Circular of 2015: Medical Scheme benefit options for open and restricted schemes approved for 2016
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1 Circular of 2015: Medical Scheme benefit options for open and restricted schemes approved for The Council for Medical Schemes (CMS) would like to share the status of benefit options in open schemes for the 2016 calendar year. Name of medical scheme Name of benefit option Decision Remark/Comment BESTMED MEDICAL SCHEME PACE 4 PACE 3 PACE 2 PACE 1 BEAT 4 BEAT 3 BEAT 3 NETWORK BEAT 2 BEAT 2 NETWORK BEAT 1 BEAT 1 NETWORK PULSE 2 PULSE 1 BONITAS MEDICAL FUND BONCAP BONCOMPREHENSIVE BONSAVE 1
2 PRIMARY STANDARD STANDARD EDO (New) PENDING Awaiting exemption approval from Council BONESSENTIAL BONCLASSIC BONFIT New from 01/01/2016 CAPE MEDICAL PLAN HEALTHPACT PREMIUM HEALTHPACT SILVER HEALTHPACT SELECT COMMUNITY MEDICAL AID SCHEME (COMMED) DELUXE STANDARD ROOTS SHINA New from 01/01/2016 COMPCARE WELLNESS MEDICAL SCHEME DYNAMIX DSP NETWORK PINNACLE DSP NETWORK MUMED DSP NETWORK SYMMETRY DSP NETWORK AXIS DSP NETWORK NETWORX DSP NETWORK DISCOVERY HEALTH MEDICAL SCHEME CLASSIC COMPREHENSIVE CLASSIC DELTA COMPREHENSIVE CLASSIC CORE CLASSIC DELTA CORE CLASSIC PRIORITY 2
3 CLASSIC SAVER CLASSIC DELTA SAVER COASTAL CORE COASTAL SAVER ESSENTIAL COMPREHENSIVE ESSENTIAL DELTA COMPREHENSIVE ESSENTIAL CORE ESSENTIAL DELTA CORE ESSENTIAL PRIORITY ESSENTIAL SAVER ESSENTIAL DELTA SAVER EXECUTIVE KEYCARE CORE KEYCARE PLUS KEYCARE ACCESS CLASSIC COMPREHENSIVE ZERO MSA SMART New from 01/01/2016 FEDHEALTH MEDICAL SCHEME MAXIMA BASIS MAXIMA CORE MAXIMA PLUS MAXIMA STANDARD MAXIMA STANDARD ELECT Option Name change from 01/01/2016 (was MAXIMA STANDARD NET) MAXIMA ENTRYZONE MAXIMA EXECUTIVE ULTIMA 200 ULTIMAX BLUE DOOR PLUS MAXIMA SAVER MAXIMA ENTRYSAVER GENESIS MEDICAL SCHEME PRIVATE PRIVATE PLUS 3
4 PRIVATE COMPREHENSIVE PRIVATE CHOICE HOSMED MEDICAL AID SCHEME PLUS ESSENTIAL VALUE ACCESS KEYHEALTH PLATINUM GOLD SILVER EQUILIBRIUM ESSENCE ORIGIN LIBERTY HEALTH MEDICAL SCHEME TRADITIONAL ULTIMATE HOSPITAL STANDARD HOSPITAL SELECT SAVER STANDARD SAVER SELECT COMPLETE PLUS HOSPITAL PLUS SAVER PLUS TRADITIONAL STANDARD COMPLETE STANDARD COMPLETE SELECT TRADITIONAL BASIC MAKOTI MEDICAL SCHEME COMPREHENSIVE PRIMARY MEDIHELP DIMENSION ELITE DIMENSION PRIME 1 4
5 DIMENSION PRIME 1 NETWORK DIMENSION PRIME 2 DIMENSION PRIME 2 NETWORK DIMENSION PRIME 3 DIMENSION PRIME 3 NETWORK MEDIHELP PLUS NECESSE UNIFY MEDIMED MEDICAL SCHEME ALPHA MEDISAVE ESSENTIAL MEDISAVE - MAX MEDISAVE - STANDARD MEDSHIELD MEDICAL SCHEME MEDIBONUS MEDIPLUS MEDIVALUE MEDICORE (was CORE PLUS) Option Name change from 01/01/2016 PREMIUM PLUS MEDISAVER (was STANDARD) Option Name change from 01/01/2016 MEDIPHILA MOMENTUM HEALTH MEDICAL SCHEME INGWE PRIMARY CARE/STATE HOSPITAL NETWORK PRIMARY CARE/INGWE HOSPITAL NETWORK ACTIVE NETWORK/INGWE ANY OPTION CUSTOM 5
