Product summary 2015

Product summary 2015

Product overview CompCare CompCare Medical Scheme offers a wide range of options to take care of most people s healthcare needs. The options offer a wide range of s at affordable prices. The Mumed option is an affordable plan with traditional s for young members and families who want the freedom to see a healthcare provider of choice when necessary. Mumed Pinnacle The Pinnacle option offers comprehensive cover for the discerning achiever, with exceptional hospital and superior day-to-day s comprising a combination of savings account, traditional risk cover and very competitive above threshold s. The Excess Direct option, a traditional type of option which requires members to contribute 20% of the cost of any out of hospital healthcare services, whilst a sliding scale co-payment is applied for hospital accounts with a limit of R10 000 per admission. Excess Direct Dynamix The Dynamix option is an attractive new generation plan that offers comprehensive private hospital cover, a savings account and traditional risk s with above threshold s for day-to-day healthcare expenses. The Axis option is a premium comprehensive private hospital plan with post-operative rehabilitation s for complete peace of mind. Axis Symmetry The Symmetry Option provides unlimited cover in a private hospital of your choice and comprehensive day-today s and traditional risk cover, for complete peace of mind. The NetworX option is an affordable healthcare plan with exceptional value for students and low-income employees in the corporate sector, and offers essential cover within the Universal Healthcare Provider Network. NetworX CompCare Wellness has implemented overall and limit enhancements of 6% across all options for 2015 whilst limiting contribution increases to 8.9% on all options. CompCare is financially strong with a solvency level of 38%, considerably higher than the 25% minimum required by the Council for Medical Schemes. Those who are new to the Scheme will find that CompCare is sensitive to both healthcare and budgetary needs with no less than eight options to choose from as well as efficiency discounted options for those that may prefer using designated service providers in return for a more affordable contribution rate. CompCare has introduced a few exciting new s: Utilisation of Universal Network Providers (GP, dental, optometrists) will earn you 10% of the payment amount into your AFB++ account A referral by your Universal Network provider GP to a specialist will earn you 10% to your AFB++ account CompCare has always been concerned about individuals health so look at the new Newborn to Adult and Emotional Wellness s. We trust that this summary will provide you with relevant information on the options that we offer, that will not only help you to stay well, but also cover your health costs when in need.

2015 s BENEFIT SCHEDULE PINNACLE DYNAMIX SYMMETRY MUMED EXCESS DIRECT AXIS NETWORX Hospitalisation (private hospitals and nursing homes) Efficiency Discount Efficiency Discount with Network Overall Annual Limit (OAL) All Specialised Radiology including MRI, CT and PET Scans 100% of AT - Treatment subject to pre-authorisation, N/A N/A N/A Hospitalisation All day-to-day s paid from an Annual Flexi Benefit at a provider within the Universal Network of Service Providers Unlimited Unlimited Unlimited R1.5 million p/f 100% of AT. Unlimited. Pre-authorisation required for all MRI and CT Scans. High Resolution CT Scans/PET Scans subject to special medical motivation and pre-authorisation. No for unauthorised scans. for screening purposes. The first R2 250 paid from available MSA. Accumulates to threshold 100% of AT. Unlimited. Pre-authorisation required for screening purposes. The first R2 250 paid from available MSA. Accumulates to threshold R15 170 p.a. unless otherwise pre-authorised. Pre-authorisation required for screening purposes R13 100 p.a. unless otherwise pre-authorised. Pre-authorisation required for screening purposes Access to Private Hospitals is covered up to the Overall Annual Limit at 100% of cost and there after unlimited through Public Hospital facilities. Co-payment applies to the Hospital Account at Private Hospital Facilities. 50% of the first R4 650 per incident for the members account thereafter 10% of the remainder, up to a maximum co-payment of R10 000 N/A in a Preferred Hospital Network if Public Hospitals are provider for in-hospital treatment and related services N/A N/A N/A R500 000 per incident per year. 20% co-payment and Individual Benefits apply except MRI and CT scans where the co-payment is R1 000 per scan Unlimited } R15 170 p.a. Preauthorisation required for screening purposes R1 million p/f 100% AT. Subject to protocols and DSP. Pre-authorisation required for screening purposes. Subject to OAL

