instinct the says: cherish the says: individual. cherish individual. cherish the the individual. individual. At Grant Thornton, we recruit people with a passion for business, At Grant who Thornton, combine we reason recruit and people instinct with to a passion give the for kind of business, advice that who makes combine a real reason difference and instinct to the organisations to give the kind they At of Grant advice work Thornton, that with. makes we a recruit real difference people with to the a passion organisations for business, they At Grant work who with. Thornton, combine we reason recruit and people instinct with to a give passion the kind for They of business, advice know that it s who makes about combine a more real reason than difference just and the instinct to the numbers, organisations to give it s the about kind enjoying they They of advice work know tough with. that it s challenges, about makes more a real than seeking difference just out the to opportunities numbers, the organisations it s about and enjoying they adding work tough real with. value challenges, to our seeking clients by out unlocking opportunities their potential They and adding know for it s real growth. about value more to our than clients just the by unlocking numbers, it s their about enjoying potential They know tough for growth. it s challenges, about more seeking than just out the opportunities numbers, it s about and enjoying adding tough real value challenges, to our clients seeking by out unlocking opportunities their potential and adding for growth. real value to our clients by unlocking their potential for growth Grant Thornton South Africa. All rights reserved. Grant Thornton South Africa is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. Services are delivered by the member firms. GTIl and its member firms are not agents of, and do not obligate, one another and are not liable for one another s acts or omissions. Please see for further details Grant Thornton South Africa. All rights reserved. Grant Thornton South Africa is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the 2015 member Grant firms Thornton are not South a worldwide Africa. All partnership. rights reserved. Services Grant are Thornton delivered South by the Africa member is a firms. member GTIl firm and of its Grant member Thornton firms International are not agents Ltd of, (GTIL). and do not obligate, one another and are not liable for one another s acts or omissions. Please see for further details. GTIL and the member firms are not a worldwide partnership. Services are delivered by the member firms. GTIl and its member firms are not agents of, and do not obligate, one another and are not liable for one another s acts or omissions. Please see for further details Grant Thornton South Africa. All rights reserved. Grant Thornton South Africa is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. Services are delivered by the member firms. GTIl and its member firms are not agents of, and do GTC_SAPSA.indd /04/24 10:18 AM not obligate, one another and are not liable for one another s acts or omissions. Please see for further details Grant Thornton South Africa. All rights reserved. Grant Thornton South Africa is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. Services are delivered by the member firms. GTIl and its member firms are not agents of, and do GTC_SAPSA.indd /04/24 10:18 AM not obligate, one another and are not liable for one another s acts or omissions. Please see for further details.

9 Introduction Whilst this survey compares open medical aid schemes with one another, it is not a complete medical aid report/analysis. The purpose of this survey is to highlight the similarities and differences in Medical Aid and Service Providers plans, and their design. These plans have been grouped together (as closely as possible) to enable a better comparison between their biggest cost elements. (See Disclaimer on inside front cover). Categories analysed Network and Non-Network plans: many service providers offer members the opportunity to choose a cheaper option by agreeing to be limited to a Network of hospitals. It would be unfair to compare this limited range of hospital choice type of plan with those that are unlimited. Beginner / Starter Plans: these plans offer members the option of using a limited Network for In-Hospital benefits, along with the Network of Out-of-Hospital Service providers, such as dentists, GPs, opticians, radiologists etc. Premiums are usually salary banded, creating an effective crosssubsidisation between high and low earners. These types of plans are generally Capitation plans, as Network Service Providers are paid a set fee for the number of people serviced/situated in their geographic area, and who are likely to make use of that service provider (per Capita). This type of plan is comparable to the Traditional plans of old and its premium is generally based on different salary levels. This survey has given more weight to the plans that charge lower premiums for the lower salary levels given their applicability to this sector. Core: these are In-Hospital only plans that cover In-Hospital costs and Prescribed Minimum Benefits, and/or chronic illnesses, at the level offered by the selected plan. : these plans offer members In-Hospital benefits with the option of having a small or limited Out-of-Hospital Benefit, usually provided in the form of a Savings Account. Comprehensive with Limited Above-Threshold Benefits Plans: this type of plan has been included in the Saver plan section as it is effectively a Saver plan, with two savings accounts, some of which are separated by a Self Payment Gap. While it may seem unfair to include this plan in the Saver plan section, for the purposes of our survey, you will note that these plan types have been separately compared (outside of the Savings section as well), providing members within these plan types an indication of their plan s performance relative to its peers. Comprehensive Plans: these offer members In-Hospital and Out-of-Hospital benefits that rely on different types of accounts, most commonly known as Savings Accounts. These plan types generally have a Self Payment Gap and an unlimited Above-Threshold Benefit. Executive Plans: this separated plan range has also been removed from this year s report, as it is effectively a Comprehensive Plan with enhanced Benefits (savings and chronic). We have therefore included them in the Comprehensive Plan section and also shown their ratings separately, specifically for our members who are in these plan ranges who wish to compare their performances against others in their peer group. Traditional Plans: an effective comparison of Traditional plans has remained extremely difficult as various medical aid schemes offer a myriad of additional benefits. Given this, the survey has not made any comparisons and merely lists their existence