6 STATE/ASSOCIATED STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC ANY GP & PHARM/ANY HOSPITAL INCENTIVE STATE/ASSOCIATED STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC ANY GP & PHARM/ANY HOSPITAL EXTENDER STATE/ASSOC STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC 6
7 ANY GP & PHARM/ANY HOSPITAL ACCESS SUMMIT RESOLUTION HEALTH MEDICAL SCHEME HOSPITAL PROGRESSIVE FLEX CLASSIC SUPREME MILLENNIUM FOUNDATION SELFMED MEDICAL SCHEME MEDXXI MED ELITE SELFMED 80% SELFSURE SELFNET SIZWE MEDICAL FUND AFFORDABLE CARE OPTION FULL CARE OPTION PRIMARY CARE OPTION SAVINGS CARE OPTION GOMOMO CARE OPTION SPECTRAMED CYAN AZURE AQUA COBALT CAPRI SUREMED HEALTH CHALLENGER NAVIGATOR SHUTTLE EXPLORER 7
8 THEBEMED Name of medical scheme Name of benefit option Decision Remark/Comment ENERGY CORE MEDIUM OPEN UNIVERSAL TOPMED MEDICAL SCHEME TOPMED RAINBOW COMPREHENSIVE TOPMED PALADIN COMPREHENSIVE TOPMED PROFESSIONAL OPTION TOPMED SAVINGS OPTION TOPMED ACTIVE SAVER TOPMED HOSPITAL PLAN TOPMED NETWORK OPTION TOPMED LIMITED OPTION 8
9 2. The CMS would like to share the status of benefit options in restricted schemes for the 2016 calendar year. Name of medical scheme Name of benefit option Decision Remark/Comment AECI MEDICAL AID SOCIETY VALUE OPTION COMPREHENSIVE OPTION (was COMPREHENSIVE PLAN) ALLIANCE-MIDMED MEDICAL SCHEME ALLIANCE-MIDMED MEDICAL SCHEME ANGLO MEDICAL SCHEME MANAGED CARE PLAN STANDARD CARE PLAN VALUE CARE PLAN ANGLOVAAL GROUP MEDICAL SCHEME ANGLOVAAL GROUP MEDICAL SCHEME BANKMED BANKMED BASIC PLAN BANKMED COMPREHENSIVE PLAN BANKMED CORE SAVER PLAN BANKMED PLUS PLAN BANKMED TRADITIONAL PLAN BANKMED PMB PLAN BARLOWORLD MEDICAL SCHEME BARLOWORLD MEDICAL SCHEME BMW EMPLOYEES MEDICAL AID SOCIETY BMW EMPLOYEES MEDICAL AID SOCIETY BP MEDICAL AID SOCIETY BP MEDICAL SOCIETY BUILDING &CONSTRUCTION INDUSTRY MEDICAL SCHEME BASIC OPTION 9
10 CHARTERED ACCOUNTANTS (SA) ALLIANCE BENEFIT OPTION MEDICAL AID FUND (CAMAF) DOUBLE PLUS BENEFIT OPTION FIRST CHOICE BENEFIT OPTION VITAL BENEFIT OPTION NETWORK CHOICE BENEFIT OPTION ESSENTIAL PLUS BENEFIT OPTION DE BEERS BENEFIT SOCIETY DE BEERS BENEFIT SOCIETY ENGEN MEDICAL BENEFIT FUND ENGEN MEDICAL BENEFIT FUND FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) PRIMARY STANDARD FOOD WORKERS MEDICAL BENEFIT FUND FOOD WORKERS MEDICAL BENEFIT FUND N/A GLENCORE MEDICAL SCHEME GLENCORE MEDICAL SCHEME GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) ADVANCE PRIMARY STANDARD ONYX EMERALD RUBY SAPPHIRE BERYL GRINTEK ELECTRONICS MEDICAL AID SCHEME GRINTEK ELECTRONIC MEDICAL AID SCHEME 10