BENEFIT SCHEDULE PINNACLE DYNAMIX SYMMETRY MUMED EXCESS DIRECT AXIS NETWORX Pathology 100% of AT. Unlimited 100% of AT. Unlimited Oncology including Chemotherapy and Radiotherapy Radial Keratotomy & Excimer Laser Day-to-Day Cover (non hospital expenses) Unlimited. Subject to preauthorisation and protocols Annual limit of R5 670 per eye, subject to preauthorisation and specific degree of myopia, dioptres and astigmatism, or subject to optical limit Claims are paid initially from the Annual Medical Savings Account - MSA. (20%). Once MSA become exhausted claims are paid from an Annual Flexi Benefit AFB, equal to 5% of contributions where after the member is then liable for the Self Payment (SPG). During this period, claims will accumulate to the Threshold Level at AT. Once the Threshold Level is reached, specific above threshold s will be available up to a limit of R7 525 p/b and R15 135 p/f with sub-limits Unlimited. Subject to preauthorisation and protocols Annual limit of R5 055 per eye, subject to preauthorisation and specific degree of myopia, dioptres and astigmatism, or subject to optical limit Claims are paid initially from the annual Medical Savings Account - MSA (15%). Once MSA become exhausted claims are paid from an Annual Flexi Benefit AFB, equal to 5% of contributions where after the member is then liable for the Self Payment Gap (SPG). During this period, claims will accumulate to the Threshold Level at AT. Once the Threshold Level is reached, specific above threshold s will be available up to a limit of R5 055 p/b and R10 110 p/f with sub-limits R25 165 p/f unless otherwise pre-authorised Unlimited. Subject to preauthorisation and protocols Annual limit of R3 820 per eye, subject to preauthorisation and specific degree of myopia, dioptres and astigmatism, or subject to optical limit Benefits are paid from an annual Flexi- (AFB). If AFB is exhausted additional s are available. AFB limits: P: R6 552 A: R4 164 C: R1 548 Total AFB = Family limit. No p/b limit Max 3 child dependants Hospitalisation R19 550 p/f unless otherwise pre-authorised. Subject to OAL Unlimited. Subject to pre-authorisation and protocols. Limited to OAL Subject to optical Benefits are paid from an - (AFB). If AFB is exhausted additional s are available. AFB limits: P: R4 944 A: R3 096 C: R1 236 Total AFB= Family limit. No p/b limit Max 3 child dependants 80% of AT. Limited to OAL 80% of AT Subject to OAL except for PMB s 80% of AT Subject to optical, pre-authorisation required Reimbursed on an 80% basis for doctors and healthcare providers. Sub limits apply R25 170 p/f unless otherwise pre-authorised Unlimited. Subject to preauthorisation and protocols Post operative rehab physio, occupational therapy, Biokinesis, limited to R5 750 p/f for 14 Days Pre-authorisation required. PMB s only Subject to OAL, protocols in DSP Unlimited. Subject to pre-authorisation and protocols. Limited to OAL If services are rendered by Universal Network Providers, s will be paid at AT up to specified limits. Some s subject to an Benefit (AFB): R2 532 p/b R3 780 p/f

BENEFIT SCHEDULE PINNACLE DYNAMIX SYMMETRY MUMED EXCESS DIRECT AXIS NETWORX General Practitioners Specialists Chronic Medicine 100% AT. Paid from MSA, AFB, SPG, after threshold unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into 200% AT. above threshold of R3 785 is available, threshold limit. Utilisation 72 Conditions (27 CDL conditions + 45 Chronic) Unlimited for registered CDL conditions. Paid from risk. Non-CDL Chronic medication is paid from MSA, AFB and SPG first, limited to R10 090 p/b, Max R15 150 p/f Above threshold s limited to R3 785 and threshold limit 100% AT. Paid from MSA, SPG, after threshold unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into 100% AT. above threshold of R3 275 is available threshold limit. Utilisation 63 Conditions (27 CDL conditions + 36 Chronic) Unlimited for registered CDL conditions. Paid from risk. Non-CDL Chronic medication is paid from MSA, and SPG first limited to R7 570 p/b, Max R12 625 p/f Above threshold s limited to R2 520 and threshold limit 100% AT. Paid from AFB first, thereafter consultations (excluding procedures and materials) are unlimited. Utilisation 100% AT Paid from AFB. Utilisation 46 Conditions (27 + 19 non-cdl Chronic) Limited to R3 785 p/b, R5 670 p/f. Once, depleted CDL medicines are unlimited Day-to-day s 100% AT. Paid from AFB first. Consultations (excluding procedures and