10 Introduction (continued) Hybrid Plans: While a separation of this category is no longer necessary, you will find the comparison of each hybrid category within its relative group. It is acknowledged that this remains an unfair comparison as the additional costs for these added benefits provided by hybrid plans are funded from the Risk portion of the premium. In addition, these costs have not been deducted in the calculation of the Basic cost. The ratings for these options have been listed separately for ease of comparison for members who are on plans that fall within these categories. Doctor Network Plans: these plans provide Out-of-Hospital benefits only, offering access to a Network of Doctors, but exclude any In-Hospital Benefits. Should a member require hospitalisation, this will be provided by public sector facilities. History of the GTC Medical Aid Annual Survey The GTC Medical Aid Annual survey originated from the need to make informed recommendations to clients on preferred plans and benefits for the coming year. In order to provide clients with proper advice, this required an annual investigation into all available plans, whilst still fulfilling the requirements of the FAIS Act. Over the years, this investigation has evolved into an annual survey that has become a standard referred to by our clients and the industry alike. According to the Council for Medical Schemes Annual Survey released in October 2014, 35.5% of all medical aid costs are In-Hospital, followed by medical specialists (24.5%), most of whom earn their revenue from hospital-related procedures. In-Hospital costs borne by medical schemes therefore could account for approximately 60% of contributions. In an effort to identify the In-Hospital only elements of the medical aid plans, it is understood that many service providers have included an Out-of-Hospital element in their plan designs. These expense accounts assist members with Out-of-Hospital expenses and the cost thereof must be deducted from the overall contribution. Many medical aids schemes have further complicated this comparison by adding additional benefits, such as wellness programmes, immunisations, maternity programs, contraception, MRI and CT scans, and even dentistry benefits. To accommodate these additional benefits, these hybrid type plans have been included in the general overall plan group, but also separated into their own Hybrid Category and re-rated accordingly. These Hybrid plans have been listed and rated separately in previous GTC surveys, but as the majority of plans now include wellness programmes, additional GP visits, or special additional benefits in an effort to differentiate themselves from the balance of the schemes out there, they have been included in the general groups. In preparing the 2015 survey, therefore, it was decided not to separate these schemes, but merely indicate the existence of additional benefits by placing such plan ranges into a special division called the Hybrid range and highlighting that these plans offer additional benefits outside of the Savings Account. It would be difficult to place a value on these additional benefits, which skew In-Hospital costs, given that many of the additional special Out-of-Hospital benefits are funded from the risk portion. Methodology It is important to note that this survey is concerned mainly with the major medical expenses members are likely to incur. These expenses relate mostly to In-Hospital costs, as this is where the bulk of medical aid resources are consumed. Some of the medical aids analysed and compared do provide Out-of-Hospital cover, however, the benefit structures of the Out-of-Hospital benefits between plans were not compared. This exercise can be undertaken upon request (between selected plans), however due to time constraints, this level of analysis has been excluded from this survey. An important difference in the analysis applied in this year s survey relates to how Top-up or Gap cover is accounted for. In previous years we had standardised the In-Hospital benefits by making all plans 500% In-Hospital cover plans. To do this, the benefit provided by the plans were enhanced by the appropriate additional level of Top-up or Gap insurance cover to enable a like for like comparison of In-Hospital benefits across all plan types and ranges. The Top-up Gap providers have standardised their cost for the additional benefit, into a single premium, regardless of the level of additional cover required to enhance In-Hospital benefits to 500%. It would cost the same to enhance 100% as it would a 300% plan. For this year s survey the practice of adding this premium to all medical plans has not been done, with the comparison made on the understanding that the same rand value would be added to all plans to make them all 500% plans. Underwriting and previous medical conditions may prohibit this cover for all members, but for purposes of this survey we have assumed that the Top-up/Gap cover will be provided to everyone. It is acknowledged that all plans provide Prescribed Minimum Benefit levels of cover from risk, inclusive of chronic illness benefits, and that these amounts of cover differ from plan type to plan type. We have not included this analysis in our survey. Some plans extend the number of chronic conditions they cover, which is funded out of Risk. This survey does not take this additional funding into account and provides no acknowledgement to those plans that have enhanced their chronic Illness benefits. Basic cost comparisons The methodology used to arrive at a basic cost for each plan type was to strip each plan down to its basic costs. These basic costs reflect that part of the premium the medical aid is charging, which can be ascribed to their risk costs