11 HORIZON MEDICAL SCHEME HOSPITAL PLAN MAJOR MEDICAL PLAN MAJOR MEDICAL PLUS CARECROSS IMPALA MEDICAL PLAN IMPALA MEDICAL PLAN IMPERIAL GROUP MEDICAL SCHEME IMPERIALMED HEALTH PLAN IMPERIALMED BUDGET PLAN LA-HEALTH ACTIVE COMPREHENSIVE CORE FOCUS KEYPLUS LIBCARE MEDICAL SCHEME LIBCARE LONMIN MEDICAL SCHEME LONMIN MEDICAL SCHEME MALCOR MEDICAL SCHEME PLAN A PLAN B PLAN C PLAN D MASSMART HEALTH PLAN CHOICE OPTION NETWORK OPTION ESSENTIAL OPTION MBMED MEDICAL AID FUND MBMED MEDIPOS MEDICAL SCHEME OPTION A OPTION B 11
12 OPTION C METROPOLITAN MEDICAL SCHEME CLASSIC PREMIER MOTO HEALTHCARE OPTIMUM CLASSIC HOSPICARE CUSTOM ESSENTIAL NASPERS MEDICAL FUND M-MED OPTION N OPTION BASIC N OPTION PLUS NEDGROUP MEDICAL AID SCHEME PLATINUM PLAN TRADITIONAL PLAN TRADITIONAL PLUS PLAN SAVINGS PLAN HOSPITAL PLAN NETCARE MEDICAL SCHEME NETCARE SAVINGS OPTION OLD MUTUAL STAFF MEDICAL AID FUND TRADITIONAL PLUS PLAN TRADITIONAL PLAN SAVINGS PLAN NETWORK PLAN HOSPITAL PLAN PARMED MEDICAL AID SCHEME PARMED MEDICAL AID SCHEME PG GROUP MEDICAL SCHEME PG GROUP MEDICAL SCHEME 12
13 PICK & PAY MEDICAL SCHEME PICK N PAY MEDICAL SCHEME PLATINUM HEALTH PLATCOMPREHENSIVE PLATCAP PLATSAVE PROFMED PRO ACTIVE PRO ACTIVE PLUS PRO PINNACLE PRO SECURE PRO SECURE PLUS QUANTUM MEDICAL AID SOCIETY ESSENTIAL COMPREHENSIVE PLAN ESSENTIAL SAVER PLAN KEYCARE PLUS PLAN RAND WATER MEDICAL SCHEME OPTION A OPTION B PLUS REMEDI MEDICAL AID SCHEME CLASSIC COMPREHENSIVE STANDARD RETAIL MEDICAL SCHEME ESSENTIAL OPTION ESSENTIAL PLUS OPTION RHODES UNIVERSITY MEDICAL SCHEME S A BREWERIES MEDICAL AID SOCIETY RUMED ESSENTIAL COMPREHENSIVE 13
14 SABC MEDICAL AID SCHEME SABC SOUTH AFRICAN MUNICIPAL UNION NATIONAL MEDICAL SCHEME (SAMWUMED) OPTION A OPTION B SASOLMED SASOLMED SEDMED SEDMED SISONKE HEALTH MEDICAL SCHEME HERITAGE PLAN PRIDE PLAN SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME (POLMED) MARINE (was HIGHER PLAN) Option Name change from 01/01/2016 AQUARIUM (was LOWER PLAN) Option Name change from 01/01/2016 TFG MEDICAL SCHEME PLAN A PLAN B TIGER BRANDS MEDICAL SCHEME OPTION 1 MZANSI NETWORK OPTION TRANSMED MEDICAL FUND GUARDIAN STATE PLUS NETWORK STATE PLUS OWN CHOICE PRIVATE NETWORK TSOGO SUN GROUP MEDICAL SCHEME CLASSIC COMPREHENSIVE PLAN CLASSIC SAVER PLAN UMVUZO HEALTH MEDICAL SCHEME STANDARD SUPREME ULTRA AFFORDABLE 14
15 EXTREME ACTIVATOR NOT New from 01/01/2016 UNIVERSITY OF KWAZULU-NATAL MEDICAL SCHEME UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG STAFF MEDICAL AID SCHEME WITBANK COALFIELDS MEDICAL AID SCHEME STANDARD PLAN UNIVERSITY OF WITWATERSRAND STAFF MEDICAL AID WITSMED LOW INCOME OPTION COMPREHENSIVE OPTION YEBOMED WOOLTRU HEALTHCARE FUND CORE OPTION EXTENDED OPTION PLUS OPTION 15
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