materials) limited to M: 6 visits, M+1: 8 visits, M+2: 10 visits, M+3+: 11 visits Once the AFB is depleted, the balance of the visits will be available. Utilisation of a Universal Network GP will earn you 10% of payment amount into 100% AT Paid from AFB. Utilisation Unlimited for the 27 Conditions. Not subject to AFB Limit of R5 935 p/f. Combined limit with specialists. Payable at 80% of AT Limit of R5 935 p/f. Combined limit with GPs. Payable at 80% of AT Non CDL, Max R9 645 per family per year CDL/PMB Unlimited through DSP, Formulary and reference pricing apply Unlimited for the 27 CDL Conditions. Not subject to AFB Unlimited at Universal Network GP. However Universal Care requires clinical motivation to give an authorisation for GP visits, where more than 3 visits p/b are required. 2 out-of-area visits p/b. Co-payment of 20%. Pay at point of service. limited to R900 per event. 100% AT. 2 visits p/b max 3 p/f per annum. Two additional anti-natal visits per pregnancy. Subject to referral by a Universal Network GP and preauthorisation of each specialist visit. Referrals limited to specialists located at DSP Network Hospitals only. Subject to AFB. 27 CDL conditions - unlimited only if prescribed by Universal Network Provider and dispensed within Universal Network pharmacy or dispensing Universal Network doctor. Any voluntary use of chronic medicine prescribed by out-of-network provider and any non-formulary medicines are for member s own account, unless pre-authorised by the medical advisor. PMB rules apply

BENEFIT SCHEDULE PINNACLE DYNAMIX SYMMETRY MUMED EXCESS DIRECT AXIS NETWORX Day-to-day s Acute medicines (Schedule 3 and higher) All Specialised Radiology including MRI, CT and PET Scans Pathology Conservative dentistry including consultations, preventative care, fillings, extractions and infection control Specialised Dentistry, including Maxillo- Facial and Oral surgery (In-and-out of hospital combined limit) Optometry visits above threshold of R3 150 p/f is available, threshold limit Subject to in-hospital Specialised radiology 100% of AT. above threshold of R3 785 p/f is available, threshold limit. Combined limit with radiology 100% AT. Paid from MSA, AFB, SPG, after threshold unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into your AFB++ Account 100% AT. Paid from MSA and AFB, subject to a sub-limit of R14 575 p/b, including hospital & related costs. above threshold of R2 520 p/f is available, threshold limit Subject to in-hospital Specialised radiology above threshold of R2 520 p/f is available, threshold limit. Combined limit with radiology 100% AT. Paid from MSA, AFB, SPG, after threshold unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into your AFB++ Account 100% AT - Paid from MSA and AFB, subject to a sub-limit of R9 530 p/b or R13 260 p/f, including hospital & related costs. Paid from AFB Subject to in-hospital Specialised radiology 100% of AT. Paid from AFB subject to scheme protocols 100% AT. Unlimited. Paid from AFB, thereafter unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into your AFB++ Account Paid from AFB. Subject to scheme protocols. Limited to R6 360 p/b Implants: for member s account Paid from AFB Subject to in-hospital Specialised radiology 100% of AT. Limited to hospital basic pathology limit of R19 550 100% AT. Unlimited. Paid from AFB. thereafter unlimited. Utilisation of a Universal Network GP will earn you 10% of payment amount into your AFB++ Account Paid from AFB. Subject to scheme protocols. Limited tor1 700 p/b Implants: for member s account 80% of AT. Max R6 600 per family per year 1 incident per family per year. Co-payment of R1 000 80% AT. Maximum of R4 280 per family per year. Combined limit with radiology 80% AT. Max R4 220 per family per family per year 80% AT. Max R6 730 per family per family per year s Unlimited if prescribed by a Universal Network GP, or by a specialist, provided member was referred by a Universal Network GP. No cover for non-formulary medicines unless otherwise pre-authorised. No cover in s of voluntary use of non-dsps, or voluntary use of specialist without referral by a Universal Network GP 100% AT. PMB s only. Subject to preauthorisation and management 100% AT. Unlimited when clinically appropriate within a Universal Network and subject to referral by a Universal Network GP. Limited to list of codes. Subject to management. No if not referred by a Network provider, or by a specialist following referral by a Universal Network GP (except when involuntary) 100% of AT. Subject to AFB, protocols apply unless PMB.. Paid from AFB Optical 100% SAOA Rates 100% SAOA Rates 100% SAOA Rates 100% SAOA Rates 80% of SAOA rates 100% SAOA Rates DSP Network only 2 visits p/b per annum. 2 visits p/b per annum. 1 visit p/b per annum. 1 visit p/b per annum. Utilisation of a Universal Utilisation of a Universal Utilisation of a Universal Utilisation of a Universal 1 test payable at 80% to a 1 visit p/b every second Network GP will earn you Network GP will earn you Network GP will earn you Network GP will earn you limit of R390 year. Paid from AFB 10% of payment amount 10% of payment amount 10% of payment amount 10% of payment amount into into into into