11 Introduction (continued) In other words, the Out-of-Hospital benefits (like savings accounts, but not PMBs) have been stripped away. As the Top up/gap cover cost is now calculated at the same rate for all plans, this year s survey has dispensed with the past practice of adding this cost to raise the level of In-Hospital cover to 500%. All premiums in the cost comparison are therefore as quoted by the service providers. Should any of the plans have an Overall Annual Limit, this has been extended to a minimum of R2 million per annum. This additional premium has been added to the premium provided by the service provider, which reflects the overall annual Basic cost per plan type. These Basic costs have been used to arrive at the preferential service providers for Core and Saver type plans. Overall or Complete cost comparisons Comprehensive plans offer members the choice of having a savings plan (or not), and provide an Above-Threshold Benefit, which in most cases is an unlimited additional savings type account to fund Out-of-Hospital expenses. These two accounts are usually separated by a Self Payment Gap. To properly indicate a medical aid member s overall annual expense for the year, one would have to assume that members on the comprehensive plans would make use of their full savings and then cover their Self Payment Gap on their way to reaching the Threshold. They would then benefit by using a substantial amount of the Above-Threshold Benefit, which is unlimited. To arrive at an overall or complete cost for each Comprehensive plan, it is therefore necessary to calculate a total premium for the year, add any Overall Annual Limit extender premium (if required), as well as any Self Payment Gap from their own pocket. This could be expressed as: Premium + Gap + Overall Annual Extender + Self Payment Gap = Complete cost. This calculation assumes that all costs for the year will be accumulated and paid out at 100% of the Medical Aid rate, thus not extending the Self Payment Gap experienced by the member. In reality this does not happen and many of the costs payable are at private rates, which extend or seem to increase the Self Payment Gap. For this reason, the Overall or Complete cost indicated is a theoretical figure that would apply only in extremely rare circumstances. It must be noted that the Self Payment Gap is calculated assuming that members costs for the year are all only at 100%. This calculation is only relevant to Comprehensive Plans, as there is no Self Payment Gap or Above-Threshold Benefit on either the Saver or Core plans. Family size comparisons To further assist with the analysis of costs, these have been divided into three family sizes and our results are reflected accordingly. Family size Primary member Primary member + adult dependant Primary member + adult dependant + 2 children P P + A P + A + 2C Council for Medical Schemes annual report No weight was afforded the annual survey issued by the Council for Medical Schemes, which is available from its website. However, some of the more interesting statistics gathered from the survey, which relate to the service providers that are considered in our own survey, are as follows: (This comparison of the 2010, 2011, 2102 and 2013 statistics provided by the Medical Schemes Council shows whether the scheme is growing or not, has more, or less, pensioners and whether it meets the 25% minimum solvency levels required. These are all very important macro level indicators of the schemes well being)

12 Introduction (continued) Comparable No of Principal Members Pensioner Ratio Solvency Ratio % Bestmed Bonitas Cape Medical Plan Compcare Discovery Fedhealth Genesis Hosmed Liberty Medihelp MediMed MedShield Momentum Resolution Health Selfmed Sizwe Spectramed Suremed Topmed % 2012 % 2013 % 2010 % 2011 % 2012 % 2013 % 18 19

13 Introduction (continued) Categorisation of plans Below are the tables reflecting which categories the different plans have been placed into. NON Hospital Plans Discovery Primary Care Makoti Primary OcsaCare Network Plans Starter Beginner Plan - COMPREHENSIVE Discovery KeyCare Plus Fedhealth Blue Door Plus Sizwe Gomomo Care Bonitas BonCap Momentum Ingwe Network Momentum Access BestMed Pulse 1 TopMed Network Medshield MediPhila CompCare NetworX Makoti Comprehensive Liberty Traditional Basic Hosmed Essential Resolution Foundation Suremed Explorer Starter Beginner Plan - COMPREHENSIVE STATE Discovery KeyCare Access CompCare NetworX Momentum Ingwe - STATE Starter Beginner Plan - CORE Discovery KeyCare Core Network Plans CORE Network Fedhealth Maxima EntryZone Momentum Custom Assoc Any Momentum Custom Assoc Assoc Momentum Custom Assoc State Discovery Classic Delta Core Discovery Essential Delta Core Discovery Coastal Core BestMed Beat 1 N Spectramed Aqua Hybrid Core Network Medshield Core Plus CompCare Axis N Liberty Hospital Select SAVER Network Fedhealth Maxima EntrySaver Momentum Incentive Assoc Any Momentum Incentive Assoc Assoc Momentum Incentive Assoc State Discovery Classic Delta Saver Discovery Essential Delta Saver Discovery Coastal Saver BestMed Beat 2 N Hybrid Limited Comprehensive Network CompCare Pinnacle - Network CompCare Dynamix - Network Liberty Complete Select Hybrid Saver Network BestMed Beat 3 N Medshield MediBonus Medshield MediPlus Medshield Premium Plus Medshield MediValue Medshield Standard 20 21

14 Introduction (continued) No Network Plans Plans Starter Beginner Plan - COMPREHENSIVE Momentum Ingwe - ANY Network Plans SAVER Network (continued) CompCare Symmetry N CompCare Mumed N R 0 - R 6000 CompCare Mumed N R R CompCare Mumed N R R CompCare Mumed N R CompCare Mumed NN R R 7900 CompCare Mumed NN R R CompCare Mumed NN R Liberty Saver Select Hosmed Access R 0 - R Hosmed Access R R Hosmed Access R Resolution Progressive Flex Topmed Active Saver Comprehensive Fedhealth Maxima Standard Net Momentum Extender Assoc Any Momentum Extender Assoc Assoc Momentum Extender Assoc State Discovery Classic Delta Comprehensive Discovery Essental Delta Comprehensive Traditional CompCare Excess Direct Suremed Challenger TopMed Limited Bonitas BonClassic Liberty Traditional Standard BestMed Beat 1 Discovery Classic Core Discovery Essential Core Fedhealth Maxima Core Momentum Custom Any Any Momentum Custom Any Assoc Momentum Custom Any State TopMed Hospital Hybrid Core No Network Bonitas BonEssential Cape Medical Plan Premium CompCare Axis Genesis Private Genesis Private Choice Liberty Hospital Plus Liberty Hospital Standard Resolution Hospital Suremed Shuttle BestMed Beat 2 Bonitas Standard Cape Medical Plan - Select Discovery Classic Saver Discovery Essential Saver Fedhealth Maxima Saver Fedhealth Ultima 200 CORE No Network SAVER No Network 22 23

