2016 Benefit Changes
2016 Increases Option % Increase R – Value Increase Private Choice 5.6% R50 Private 6.0% R80 Private Plus 6.8% R115 Private Comprehensive 3.6% R75 Average Increase 5.5%(*) (*) Based on adult contributions
Specific Benefit Changes Diagnostic scopes Colonoscopy benefit increased by 7% to R3 750 per scope (Private, Private Plus & Private Comprehensive) External medical / surgical appliances Benefit increased by 10%. New benefit is 75% of cost up to R16 500 per member family p.a. (All benefit options) In-and-out-of-hospital MRI / CT scans Benefit enhanced to now include previously excluded scans relating to the conservative treatment of back / neck conditions (Private, Private Plus & Private Comprehensive) Maxillo-facial surgery New in-hospital benefit added to provide cover if required as a result of major trauma / accident (Private Choice)
Specific Benefit Changes Basic dental benefits New benefit for dentures & bridges now included. New benefit is R3 000 per beneficiary p.a. for crowns, dentures & bridges. In-hospital age limit for extractions & fillings improved to include beneficiaries < 9 years Fillings capped at 6 fillings per beneficiary p.a. Plain X-rays capped at 6 X-rays per beneficiary p.a. Root canal treatment capped at two root canal treatments per beneficiary p.a. (All options)
Specific Benefit Changes Medical savings account Increased by 10% to R3 960 per adult p.a. (18% of contribution) (Private Plus) Decreased by 9% to R2 520 per adult p.a. (10% of contribution) (Private Comprehensive) Medication benefit Increased by 20% to R3 600 per adult p.a. (Private Comprehensive) Consultation benefit Consultation benefit increased by 13% to R350 per consultation per adult p.a. Number of consultations reduced from 6 to 4 consultations per adult p.a. (Private Comprehensive)
Unique Benefits • Average contribution increase of 5.5% lowest in industry (4th consecutive year) • Private Choice rated as best value for money hospital plan in South Africa (Towers Watson & GTC Healthcare) • The luxury to choose (no networks) • Unique basic dentistry benefit – R25 000 per beneficiary p.a. on all benefit options • Child dependent rates exceptionally well positioned • Out of hospital MRI / CT benefits • No upfront deposits prior to hospitalisation • Provides excellent financial cover (200% on 3 of the 4 benefit options) • Strong financial position • “You don’t need to pay more to occupy the same bed in hospital”
Financial sustainability One of the TOP 5 Open Schemes since 1st Position 2013
Annual contribution Increases Year Average annual contribution increase 2016 5.50% 2015 5.30% 2014 6.43% 2013 4.95% 2012 7.20% 2011 9.50%
2016 contributions Private Choice Adult R950 First Child Dependent Additional Children R250 Private Adult R1 420 Child R350 Additional Children R275 each Private Plus Adult R1 800 Child R350 Additional Children R275 each Private Comprehensive Adult R2 150 Child R350 Additional Children R275 each