BENEFIT SCHEDULE PINNACLE DYNAMIX SYMMETRY MUMED EXCESS DIRECT AXIS NETWORX Lenses, Frames and Contact Lenses Frames Speech Therapists, Social Workers, Podiatrists, Occupational Therapists, Homeopaths & Naturopaths, Dieticians, Chiropractors (x-rays excluded), Audiologist, Physiotherapy and Biokinetics () 100% AT. Paid from MSA and AFB, subject to a sub-limit of R3 785 p/b. Max of R1 910 per frame - 1 frame p/b per annum - included in lenses limit 100% of AT. Initially paid from MSA, AFB and SPG up to a collective limit of R6 295 p/f, thereafter an above threshold for physiotherapy and bio kinetics of R2 530 is available. Subject to overall above threshold limit 100% AT. Paid from MSA and AFB, subject to a sub-limit of R3 030 p/b. Max of R1 270 per frame - 1 frame p/b per annum - included in lenses limit 100% of AT. Initially paid from MSA, AFB and SPG up to a collective limit of R4 380 p/f, thereafter an above threshold for physiotherapy and bio kinetics of R1 640 is available. Subject to overall above threshold limit 100% of AT. Paid from AFB, subject to a sub-limit of R1 700 p/b per annum Max of R900 per frame - 1 frame p/b per annum - included in lenses limit 100% of AT. Collective limit of R 2 530 p/b. Paid from AFB Wellness Benefits 100% of AT. Paid from AFB, subject to a sub-limit of R1 315 p/b and R3 795 p/f per annum Max of R660 per frame - 1 frame p/b per annum - included in lenses limit 100% AT - Collective limit of R1 645 p/b and R2 615 p/f. Paid from AFB Single vision (incl. test) R770 Bifocal (incl. test) R1 170 Multifocal (incl. test) R1 550. Frames included in the lens Included in lenses limit Physiotherapy, Chiropractor and Biokineticist: Max R2 390 per family per year for all services Audiologist, Dietician, Occupational therapist, Speech therapist: Max R1 900 per family per year for all services Clear plastic single vision (limited to R695) or bi-focal lenses (limited to R1 113) every second year. for contact lenses. Paid from AFB Limited range of frames within DSP Network. Paid from AFB unless PMB. PMB rules apply Wellness, Lifestyle and Preventative Care (All s are paid from risk, except where indicated differently) Blood Pressure, Blood sugar, Cholesterol, BMI R155 p/b over the age of 18 only at DSP pharmacy Rapid HIV tests 1 test p/b per annum Prophylaxis Malaria as required Flu Vaccine, once per year p/b, limited to R80 Tetanus vaccine, one injection when required PSA (Prostate specific antigen) one test per male beneficiary over age 40. Quite smoking programme limited to R2 650 once a lifetime. Cost of programme will be refunded after the cotanine test to prove nonsmoking Glaucoma test one p/b per annum Pap Smear one test per female over age of 18 per annum Mammogram one test per female beneficiary over the age of 35 every second year HPC (Cervical Cancer) vaccine One course (3 doses per registered schedule) per female beneficiary between 12 and 18 years of age per life Adult Pneumococcal Vaccine, PB over 60 and high risk members subject to pre-authorisation. Fitness Assessment and exercise prescription: Access to Universal Network Biokineticists for: annual fitness assessment, exercise prescription, regular monitoring. Strict Protocols apply Nutritional assessment and healthy eating plan: Access to the Universal Network of dieticians for: annual assessment, healthy eating plan prescription, regular monitoring. Strict protocols apply Blood Pressure, Blood sugar, Cholesterol, BMI R155 p/b over the age of 18 only at DSP pharmacy. Flu Vaccine, once per year p/b, limited to R80 Newborn to Adult Benefit Emotional Wellness Oral contraceptives, limited to R110 p/b per month Baby wellness visit, two visits per annum for children between 4 weeks and 18 months at a DSP Baby bag or voucher to value of R1 000. Childhood immunisations, applicable to children up to the age of 12 years, as per recommendation of the Department of Health School readiness, 5-7 years old Psychometric testing, 14-18 years Unlimited telephone counseling with referral for one on one counseling, to a limit of 3 sessions per annum NEW!