15 Introduction (continued) No Network Plans SAVER No Network (continued) Momentum Incentive Any Any Momentum Incentive Any Assoc Momentum Incentive Any State Momentum Summit Spectramed Azure + R Spectramed Azure < R Spectramed Azure R R Spectramed Capri Spectramed Cobalt Spectramed Cyan + R Spectramed Cyan <R TopMed Savings Hybrid Limited Comprehensive No Network CompCare Dynamix CompCare Pinnacle Discovery Classic Priority Discovery Essential Priority Liberty Complete Standard Resolution Millennium Hybrid Saver No Network BestMed Beat 3 BestMed Beat 4 BestMed Pace 1 BestMed Pace 2 BestMed Pace 3 R 0 - R BestMed Pace 3 R BestMed Pace 4 No Network Plans SAVER No Network (continued) Hybrid Saver No Network (continued) Bonitas BonSave Bonitas Primary Cape Medical Plan - Silver CompCare Mumed R CompCare Mumed R R 6000 CompCare Mumed R R CompCare Mumed R R CompCare Symmetry Genesis Private Comprehensive Genesis Private Plus Hosmed Plus Hosmed Value R 0 - R 7000 Hosmed Value R Liberty Saver Plus Liberty Saver Standard Liberty Traditional Ultimate Profmed ProActive Plus Profmed ProActive R 0 - R Profmed ProActive R R 9000 Profmed ProActive R Profmed ProPinnacle Profmed ProSecure Plus Profmed ProSecure R 0 - R 9000 Profmed ProSecure R Resolution Classic Resolution Supreme Sizwe Affordable Care R 0 - R Sizwe Affordable Care R Sizwe Full Benefit R 0 - R Sizwe Full Benefit R

16 Introduction (continued) Results and comparison No Network Plans SAVER No Network (continued) Hybrid Saver No Network (continued) Sizwe Primary Care R 0 - R Sizwe Primary Care R Sizwe Savings Care R 0 - R Sizwe Savings Care R Suremed Navigator Limited Comprehensive No Network TopMed Paladin Comprehensive COMPREHENSIVE No Network Discovery Classic Comprehensive Discovery Classic Comprehensive R0 MSA Discovery Essential Comprehensive Fedhealth Maxima Basis Fedhealth Maxima Standard Momentum Extender Any Any Momentum Extender Any Assoc Momentum Extender Any State TopMed Professional Hybrid Comprehensive No Network Bonitas BonComprehensive Discovery Executive Extended Comprehensive Fedhealth Maxima Exec Fedhealth Maxima Plus Fedhealth Ultimax Liberty Complete Plus TopMed Rainbow Comprehensive 26 27

17 Results and comparison (continued) To enable an understanding of the methodology behind the comparisons, please see below an example of how these calculations are performed. For ease of understanding and demonstration, the Discovery Classic Comprehensive plan, that falls within the Comprehensive range mentioned above, has been used. Example This is an example of our comparison table: The Basic costs reflected on the table are an accumulation of the premiums for the year (Medical Aid and Top Ups), less the Annual Medical Savings Account allocation reflected. The Complete costs are the Total Premium (Medical Aid + Top Ups) PLUS any amount in the Self Payment Gap, reflecting the total premium payable for this member to enjoy cover at 100% for the year. A manipulation of the data provided by Discovery, in this case, has facilitated the comparison table, upon which this survey has been based. Comparison tables are prepared for each of the plans considered in this survey. Example Discovery Classic Comprehensive Premium Cumulative Top up premium Subtotal per month Total per annum (R) (R) (R) (R) (R) Single member Spouse / Adult dependant Child Monthly Savings Total Cumulative Premium (R) (R) (MSA) +OHEB Single member Spouse / Adult dependant Child Annual Threshold Total Cumulative Premium (R) (R) (MSA) +OHEB + SP Single member Spouse / Adult dependant Child Self Payment Gap Total Cumulative Premium (R) (R) + SPG Single member Spouse / Adult dependant Child Brief Description of Plan % in hospital 200% Overall annual limit No Above threshold benefit Unlimited Network No 28 29

18 Non-Hospital Plans NON Hospital Plans Single Members Non-Hospital Plans Salary Band R 0 - R R R R R R R R R R R R R R R R R R R R R R R R R R Rating Plan Name Discovery Primary Care Makoti Primary OcsaCare Member + 1 Adult Dep Makoti Primary Member + Adult Dep + 2 Children Makoti Primary

