1. LA Health 2012

2. Extent of cover and access The LA Health benefit options cater for different medical and financial needs Cost

3. Members can rely on LA Health to look after their health During 2010, LA Health Welcomed 893 new babies, 26 of whom were premature and required extra care Funded R61.4 million worth of medicine for 17 000 chronic members Paid treatment costs of R28.4 million for the 583 LA Health members with cancer Helped 1 376 HIV positive members manage their condition Bringing healthcare to you

4. On all options LA Health provides access to very high levels of cover Members can rely on LA Health to look after their health

5. Drivers of contribution increases Medical price inflation Increases in utilisation Advancements in medical technology Changes in demographic profile Reserve funding and solvency requirements

6. Medical price and utilisation drivers 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% Healthcare goods and services Consumer goodsMedicine prices Price inflation scale Medical inflation : 5% to 7%

7. LA Health has achieved phenomenal levels of growth, which has improved the Scheme’s profile For every year that the Scheme’s average age goes down, claims costs reduce by approximately 2%

8. LA Health has shown strong simultaneous growth in membership and reserves Growth in reserves is needed to support membership growth and increasing utilisation

9. 2012 contribution increases Headline increase for 2012 = 8.9% Benefit structures are unchanged in 2012 All limits will were increased by 6% MSA levels will were increased in line with contributions, except on LA Comprehensive

10. 2012 expected competitive position LA KeyPlus LA KeyPlus offers the greatest value for money in the market Note : *Assumes an increase of 7% on competitor options Scheme A Scheme B Scheme C Scheme D

11. 2012 expected competitive position LA Active and LA Focus Risk Note : *Assumes an increase of 7% on competitor options MSA LA Active and LA Focus are competitively priced compared to comparable options offered in the Local Government space Scheme A Scheme B Scheme D

12. 10 + 2 good reasons why LA Health 1.Comprehensive hospital cover on all Options: unlimited / managed 2.LA KeyPlus: in-hospital and GP network benefits unlimited and without co-payments in Networks 3.MSA enhanced by IPB / ATB and certain day-to-day Risk benefits 4.Unique emergency evacuation benefits through Discovery 911 5.Chronic Illness Benefit with CDA for non-formulary flexibility 6.Excellent dental benefits: flexibility ensures appropriate access 7.Screening benefits that help prevent serious illnesses 8.Best service and support 9.Amazing rewards and great savings when members improve their health through Vitality 10.Governance excellence, affordable contributions, reserves and growing membership 11.Registered 2012 Rules 12.Accredited by SALGBC

13. The benefit options meet member’s different needs Major Risk Benefits Day-to-day benefits MSASPGATB MSAIPB MSAIPB MSA KEYPLUS NETWORK

14. Overall benefit changes Increased all limits by 6% to keep pace with inflation Implementing the Discovery Pharmacy Networks on all Benefit Options Minimising member co-payments where pharmacies charge dispensing fees that are in line with Scheme Rate for Medicine Network includes all large corporate pharmacies (Dischem, Clicks, MediRite, etc) and courier pharmacies Scheme Rate for medicine at other pharmacies = 26% /R26

15. At KeyCare network hospitals and State Pre-authorisation required Emergency only in any hospital until stabilised Unlimited in-hospital benefit Ambulance or helicopter sent for specific type of emergency Access to Discovery 911 Ambulance Cover Limited to providers in the KeyCare network of hospitals Specialist Benefit In-Hospital Unlimited, subject to pre-authorisation Paid from Hospital Benefit Internal Prostheses In State hospitals Dialysis R 20 000 per person Excludes frail care Terminal Care Benefit limits increased by 6%. Some higher increases on Trauma Recovery Benefit KEYPLUS NETWORK

16. 27 Chronic conditions and the DTPMB conditions Unlimited according to medicine list PMB visits and tests Chronic Illness Benefit Chronic condition and ARTs Disease management for enrolment and information Unlimited HIV Benefit Rape, Mother to child transmission Unlimited Prophylaxis Authorised and referred by KeyCare GP SAOC: Tier 1 treatment Must submit treatment plan and use ICON / State Oncology Benefit For one of these conditions: Paraplegia, Quadriplegia, Severe burns, External and internal head injuries Certain limits and strict entry criteria apply Trauma Benefit – specific day- to-day care after a traumatic incident Limited Preventative screening tests Body mass index, Blood glucose, Blood pressure and Cholesterol Screening Tests at network of pharmacies

