Sizwe Comparative Brochure
Transcription
Sizwe Comparative Brochure
COMPARATIVE G U I D E 2016 #caring4life WHY SIZWE? We offer a range of medical aid products, starting with a network healthcare product ideal for lower-income earners right up to premium medical aid products for high-income earners. To assist you in making an informed choice on our various benefit options, have a look at what each option offers. DISCLAIMER: Our 2016 benefits and contributions are subject to approval by the Registrar of Medical Schemes. This brochure is for information purposes only and does not supersede the rules of the Fund. A full set of the rules is available on our website: www.sizwe.co.za 2016 HEALTHCARE OFFERINGS GOMOMO CARE This is our entry-level option. Gomomo provides excellent value for money. GPs, specialists and acute medicines are accessible through a selected network provider. Dentistry, radiology and pathology are also available from a network provider. No overall limit for in-hospital at selected network hospital Covers the 27 CDL conditions. SAVINGS CARE This is our new generation option. Comprehensive in-hospital benefits. Out-of-hospital benefits paid from a 15% savings portion available up front for the year. No overall in-hospital limit with the freedom to go to any private hospital. PRIMARY CARE Primary Care option offers good value for money with unlimited hospitalisation at any private hospital. This traditional option has generous day-to-day benefits which cover acute medicines, GP’s, specialists, radiology, pathology and more to meet the needs of any family. AFFORDABLE CARE Our Affordable Care option offers generous comprehensive cover with unlimited hospitalisation in any private hospital. It also covers additional chronic conditions with specialised dentistry and preventative benefits. FULL BENEFIT CARE Our Full Benefit Care option offers comprehensive cover, generous benefits to cover families and individuals who need access to unlimited hospitalisation at any private hospital. Full benefit offers additional chronic conditions, specialised dentistry, GP’s, specialists, acute medication, preventative care benefits and more rich benefits. This is the only option which offers additional cover when in hospital up to 200% of the Sizwe rate. GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Day to Day Benefits Includes: General Practitioners (GP’s) Specialists (excluding Psychiatrists), Acute Medicine, Pathologists, Radiologists & Physiotherapists. % Benefit OUT OF HOSPITAL BENEFITS Member Member Member Member Member Member Member 100% Sizwe Rates +1 +2 +3 +4 +5 +6+ General Practitioners Limited to stipulated number of visits 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Subject to available savings R5 390 R7 980 R9 330 R10 670 R12 020 R13 370 R14 720 R9 330 R13 370 R15 390 R16 740 R18 760 R20 790 R15 390 R20 790 R23 370 R26 060 R28 770 R31 460 R34 150 R22 690 Additional GP visits per family on the Primary Care option only. 100% Sizwe Rates Required benefits for full year Subject to Chosen GP Out of area visits: 4 GP visits per beneficiary. Subject to pre-authorisation. 100% Sizwe Rates Subject to available savings Member: Member +1 : Member +2 : Member +3 : Member +4 : Member +5 : Member +6+ : 4 9 12 14 15 16 17 Member Member Member Member Member Member Member : +1 : +2 : +3 : +4 : +5 : +6+ : 7 14 16 18 20 21 22 Member Member Member Member Member Member Member : +1 : +2 : +3 : +4 : +5 : +6+ : 12 20 25 29 30 31 32 Specialists (Excluding Psychiatrists) Acute Medicine, Pathologists, Radiologists & Physiotherapists. Limited to stipulated number of visits All visits subject to referral from a GP. 100% Sizwe Rates Subject to available savings 2 M 4 M 7 M 6 7 M+1 M+2 8 9 M+1 M+2 12 15 M+1 M+2 8 9 M+3 M+4 10 11 M+3 M+4 16 17 M+3 M+4 10 11 M+5 M+6+ 12 13 M+5 M+6+ 19 20 M+5 M+6+ First time specialist visits are subject to GP referral. First time specialist visits are subject to GP referral. GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Acute Medicines & Pharmacy Advised Therapy (PAT) - falls within day-to-day benefit with the following sub-limits Member 100% Sizwe Rates Member +1 Member +2 Required benefits for full year. Member +3 Member +4 Member +5 100% Sizwe Rates Subject to available R1 680 R3 250 R4 380 R3 030 R3 370 R4 940 R5 840 R7 750 R8 990 Subject to Formulary R3 820 R6 290 R10 230 Over the counter: R265 per family R3 930 R4 150 R7 190 R7 420 R10 890 