19 Starter Beginner Plans - COMPREHENSIVE No Network Starter Beginner Plans Single Member Salary Band R 0 - R 4000 Plan Name R R 5000 R R 6000 R R 7000 R R 8000 Liberty Traditional Standard Momentum Ingwe - ANY Starter Beginner Plan - COMPREHENSIVE - Member + Adult Dep R R R R R R R R R R R Rating Starter Beginner Plans Liberty Traditional Standard Momentum Ingwe - ANY Starter Beginner Plan - COMPREHENSIVE - Member + Adult Dep + 2 Children Liberty Traditional Standard Momentum Ingwe - ANY

20 Starter Beginner Plans - CORE Network Starter Beginner Plans Single Member Salary Band R 0 - R 4000 Plan Name R R 5000 R R 6000 R R 7000 Discovery KeyCare Core Member + Adult Dep Discovery KeyCare Core R R 8000 R R R R R R R R Rating Starter Beginner Plans Member + Adult Dep + 2 Children Discovery KeyCare Core

21 Starter Beginner Plans - COMPREHENSIVE STATE Network Starter Beginner Plans Single member Salary Band Plan Name R 0 - R 4000 R R R R R R R R CompCare NetworX Discovery KeyCare Access Momentum Ingwe - STATE R R R R R R R R R R R Rating Starter Beginner Plans Member + 1 Adult Dep CompCare NetworX Discovery KeyCare Access Momentum Ingwe - STATE Member + Adult Dep + 2 Children CompCare NetworX Discovery KeyCare Access Momentum Ingwe - STATE

22 Starter Beginner Plans - COMPREHENSIVE Network Starter Beginner Plans Single Members Salary Band Plan Name R 0 - R 4000 R R R R R R R R BestMed Pulse Bonitas BonCap CompCare NetworX R R R R R R R R R R R Rating Starter Beginner Plans Discovery KeyCare Plus Fedhealth Blue Door Plus Hosmed Essential Liberty Traditional Basic Makoti Comprehensive Medshield MediPhila Momentum Access Momentum Ingwe Network Resolution Foundation Sizwe Gomono Care Suremed Explorer TopMed Network

23 Starter Beginner Plans - COMPREHENSIVE Network (continued) Starter Beginner Plans Member + 1 Adult Dep Salary Band Plan Name R 0 - R 4000 R R R R R R R R BestMed Pulse Bonitas BonCap CompCare NetworX R R R R R R R R R R R Rating Starter Beginner Plans Discovery KeyCare Plus Fedhealth Blue Door Plus Hosmed Essential Liberty Traditional Basic Makoti Comprehensive Medshield MediPhila Momentum Access Momentum Ingwe Network Resolution Foundation Sizwe Gomono Care Suremed Explorer TopMed Network

24 Starter Beginner Plans - COMPREHENSIVE Network (continued) Starter Beginner Plans Member + Adult Dep + 2 Children Salary Band Plan Name R 0 - R 4000 R R R R R R R R BestMed Pulse Bonitas BonCap CompCare NetworX R R R R R R R R R R R Rating Starter Beginner Plans Discovery KeyCare Plus Fedhealth Blue Door Plus Hosmed Essential Liberty Traditional Basic Makoti Comprehensive Medshield MediPhila Momentum Access Momentum Ingwe Network Resolution Foundation Sizwe Gomono Care Suremed Explorer TopMed Network

25 CORE Network Single Member Plan Name Cost Overall Rating / 12 Core / 9 Hybrid Core / 3 BestMed Beat 1 N Discovery Classic Delta Core Discovery Coastal Core Discovery Essential Delta Core Fedhealth Maxima EntryZone Momentum Custom Assoc Any Core Plans Momentum Custom Assoc Assoc Momentum Custom Assoc State Spectramed Aqua Core Plans Hybrid Core Network CompCare Axis N Liberty Hospital Select Medshield Core Plus

26 CORE Network (continued) Member + 1 Adult Dep Plan Name Cost Overall Rating / 12 Core / 9 Hybrid Core / 3 BestMed Beat 1 N Discovery Classic Delta Core Discovery Coastal Core Discovery Essential Delta Core Fedhealth Maxima EntryZone Momentum Custom Assoc Any Core Plans Momentum Custom Assoc Assoc Momentum Custom Assoc State Spectramed Aqua Core Plans Hybrid Core Network CompCare Axis N Liberty Hospital Select Medshield Core Plus

27 CORE Network (continued) Member + Adult Dep + 2 Children Plan Name Cost Overall Rating / 12 Core / 9 Hybrid Core / 3 BestMed Beat 1 N Discovery Classic Delta Core Discovery Coastal Core Discovery Essential Delta Core Fedhealth Maxima EntryZone Momentum Custom Assoc Any Core Plans Momentum Custom Assoc Assoc Momentum Custom Assoc State Spectramed Aqua Core Plans Hybrid Core Network CompCare Axis N Liberty Hospital Select Medshield Core Plus

28 CORE No Network Single Member Plan Name Cost Overall Rating / 17 Core / 7 Hybrid Core /10 BestMed Beat Discovery Classic Core Discovery Essential Core Fedhealth Maxima Core Momentum Custom Any Any Momentum Custom Any Assoc Core Plans Momentum Custom Any State Hybrid Core Network Bonitas BonEssential Core Plans Cape Medical Plan Premium CompCare Axis Genesis Private Genesis Private Choice Liberty Hospital Plus Liberty Hospital Standard Resolution Hospital Suremed Shuttle TopMed Hospital