17. One mammogram, One pap smear One prostrate screening, Unlimited HIV screening Screening Benefit Choose your GPs on the Network Unlimited visits and minor procedures 3 after-hours visits at your GP per person per year K eyCare GP Network Acute medicine on the formulary Basic X-rays Basic blood tests Prescribed by your GP One GP visit; One X-ray, One blood test and One pharmacy claim (each) Out of network visits R185 co-pay at a Casualty Unit in a KeyCare Network Hospital Medicine, x-rays and blood test subject to formulary Casualty visits R3 800 per person per year Crutches, wheelchairs, long-leg calipers, commodes From Scheme’s DSP Mobility Benefit

18. Visit, infection control, fillings, extractions, and local anaesthetics Anti-fever and anti-microbial, pain medicine Incision and drainage of abscesses KeyCare Dentistry network One eye test One pair of mono or bifocal lenses with basic frame/ basic contact lenses every 24 months from last date of service KeyCare Optometry network: Iso Leso Optics Pays up to Scheme Rate when authorised and referred by GP Includes X-rays, blood tests, cost of materials, CT/MRI scans and visits in Casualty Specialist Benefit (out-of-hospital) (R2 300 per person per year ) Authorised and referred by your GP (once per member per year) Four consultations, One scan and elected screening tests Antenatal Benefit

19. Exclusions In-hospital dentistry In-hospital management of hearing disorders Obesity Spinal surgery for back and neck Skin disordersNon-cancerous breast conditions In-hospital diagnostic work-ups and investigative procedures Refractive eye surgery In-hospital conservative back treatmentIncontinence Functional and nasal surgeryBrachytherapy for prostate cancer All joint replacements, including hips and kneesSexual dysfunction Cochlear implants, internal nerve stimulators and auditory brain implants Elective caesarian section Surgery for oesophageal reflux, hiatus hernia repair and nissen funduplication Any claim incurred beyond the borders of South Africa Removal of varicose veinsBunionectomy Arthroscopy

20. At any private hospital Pre-authorisation required Related accounts paid at 100% of Scheme Rate Unlimited in-hospital benefit Ambulance or helicopter sent dependent on type of emergency Access to Discovery 911 Ambulance Cover Unlimited Claims paid at the Scheme rate Specialist Benefit In-Hospital Subject to pre-authorisation Cochlear implants, implantable defibrillators and auditory brain implants limited to R 143 000 per person per year. Internal Prostheses Unlimited, subject to clinical entry criteria, pre-authorisation and case management Organ Transplants R 26 700 per person Excludes frail care Terminal Care Unlimited, subject to authorisation and use of DSP. Voluntary use of non-DSP attracts co-payments Renal Care, including Dialysis MSAIPB

21. 27 PMB Chronic conditions and DTPMB conditions Unlimited according to medicine list and CDA PMB visits and tests Chronic Illness Benefit Mother to child transmission Chronic condition and ARTs Disease management for enrolment and information UNLIMITED HIV Benefit, including prophylaxis treatment R125 per person per year Body mass index, Blood glucose, Blood pressure and Cholesterol Preventative screening test R105 per person per year Preventative screening test

22. Oncology Management Programme Unlimited in a 12-month cycle, subject to pre-authorisation and a treatment plan After threshold of R 228 000 is reached, a 20% co-payment applies Oncology Benefit (includes all Oncology and related treatment and care) PET Scans Unlimited in a 12-month cycle from the Scheme’s DSPs. If a DSP is not used, a co-payment of R 3 125 applies Stem cell transplants Covered in full at centres of excellence If DSP is not used, a limit of R1 million applies Unless authorised to pay from this programme, normal day-to-day benefits apply

23. One mammogram, One pap smear One prostrate screening, Unlimited HIV screening Screening Benefit First R 2 440 paid by the Scheme; then MSA /IPB Basic dentistry only (no dentures) All dental subject to joint in- and out-of-hospital limit Day-to-day dentistry from risk – joint limit of R 15 050 R 1 800 of hospital account paid from MSA, remainder from MMB. All related accounts paid from MSA/IPB Subject to joint overall dentistry limit of R 15 050 per person Dentistry in-hospital First R 1 800 from MSA thereafter from MMB MRI/CT scans in-hospital R 1 800 of hospital account paid from MSA, remainder from MMB. All related accounts paid from MSA/IPB Subject to pre-authorisation Endoscopic procedures in-hospital

