Presentation on theme: "Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders."— Presentation transcript:
Who are we? We are a registered medical scheme – serving our members since 1961. We are a non-profit organisation with our members as our primary stateholders. We are truly independent – being a self administered fund. Excellent administration system – we process patient claims within 48 hours. Our reserves exceed the statutary regulation by 120%. (Current Solvency 150%) – amongst the industries highest.
When considering a Medical Scheme - we think you need to ask? Is in-hospital or out-of-hospital/ Day to Day benefits important to you? Can I go to a hospital of my choice and will it be a Government or a Private Hospital? AND can I have a private Ward? Can I choose my own doctors? How long must I wait for my bills to be paid? Do I have a say in how “ they ” use my money? Does your company contribute towards your Medical Aid subscriptions and if so, how much per month? – What's the tax implication to me?
OPTION 1 - Health Pact Premium aimed at … Individuals that require top quality private hospital care. Not concerned about day-to-day care, because he/she has disposable cash to cover this. Tax efficient product. Our offer to you. Chronic Meds: Asthma, Epilepsy, Juvenile Rheumatoid Arthritis Pediatrics R600 per child Ante-natal R1600 per family Unlimited Hospital cover in a hospital of your choice Full Pathology MRI / CT R6000 per beneficiary,with co- payment of R1500 Specialists up to 200% of NHRPL/CMP tariff Emergency ambulance services of your choice Laparoscopic procedures according to (SASES) SA Society of Endoscopic Surgeons guidelines and pre-authorization This product is not designed for ongoing chronic usage PMB’s HealthPact Premium
OPTION 2 - Health Pact Silver aimed at … This option is not designed for, “ I want full freedom of choice ”, but rather at members that require – Balanced cover at an Affordable cost. Families with children, often single parent families. Little disposable income – monthly budgeting may be an issue. Limited chronic medicine requirements. Hospital benefits are important, but secondary to day-to-day Our offer to you. PMB’s Chronic Meds: Asthma, Epilepsy, Juvenile Rheumatoid Arthritis 2 Visits to GP Dental R300 per beneficiary Pediatrics R600 per child Ante-natal R1600 per family Acute medication R300 per family Unlimited Hospital cover in a hospital of your choice Full Pathology MRI / CT R6000 per beneficiary, with co- payment of R1500 Specialists up to 111% of NHRPL /CMP tariff Emergency ambulance services of your choice No Laparoscopic procedures Pre-Funded Med Savings R2100 per adult HealthPact Silver
OPTION 3 - Health Pact Gold aimed at … The high income business executive. The person who requires significant savings and day-to-day cover, to avoid the hassle factor. Who demands seeing top quality medical practitioners – who charge above tariff. Who demands top quality hospital cover. The person who requires top quality chronic medication. Who demands freedom of choice and is not really worried about monthly cost. In most cases these individuals are subsidised. Our offer to you. Unlimited Hospital cover in a hospital of your choice. Semi Pvt Wards Included. Full Pathology MRI / CT R12000 per beneficiary, with co- payment of R1500 Specialists up to 200% of NHRPL/CMP tariff Emergency ambulance services of your choice Laparoscopic procedures according to (SASES) SA Society of Endoscopic Surgeons guidelines and pre-authorization Dental R1200 per family Orthodontic R8000 per minor beneficiary per family 4 Visits to GP per beneficiary Pediatrics R1200 per child Ante-natal R2400 per family 28 Chronic conditions Acute medication R1200 per family Pre-Funded Med Savings R4800 per adult HealthPact Gold PMB’s
Typical Hospital Event Medicine 10% Specialist 20% Hospital 70% CMP Portion Medicine Co- Payment Amount over NHRPL Limit Covered by Medical Aid Co-Payment Procedure 2006 New Age Payment of Procedure 2007 New Age Payment of Procedure CMP Portion Co-Payment Procedure Amount over NHRPL Limit Take Home Tablets 2008 The CMP Difference CMP Manages Industy Overview Paid by member either cash or from savings portion Work with us and we manage on your behalf
Rates 2008 BeneficiariesPremiumSilverGold AdultR610 R805 ---------------- MSA=R2100 Per adult R2025 --------------- MSA=R4800 Per adult ChildR100 R115 ----------------- MSA=R300 per child R498 ---------------- MSA = R1176 per child
All claims are processed within 48 hours & paid within two weeks A positive balance on your MSA earns you 5% pa and your funds are carried forward. Financial stability. No channeling – freedom of choice when going to hospital. Unlimited pathology (blood tests) via Pathcare or Lancet Laboratories. 5 Nursing sisters at your disposal. Their job is to manage and PRE QUOTE all hospital events, remove the stress points in you r time of need and just as important, give you a say in what you are going to be charged, BEFORE YOU ARE CHARGED IT! We understand Medical Schemes and we promise listen to you. What we promise you is :