R11 460 R4 490 R7 640 R12 020 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates savings Member +6+ % Benefit 100% Sizwe Rates General Radiology/ Radiography Limit Managed care protocol pre-authorisation. Specialised R6 360 per family R22 500 per family R16 630 per family R25 280 per family R33 260 per family Subject to preauthorisation and clinical protocols Subject to preauthorisation and clinical protocols Subject to preauthorisation and clinical protocols or day to day. Subject to preauthorisation and clinical protocols Subject to preauthorisation and clinical protocols 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Radiology (Separate Limit for MRI/CT/Angiograms combined In and Out of Hospital) Interventional Radiology Physiotherapy % Benefit 100% Sizwe Rates 100% Sizwe Rates Pathology % Benefit 100% Sizwe Rates At designated service provider (DSP) 100% Sizwe Rates 100% Sizwe Rates OUT OF HOSPITAL BENEFITS Radiology & Radiography GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Dentistry OUT OF HOSPITAL BENEFITS Conservative Dentistry: Subject to Dental Management Programme - 0860 109556 % Benefit 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Consultations, Oral Hygiene, Extractions, Filling Consultation and Oral hygiene treatment is available once a year per beneficiary. Subject to available savings. Consultations and Oral hygiene treatment is 2 annual consultations and oral hygiene treatment per year, once every 6 months. 2 annual consultations and oral hygiene treatment per year, once every 6 months. available once a year, every 6 months Subject to managed care protocols. 2 annual consultations and oral hygiene treatment per year, once every 6 months. Subject to managed care protocols. 100% Sizwe Rates Orthodontics on this 100% Sizwe Rates Subject to managed care protocols. Subject to managed care protocols. Specialised Dentistry % Benefit 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates option has a 35% co-payment. Crowns and Bridges No Benefit Benefit is subject to No Benefit Pre-authorisation is required. 1 crown per family per year. Benefit is subject to managed care protocols. Pre-authorisation is required. 3 crowns per family per year. Benefit is subject to managed care protocols. No Benefit Pre-authorisation is required. On preauthorisation cases will be clinically assessed and funding can be granted up to 65% of the Sizwe Rates. Orthodontic treatment is limited to beneficiaries from age 9 and younger than 18 years of age. Benefit is subject to managed care protocols. Pre-authorisation is required. Orthodontic treatment is limited to beneficiaries from age 9 and younger than 18 years of age. Benefit is subject to managed care protocols. managed care protocols. Benefit for crowns are limited to once per tooth in 5 years. Orthodontics (Braces) No Benefit Benefit is subject to managed care protocols. Benefit for orthodontic treatment is limited to beneficiaries from age 9 and younger than 18 years of age. GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Specialised Dentistry Implants No Benefit Subject to the available No Benefit No Benefit savings. Benefit is subject to Pre-authorisation is required. 2 Implants per beneficiary per annum managed care protocols. over a 5 year period. The cost of the implant Partial Metal Frame Dentures Plastic Dentures No Benefit 1 Set of plastic dentures, an upper and a lower per beneficiary in a 4 year period. Benefit is subject to managed care protocols. Benefit is subject to managed care protocols. Subject to the available savings. Managed Care protocols apply. X2 partial frames per beneficiery in a 5 year period. Limited to X1 family member per anumm. X2 partial frames per beneficiery in a 5 year period. Limited to X2 family member per anumm. Plastic Dentures and associated laboratory costs: 1 set of plastic Plastic Dentures and associated laboratory costs: 1 set of plastic Plastic Dentures and associated laboratory costs: 1 set of plastic dentures (an upper and a lower) per beneficiary in a 4 year period. 1 set dentures (an upper and a lower) per beneficiary in a 4 year period. 1 set dentures (an upper and a lower) per beneficiary in a 4 year period. 