29 CORE No Network (continued) Member + 1 Adult Dep Plan Name Cost Overall Rating / 17 Core / 7 Hybrid Core /10 BestMed Beat Discovery Classic Core Discovery Essential Core Fedhealth Maxima Core Momentum Custom Any Any Momentum Custom Any Assoc Core Plans Momentum Custom Any State Hybrid Core No Network Bonitas BonEssential Core Plans Cape Medical Plan Premium CompCare Axis Genesis Private Genesis Private Choice Liberty Hospital Plus Liberty Hospital Standard Resolution Hospital Suremed Shuttle TopMed Hospital

30 CORE No Network (continued) Member + 1 Adult Dep + 2 Children Plan Name Cost Overall Rating / 17 Core / 7 Hybrid Core /10 BestMed Beat Discovery Classic Core Discovery Essential Core Fedhealth Maxima Core Momentum Custom Any Any Momentum Custom Any Assoc Core Plans Momentum Custom Any State Hybrid Core No Network Bonitas BonEssential Core Plans Cape Medical Plan Premium CompCare Axis Genesis Private Genesis Private Choice Liberty Hospital Plus Liberty Hospital Standard Resolution Hospital Suremed Shuttle TopMed Hospital

31 SAVER Network Single Member Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 BestMed Beat 2 N Momentum Incentive Assoc Any Momentum Incentive Assoc Assoc Momentum Incentive Assoc State Hybrid Limited Comprehensive Network CompCare Dynamix - Network CompCare Pinnacle - Network Liberty Complete Select Hybrid Saver Network BestMed Beat 3 N CompCare Mumed N R 0 - R CompCare Mumed N R CompCare Mumed N R R CompCare Mumed N R R CompCare Mumed NN R CompCare Mumed NN R R CompCare Mumed NN R R CompCare Symmetry N Discovery Classic Delta Saver Discovery Coastal Saver Discovery Essential Delta Saver Fedhealth Maxima EntrySaver Hosmed Access R 0 - R

32 SAVER Network (continued) Single Member (continued) Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 Hybrid Saver Network (continued) Hosmed Access R R Hosmed Access R Liberty Saver Select Medshield MediBonus Medshield MediPlus Medshield MediValue Medshield Premium Plus Medshield Standard Resolution Progressive Flex TopMed Saver Active

33 SAVER Network (continued) Member + 1 Adult Dep Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 BestMed Beat 2 N Momentum Incentive Assoc Any Momentum Incentive Assoc Assoc Momentum Incentive Assoc State Hybrid Limited Comprehensive Network CompCare Dynamix - Network CompCare Pinnacle - Network Liberty Complete Select Hybrid Saver Network BestMed Beat 3 N CompCare Mumed N R 0 - R CompCare Mumed N R CompCare Mumed N R R CompCare Mumed N R R CompCare Mumed NN R CompCare Mumed NN R R CompCare Mumed NN R R CompCare Symmetry N Discovery Classic Delta Saver Discovery Coastal Saver Discovery Essential Delta Saver Fedhealth Maxima EntrySaver Hosmed Access R 0 - R

34 SAVER Network (continued) Member + 1 Adult Dep (continued) Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 Hybrid Saver Network (continued) Hosmed Access R R Hosmed Access R Liberty Saver Select Medshield MediBonus Medshield MediPlus Medshield MediValue Medshield Premium Plus Medshield Standard Resolution Progressive Flex TopMed Saver Active

35 SAVER Network (continued) Member + 1 Adult Dep + 2 Children Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 BestMed Beat 2 N Momentum Incentive Assoc Any Momentum Incentive Assoc Assoc Momentum Incentive Assoc State Hybrid Limited Comprehensive Network CompCare Dynamix - Network CompCare Pinnacle - Network Liberty Complete Select Hybrid Saver Network BestMed Beat 3 N CompCare Mumed N R 0 - R CompCare Mumed N R CompCare Mumed N R R CompCare Mumed N R R CompCare Mumed NN R CompCare Mumed NN R R CompCare Mumed NN R R CompCare Symmetry N Discovery Classic Delta Saver Discovery Coastal Saver Discovery Essential Delta Saver Fedhealth Maxima EntrySaver Hosmed Access R 0 - R

36 SAVER Network (continued) Member + 1 Adult Dep + 2 Children (continued) Plan Name Cost Overall Rating / 31 Saver / 4 Hybrid Saver Network / 24 Hybrid Ltd Comp Net / 3 Hybrid Saver Network (continued) Hosmed Access R R Hosmed Access R Liberty Saver Select Medshield MediBonus Medshield MediPlus Medshield MediValue Medshield Premium Plus Medshield Standard Resolution Progressive Flex TopMed Saver Active