24. LA Active Day-to-day benefits Risk benefits Day-to-day basic dentistry R2 440 MSA All day-to-day benefits and basic dentistry once risk is exhausted IPB Risk benefits for day-to-day: GPs and Specialists Acute medication Blood tests X-rays Dentists Optometrists MSA carry over Pays for all day-to-day claims once the current year MSA is exhausted (for non-IPBs) and all benefits after current year MSA is exhausted IPB pays all claims at the Scheme rate after the MSA is exhausted In MSA, claims accumulate to IPB at the member’s chosen rate of reimbursement, i.e. Scheme rate or cost. Medicine rate of reimbursement applies even in IPB – i.e. 90% of Scheme Rate for acute medicine and 100%of cost for OTC medicine

25. At any private hospital in Province with coastline Pre-authorisation required Related accounts paid at 150% of Scheme Rate Unlimited in-hospital benefit Risk benefits the same as LA Active All day-today benefits subject to available MSA MSA

26. At any private hospital Pre-authorisation required Related accounts paid at 100% of Scheme Rate Unlimited in-hospital benefit Ambulance or helicopter sent dependant on type of emergency Access to Discovery 911 Ambulance Cover Unlimited. Claims paid at the Scheme rate Specialist Benefit In-Hospital Subject to pre-authorisation Cochlear implants, implantable defibrillators and auditory brain implants limited to R 143 000 per person per year. Internal Prostheses Unlimited at the Scheme’s DSP, subject to clinical entry criteria and authorisation. If DSP is not used (by choice) co-payments apply Renal Care (including Dialysis) Unlimited from MMB Excludes frail care Terminal Care Unlimited, subject to clinical entry criteria, pre-authorisation and case management Organ Transplants MSAIPB

27. Unlimited in a 12-month cycle, subject to pre-authorisation and a treatment plan After threshold of R 456 000 is reached, a 20% co-payment applies Oncology Benefit (includes all Oncology and related treatment and care) PET Scans Unlimited in a 12-month cycle from the Scheme’s DSPs. If a DSP is not used, a co-payment of R 3 125 applies Stem cell transplants Covered in full at centres of excellence If DSP is not used, a limit of R1 million applies Unless authorised to pay from this programme, normal day-to-day benefits apply

28. 27 PMB Chronic conditions and DTPMB conditions Unlimited according to formulary; PMB visits and tests Additional chronic disease list (limited) CDA applies if non-formulary medicine is used Chronic Illness Benefit (managed by DiscoveryCare) Chronic condition and ARTs Disease management for enrolment and information UNLIMITED HIV Benefit Rape Mother to child transmission Prophylaxis Must be pre-authorised Subject to clinical criteria and guidelines Centre for Diabetes and Endocrinology (CDE) Diabetes Management Preventative screening test R125 per person per year Body mass index, Blood glucose, Blood pressure and Cholesterol Screening Tests at pharmacy network

29. First R 1 800 of the hospital costs paid from MSA. Remainder of Hospital costs from MMB. Related costs from MSA/IPB All accounts subject to joint overall dental limit for in- and out-of-hospital dentistry R 19 900 Dentistry in-hospital Unlimited, subject to specialist referral from MMB MRI/CT scans and in- and out- of-hospital Unlimited, subject to pre-authorisation. Claims paid at the Scheme rate from MMB Endoscopic procedures in- and out-of-hospital

30. Medicine benefits Additional Chronic Conditions (ADLs) Unlimited, subject to pre-authorisation and use of medicine on a formulary CDA applies if non-formulary medicine is used Chronic Disease List Conditions (CDLs) Family sizeBenefit MemberR 6 835 Member +1+R 13 570

