Changes for the new benefit year, at a glance

BENEFITS

In general the benefits were increased by 6%. As one of the objectives for this year was to differentiate the Plans more clearly, the following additional changes will be implemented:

PLATINUM PLAN

  • No co-payment when admitted to hospital by a non-Network specialists, plus addition of contraceptive benefit limit (subject to certain conditions). Please read more about this in your new member guide.
  • Oncology drugs benefit limits increased by 15%.
  • Age for mammograms reduced from 50 to 40.
  • Behcet’s Disease, Obsessive Compulsive Disorder, Paget’s Disease and Sjogren’s Disease added to list of other Scheme-covered chronic conditions.

TRADITIONAL PLUS PLAN

  • Although not a change made by the Scheme, the administrator of this Plan, ONECARE Health, has been bought by MMI Health – please see new contact details.
  • Oncology drugs benefit limits increased by 15%.
  • Age for mammograms reduced from 50 to 40.
  • Behcet’s Disease, Obsessive Compulsive Disorder, Paget’s Disease and Sjogren’s Disease added to list of other Scheme-covered chronic conditions.

TRADITIONAL PLAN

  • Oncology drugs benefit limits increased by 15%.
  • Age for mammograms reduced from 50 to 40.
  • Behcet’s Disease, Obsessive Compulsive Disorder, Paget’s Disease and Sjogren’s Disease added to list of other Scheme-covered chronic conditions.

SAVINGS PLAN

  • Cover for refractive procedures from personal medical savings account.
  • Age for mammograms reduced from 50 to 40.
  • Behcet’s Disease, Obsessive Compulsive Disorder, Paget’s Disease and Sjogren’s Disease added to list of other Scheme-covered chronic conditions.

HOSPITAL PLAN

  • No cover for refractive procedures.
  • Chronic medicine cover for Major Depression.

In line with a directive from the Registrar of Medical Schemes, the format of benefit limits was changed, where relevant, from a “Member, Adult and Child” structure to a “Member, Member + 1, Member + 2, Member + 3 or more” limit structure.