37 SAVER No Network Single Member Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 BestMed Beat Bonitas Standard Cape Medical Plan - Select Fedhealth Ultima Momentum Incentive Any Any Momentum Incentive Any Assoc Momentum Incentive Any State Momentum Summit Spectramed Azure < R Spectramed Azure R R Spectramed Azure R Spectramed Capri Spectramed Cobalt Spectramed Cyan <R Spectramed Cyan R TopMed Savings Hybrid Limited Comprehensive No Network CompCare Dynamix CompCare Pinnacle Discovery Classic Priority Discovery Essential Priority Liberty Complete Standard Resolution Millennium TopMed Paladin Comprehensive

38 SAVER No Network (continued) Single Member (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network BestMed Beat BestMed Beat BestMed Pace BestMed Pace BestMed Pace 3 R 0 - R BestMed Pace 3 R BestMed Pace Bonitas BonSave Bonitas Primary Cape Medical Plan - Silver CompCare Mumed R R CompCare Mumed R R CompCare Mumed R R CompCare Mumed R CompCare Symmetry Discovery Classic Saver Discovery Essential Saver Fedhealth Maxima Saver Genesis Private Comprehensive Genesis Private Plus Hosmed Plus Hosmed Value R 0 - R

39 SAVER No Network (continued) Single Member (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network (continued) Hosmed Value R Liberty Saver Plus Liberty Saver Standard Liberty Traditional Ultimate Profmed ProActive Plus Profmed ProActive R 0 - R Profmed ProActive R R Profmed ProActive R Profmed ProPinnacle Profmed ProSecure Plus Profmed ProSecure R 0 - R Profmed ProSecure R Resolution Classic Resolution Supreme Sizwe Affordable Care R 0 - R Sizwe Afford Care R Sizwe Full Benefit R 0 - R Sizwe Full Benefit R Sizwe Primary Care R 0 - R Sizwe Primary Care R Sizwe Savings Care R 0 - R Sizwe Savings Care R Suremed Navigator

40 SAVER No Network Member + 1 Adult Dep Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 BestMed Beat Bonitas Standard Cape Medical Plan - Select Fedhealth Ultima Momentum Incentive Any Any Momentum Incentive Any Assoc Momentum Incentive Any State Momentum Summit Spectramed Azure < R Spectramed Azure R R Spectramed Azure R Spectramed Capri Spectramed Cobalt Spectramed Cyan <R Spectramed Cyan R TopMed Savings Hybrid Limited Comprehensive No Network CompCare Dynamix CompCare Pinnacle Discovery Classic Priority Discovery Essential Priority Liberty Complete Standard Resolution Millennium TopMed Paladin Comprehensive

41 SAVER No Network (continued) Member + 1 Adult Dep (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network BestMed Beat BestMed Beat BestMed Pace BestMed Pace BestMed Pace 3 R 0 - R BestMed Pace 3 R BestMed Pace Bonitas BonSave Bonitas Primary Cape Medical Plan - Silver CompCare Mumed R R CompCare Mumed R R CompCare Mumed R R CompCare Mumed R CompCare Symmetry Discovery Classic Saver Discovery Essential Saver Fedhealth Maxima Saver Genesis Private Comprehensive Genesis Private Plus Hosmed Plus Hosmed Value R 0 - R

42 SAVER No Network (continued) Member + 1 Adult Dep (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network (continued) Hosmed Value R Liberty Saver Plus Liberty Saver Standard Liberty Traditional Ultimate Profmed ProActive Plus Profmed ProActive R 0 - R Profmed ProActive R R Profmed ProActive R Profmed ProPinnacle Profmed ProSecure Plus Profmed ProSecure R 0 - R Profmed ProSecure R Resolution Classic Resolution Supreme Sizwe Affordable Care R 0 - R Sizwe Affordable Care R Sizwe Full Benefit R 0 - R Sizwe Full Benefit R Sizwe Primary Care R 0 - R Sizwe Primary Care R Sizwe Savings Care R 0 - R Sizwe Savings Care R Suremed Navigator

43 SAVER No Network (continued) Member + 1 Adult Dep + 2 Children Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 BestMed Beat Bonitas Standard Cape Medical Plan - Select Fedhealth Ultima Momentum Incentive Any Any Momentum Incentive Any Assoc Momentum Incentive Any State Momentum Summit Spectramed Azure < R Spectramed Azure R R Spectramed Azure R Spectramed Capri Spectramed Cobalt Spectramed Cyan <R Spectramed Cyan R TopMed Savings Hybrid Limited Comprehensive No Network CompCare Dynamix CompCare Pinnacle Discovery Classic Priority Discovery Essential Priority Liberty Complete Standard Resolution Millennium TopMed Paladin Comprehensive

44 SAVER No Network (continued) Member + 1 Adult Dep + 2 Children (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network BestMed Beat BestMed Beat BestMed Pace BestMed Pace BestMed Pace 3 R 0 - R BestMed Pace 3 R BestMed Pace Bonitas BonSave Bonitas Primary Cape Medical Plan - Silver CompCare Mumed R R CompCare Mumed R R CompCare Mumed R R CompCare Mumed R CompCare Symmetry Discovery Classic Saver Discovery Essential Saver Fedhealth Maxima Saver Genesis Private Comprehensive Genesis Private Plus Hosmed Plus Hosmed Value R 0 - R Hosmed Value R