1 set of partial dentures (an upper and a lower) of partial dentures (an upper and a lower) of partial dentures (an upper and a lower) per beneficiary in a 2 year period. per beneficiary in a 2 year period. per beneficiary in a 2 year period. No Benefit Dentistry Surgery Benefit is subject to managed care protocols. Benefit is subject to managed care protocols. Surgery in the dental chair: Benefit is subject to Clinical restrictions apply benefit is subject to Benefit is subject to managed care protocols. Surgery in the dental rooms only. Benefit is Surgery in the dental rooms only. managed care protocols. managed care protocols. Surgery in the dental Surgery in the dental rooms only. only available for the following codes: 8931, 8935, 9011 and 9013. rooms only. OUT OF HOSPITAL BENEFITS component is limited to R2 350 per implant. GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Optical Choose either spectacles (frames and lenses) OR contact lenses once every 2 years. OUT OF HOSPITAL BENEFITS Eye Test % Benefit 100% Sizwe Rates Subject to pre-authorisation 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Limit 1 test per beneficiary every 2 years Subject to available savings 1 test per beneficiary every 2 years 1 test per beneficiary every 2 years 1 test per beneficiary every 2 years % Benefit 100% Sizwe Rates Frames limited to R465 per beneficiary. 100% of Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Member Member Member Member Member Member Member R1 R1 R1 R1 Subject to available savings R1 R1 R1 R1 R1 R1 R1 R1 570 R1 680 R1 900 R2 020 R2 086 R2 130 R2 190 R2 R2 R2 R2 R3 R3 R3 Subject to available savings R450 per lens R680 per lens R680 per lens Frames & Lenses +1 +2 +3 +4 +5 +6+ Combined Limit for frames and lenses benefit 010 160 290 850 120 240 290 350 460 570 632 360 470 810 920 030 150 200 Multi Focal Lenses Sub limit Contact Lenses % Benefit Limit No Benefit One pair of permanent contact lenses every 2 years or 12 pairs of monthly disposable contact lenses per beneficiary per annum. 100% Sizwe Rates 100% of Cost Subject to available savings 100% Sizwe Rates Included in above 100% Sizwe Rates Included in above 100% Sizwe Rates Included in above No Benefit No Benefit No Benefit 100% Sizwe Rates R5 618 per family 100% Sizwe Rates R10 791 per family Refractive Surgery % Benefit Limit GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE OUT OF HOSPITAL BENEFITS - Prescribed Minimum Benefits (PMB’s) are paid at Sizwe negotiated rates. Mental Health Psychiatrists, Clinical & Counselling Psychologists - only if related to mental health, excludes Educational Psychologists, Social Workers and Registered Counsellors % Benefit 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Family Limit Included in Specialist benefit Subject to PMB’s R6 750 R4 610 R7 640 R14 720 % Benefit Audiologists, Chiropractors, Dieticians, Homeopaths, Occupational Therapists, Podiatrists, Speech Therapists, Social Workers, Educational Psychologists, Biokinetics and Registered Counsellors. 100% Sizwe Rates Limited to R2 250 per family per annum Maternity 100% Sizwe Rates Subject to available savings 100% Sizwe Rates M: R900 M+1+: R1 460 100% Sizwe Rates M: R1 350 M+1+: R2 360 100% Sizwe Rates M: R2 470 M+1+: R4 150 Subject to registration on the maternity programme within 24 weeks of falling pregnant % Benefit 100% Sizwe Rates 100% Sizwe Rates Subject to available savings 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Ante-Natal Consultations Within GP and Specialist limit 9 GP/midwife visits 2 Specialist visits 9 GP/midwife visits 2 Specialist visits 9 GP/midwife visits 4 Specialist visits 9 GP/midwife visits 6 Specialist visits Pregnancy Scans 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy. 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy . OUT OF HOSPITAL BENEFITS Auxiliary GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE CHRONIC BENEFITS: Subject to pre-authorisation. CHRONIC MEDICINES: subject to registration on the Chronic Medicine Programme - 0860 10 34 55. PMBs subject to pre-authorisation, prefered providers and treatment protocols. % Benefit 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Limit R7 000 per beneficiery Cover for 27 PMB chronic conditions Cover for PMB chronic conditions 11 additional conditions Cover for PMB Chronic Conditions+ HRT & Major Depression R4 940 per beneficiary Cover for PMB chronic conditions. R9 770 per beneficiary Cover for PMB chronic conditions. 13 additional conditions. 33 additional conditions. % Benefit Limit Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for monitoring purposes. 