31. Day-to-day benefits MSA All day-to-day benefits and basic dentistry IPB Risk benefits for day-to-day: GPs and Specialists Acute medication Blood tests X-rays Dentists Optometrists MSA carry over Pays for all day-to- day claims once the current year MSA is exhausted (for non-IPBs) and all others after current year MSA is exhausted IPB pay all claims at the Scheme rate after the MSA is exhausted In MSA, claims accumulate to IPB at the member’s chosen rate of reimbursement, i.e. Scheme rate or cost. Medicine rate of reimbursement apply even in IPB – i.e. 90% of Scheme Rate for acute medicine and 100%of cost for OTC medicine

32. At any private hospital Pre-authorisation required Related accounts paid at 100% of Scheme Rate Unlimited in-hospital benefit Ambulance or helicopter sent dependant on type of emergency Access to Discovery 911 Ambulance Cover Unlimited. Claims paid at the Scheme rate Specialist Benefit In-Hospital Subject to pre-authorisation Cochlear implants, implantable defibrillators and auditory brain implants limited to R 143 000 per person per year. Internal Prostheses Unlimited at the Scheme’s DSP, subject to clinical entry criteria and pre-authorisation. If non-DSP is used voluntarily co-payments will apply Renal Care (including dialysis) Unlimited from MMB Excludes frail care Terminal Care Unlimited, subject to clinical entry criteria, pre-authorisation and case management Organ Transplants MSASPGATB

33. Unlimited in a 12-month cycle, subject to pre-authorisation and a treatment plan After threshold of R456 000 is reached, a 20% co-payment applies Oncology Benefit Unlimited in a 12-month cycle from the Scheme’s DSPs. If a DSP is not used, a co-payment of R 3 125 applies PET Scans Covered in full at centres of excellence I f DSP is not used, a limit of R1 million applies Stem cell transplant benefit Biologics and high technology medicine for specific conditions and medicine Limited to R 228 000 per person per year Subject to a maximum co-payment of 20% - based on the type of medicine or condition Specialised Medicine and Technology Benefit (SMTB)

34. 27 PMB Chronic conditions and DTPMB conditions Unlimited according to formulary; PMB visits and tests Additional chronic disease list (limited) CDA applies if non-formulary medicine is used Chronic Illness Benefit Managed by DiscoveryCare Chronic condition and ARTs Disease management for enrolment and information UNLIMITED HIV Benefit and Prophylaxis Must be pre-authorised Limited to R 22 800 per level, and 2 levels per procedure Further limited to one procedure per year Spinal prostheses / devices Preventative screening test R125 per person per year Body mass index, Blood glucose, Blood pressure and Cholesterol Screening Tests at pharmacy network Limited to R10 900 per bare metal stent Limited to R17 300 per drug eluting stent Implantable cardiac stents

35. MSA All day-to-day benefits first paid from MSA MSA was not increased for 2012 ATB Once MSA is exhaused,SPG and then Annual Threshold ATB pay all claims at the Scheme rate after the MSA is exhausted In MSA, claims accumulate to ATB at the Scheme rate. Medicine rate of reimbursement apply even in ATB – i.e. 90% of Scheme Rate for acute medicine. OTC paid at 100% of cost without accumulation to ATB

36. Out-of-hospital Mental Health Non-PMB Limited to R 12 000 per family per year. R 4 000 per person sub- limit for drug and alcohol rehab Private Nursing R 7 000 per family per year External Medical Items R 18 250 per family per year R 12 200 hearing aids (sub-limit) Optical R 2 860 per beneficiary per year for frame and lenses Acute Medicine M: R 6 255 M+1: R 8 005 M+2: R 9 645 M+3: R 11 130 M+4: R 12 720 Limited day-to-day benefits

37. Information sessions organised by the Scheme (mainly for pensioners) Town or Municipality Date in 2011 TimePlace Buffalo City 4 Nov12:00Library Hall, King Williams Town Buffalo City 4 Nov12:00City Hall, East London (Pensioners) Buffalo City 4 Nov15:00City Hall, East London (In-service) Jeffreys Bay10 Nov10:00Newton Hall, Jeffreys Bay Port Elizabeth10 Nov14:00Newton Park Library, Port Elizabeth Uitenhage11 Nov10:00Sun Room, Town Hall, Uitenhage Cape Town15 Nov10:30Civic Centre, Crush Hall, Cape Town Johannesburg21 Nov10:00Marks Park Sport Club, Emmarentia Johannesburg21 Nov14:00Klipriviersberg Recreation Centre, Kibler Park

38. Seize the day! Take the leap to good health Thank you