45 SAVER No Network (continued) Member + 1 Adult Dep + 2 Children (continued) Plan Name Cost Overall Rating / 68 Saver / 16 Hybrid Saver / 45 Hybrid Ltd Comp / 7 Hybrid Saver No Network (continued) Liberty Saver Plus Liberty Saver Standard Liberty Traditional Ultimate Profmed ProActive Plus Profmed ProActive R 0 - R Profmed ProActive R R Profmed ProActive R Profmed ProPinnacle Profmed ProSecure Plus Profmed ProSecure R 0 - R Profmed ProSecure R Resolution Classic Resolution Supreme Sizwe Affordable Care R 0 - R Sizwe Affordable Care R Sizwe Full Benefit R 0 - R Sizwe Full Benefit R Sizwe Primary Care R 0 - R Sizwe Primary Care R Sizwe Savings Care R 0 - R Sizwe Savings Care R Suremed Navigator

46 COMPREHENSIVE Network Single Member Basic Complete Plan Name Core Cost Core Rating / 6 Core Comp / 3 Core Hybrid Comp / 3 Complete Cost Complete Rating / 6 Momentum Extender Assoc Any Complete Comp / 3 Complete Hybrid Comp / 3 Momentum Extender Assoc Assoc Momentum Extender Assoc State Hybrid Comprehensive Discovery Classic Delta Comprehensive Discovery Essental Delta Comprehensive Fedhealth Maxima Standard Net Member + Adult Dep Basic Complete Momentum Extender Assoc Any Momentum Extender Assoc Assoc Momentum Extender Assoc State Hybrid Comprehensive Discovery Classic Delta Comprehensive Discovery Essental Delta Comprehensive Fedhealth Maxima Standard Net Comprehensive Plans Member + Adult Dep + 2 Children Basic Complete Momentum Extender Assoc Any Momentum Extender Assoc Assoc Momentum Extender Assoc State Comprehensive Plans Hybrid Comprehensive Discovery Classic Delta Comprehensive Discovery Essental Delta Comprehensive Fedhealth Maxima Standard Net

47 COMPREHENSIVE No Network Single Member Basic Complete Plan Name Basic Cost Basic Rating / 16 Basic Comp / 4 Basic Hybrid Comp/ 6 Basic Hybrid ExtComp / 6 Complete Cost Complete Rating / 16 Discovery Classic Comprehensive R0 MSA Momentum Extender Any Any Momentum Extender Any Assoc Momentum Extender Any State Hybrid Comprehensive No Network Complete Comp / 4 Complete Hybrid Comp/ 6 Complete Hybrid Ext Comp / 6 Discovery Classic Comprehensive Discovery Essential Comprehensive Fedhealth Maxima Basis Fedhealth Maxima Standard Liberty Complete Plus TopMed Professional Hybrid Extended Comprehensive Fedhealth Ultimax Bonitas BonComprehensive Discovery Executive Comprehensive Plans Fedhealth Maxima Exec Fedhealth Maxima Plus TopMed Rainbow Comprehensive Comprehensive Plans 88 89

48 COMPREHENSIVE No Network (continued) Member + 1 Adult Dep Basic Complete Plan Name Basic Cost Basic Rating / 16 Basic Comp / 4 Basic Hybrid Comp/ 6 Basic Hybrid ExtComp / 6 Complete Cost Complete Rating / 16 Complete Comp / 4 Complete Hybrid Comp/ 6 Complete Hybrid Ext Comp / 6 Discovery Classic Comprehensive R0 MSA Momentum Extender Any Any Momentum Extender Any Assoc Momentum Extender Any State Hybrid Comprehensive No Network Discovery Classic Comprehensive Discovery Essential Comprehensive Fedhealth Maxima Basis Fedhealth Maxima Standard Liberty Complete Plus TopMed Professional Hybrid Extended Comprehensive Fedhealth Ultimax Bonitas BonComprehensive Discovery Executive Comprehensive Plans Fedhealth Maxima Exec Fedhealth Maxima Plus TopMed Rainbow Comprehensive Comprehensive Plans 90 91

49 COMPREHENSIVE No Network (continued) Member + 1 Adult Dep + 2 Children Basic Complete Plan Name Basic Cost Basic Rating / 16 Basic Comp / 4 Basic Hybrid Comp/ 6 Basic Hybrid ExtComp / 6 Complete Cost Complete Rating / 16 Discovery Classic Comprehensive R0 MSA Momentum Extender Any Any Momentum Extender Any Assoc Momentum Extender Any State Hybrid Comprehensive No Network Complete Comp / 4 Complete Hybrid Comp/ 6 Complete Hybrid Ext Comp / 6 Discovery Classic Comprehensive Discovery Essential Comprehensive Fedhealth Maxima Basis Fedhealth Maxima Standard Liberty Complete Plus TopMed Professional Hybrid Extended Comprehensive Fedhealth Ultimax Bonitas BonComprehensive Discovery Executive Comprehensive Plans Fedhealth Maxima Exec Fedhealth Maxima Plus TopMed Rainbow Comprehensive Comprehensive Plans 92 93

50 Traditional Single Member Plan Name CompCare Excess Direct Suremed Challenger TopMed Limited Bonitas BonClassic Traditional Plans Traditional Plans 94 95

51