2015 contributions Income Principal Adult Child Income Principal Adult Child Pinnacle All Pinnacle ED All Risk 3 536 2 751 985 Risk 2 904 2 258 816 Savings 876 684 240 Savings 876 684 240 Total 4 412 3 435 1 225 Total 3 780 2 942 1 056 Annual Savings 10 512 8 208 2 880 Annual Savings 10 512 8 208 2 880 Benefit 2 388 1 860 660 Benefit 2 388 1 860 660 Total Day to Day 12 900 10 068 3 540 Total Day to Day 12 900 10 068 3 540 Threshold (incl AFB) Self Payment GAP 14 208 11 043 3 857 1 308 975 317 Threshold (incl AFB) Self Payment GAP Dynamix All Dynamix ED All 14 208 11 043 3 857 1 308 975 317 Risk 2 831 2 213 785 Risk 2 323 1 813 6 44 Savings 492 384 144 Savings 492 384 144 Total 3 323 2 597 929 Total 2 815 2 197 788 Annual savings 5 904 4 608 1 728 Annual Savings 5 904 4 608 1 728 Annual Flex 1 800 1 416 504 Benefit 1 800 1 416 504 Total Day to Day 7 704 6 024 2 232 Total Day to Day 7 704 6 024 2 232 Annual threshold 10 620 8 286 3 050 Annual Selfpayment GAP 2 916 2 262 818 Threshold (incl AFB) Self Payment GAP Symmetry All Symmetry ED All 10 620 8 286 3 050 2 916 2 262 818 Risk 2 640 2 055 746 Risk 2 217 1 725 627 6 552 4 164 1 548 6 652 4 164 1 548 Mumed Mumed Network ED Income Principal Adult Child Income Principal Adult Child 501-6 000 6 001-7 900 7 901-15 000 1 563 1 211 443 1 731 1 351 493 1 886 1 471 535 Mumed ED 0-6 000 6 001-7 900 7 901-15 000 1 296 1 000 366 1 429 1 105 408 1 548 1 211 436 15 001+ 2 097 1 634 591 15 001+ 1 717 1 337 479 501-7 900 7 901-15 000 1 212 946 346 1 321 1 030 376 15 001+ 1 469 1 143 415 Axis All 1 436 1 436 444 Axis ED All 1 077 1 077 339 NetworX Excess Direct 0-500 325 325 158 501-4 000 4 001-5 000 5 001-6 000 6 001-8000 8 001-9 000 9 001-10 000 523 497 183 540 513 189 646 613 227 676 643 237 NetworX ED 0-500 310 306 168 501-4 000 4 001-6 000 6 001-9 000 9 001-10 000 353 346 174 452 429 215 539 512 256 571 543 272 769 732 270 10001+ 1 126 1 013 500 816 776 286 10001+ 1 501 1 351 526 R2 161 per family All information relating to the 2015 CompCare Wellness Medical Scheme s and contributions are subject to formal approval by the Council for Medical Schemes. On joining the Scheme, all members will receive a detailed member brochure, as approved. The final registered Rules of the Scheme will apply. *This brochure is a summary of the CompCare Wellness Medical Scheme. Glossary PMB Prescribed Minimum Benefit MSA Medical Savings Account CDL Chronic Disease List P/F Per family RP Reference Pricing TTO To Take Out i.e. medicines taken out of hospital when discharged AFB Benefit AFB++ Benefit Plus Plus Account SPG Self Payment Gap P/B Per beneficiary AT Agreed Tariff DSP Designated Service Provider TL Threshold Limit OTC Over The Counter Medicine