100% Sizwe Rates 100% Sizwe Rates No limit but subject to treatment protocols. Subject to PMBs No limit but subject to treatment protocols. Subject to PMBs 100% Sizwe Rates No limit but subject to treatment protocols. Subject to PMBs 100% Sizwe Rates No limit but subject to treatment protocols. Subject to PMBs 100% Sizwe Rates No limit but subject to treatment protocols. Subject to PMBs CHRONIC BENEFITS HIV/Aids GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE IN-HOSPITAL BENEFITS % Benefit Top-up Cover (must be applied for within 3 months of hospitalisation) No Benefit No Benefit Ambulance No Benefit 100% Sizwe Rates + 200% EUROP ASSIST SA 0860 11 77 99 Private Hospitals & Nursing Homes IN-HOSPITAL BENEFITS No Benefit Subject to Treatment and Case Management Protocols and PMBs. Pre-authorisation required unless it is a medical emergency. Accommodation A co-payment will apply to all unauthorised admissions unless emergency % Benefit Limit 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit Clinical Limitations and Exclusions Advanced Laparoscopic, Reconstructive & Cardiac Surgery, Joint Replacements, Spinal Surgery, Breast Reconstructions and Augmentations. None Advanced Laparoscopic, Reconstructive & Cardiac Surgery, Joint Replacements, Spinal Surgery, Breast Reconstructions and Augmentations. None None Dental Hospitalisation General anaesthetic in hospital A co-payment will apply to all unauthorised admissions unless emergency. Subject to pre-authorisation and Dental Benefit Management Programme and Clinical Protocols. Subject to R1 500 co-payment on some options. Pre-Authorisation required. Admission protocols apply. Limited to PMB treatment only. A co-payment of R1 500 per hospital admission applies. Benefit is subject to managed care protocols. General anaesthetic benefits are available for beneficiaries under the age of 5 years for extensive dental treatment only. General anaesthetic treatment is available for the removal of impacted teeth. A co-payment of R1 500 per hospital admission applies. Benefit is subject to managed care protocols. General anaesthetic benefits are available for beneficiaries under the age of 5 years for extensive dental treatment only. General anaesthetic treatment is available for the removal of impacted teeth. A co-payment of R1 500 per hospital admission applies. Benefit is subject to managed care protocols. General anaesthetic benefits are available for beneficiaries under the age of 5 years for extensive dental treatment only. General anaesthetic treatment is available for the removal of impacted teeth. A co-payment of R1 500 per hospital admission applies. Benefit is subject to managed care protocols. General anaesthetic benefits are available for beneficiaries under the age of 5 years for extensive dental treatment only. General anaesthetic treatment is available for the removal of impacted teeth. GOMOMO CARE SAVINGS CARE PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE IN-HOSPITAL BENEFITS % Benefit Subject to pre-authorisation and Dental Benefit Management Programme and Clinical Protocols. Subject to R1 500 co-payment on some options. 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Benefit is subject to managed care protocols. Benefit is limited to extensive dental treatment. Benefit is subject to managed care protocols. Benefit is limited to extensive dental treatment. 100% Sizwe Rates Benefit is subject to managed care protocols. 100% Sizwe Rates Benefit is subject to managed care protocols. 100% Sizwe Rates Benefit is subject to managed care protocols. 100% Sizwe Rates No limit 100% Sizwe Rates No limit 100% Sizwe Rates No limit 100% Sizwe Rates No limit 100% Sizwe Rates Subject to PMB’s 100% Sizwe Rates Subject to PMB’s 100% Sizwe Rates Subject to PMB’s 100% Sizwe Rates Subject to PMB’s Conscious sedation in rooms Benefit is subject to managed care protocols. Benefit is limited to extensive dental treatment. Pre-authorisation is required. Removal of impacted teeth only. Laughing gas in dental rooms 100% Sizwe Rates Benefit is subject to managed care protocols. Subject to available savings. Benefit is subject to managed care protocols. 100% Sizwe Rates Required benefits for full year 100% Sizwe Rates Pre Authorisation required. Subject to PMB’s Benefit is subject to managed care protocols. Benefit is limited to extensive dental treatment. 100% Sizwe Rates General Practitioner % Benefit Limit Auxiliary Benefit Dietician, Speech Therapists & Occupational Therapists Radiology & Radiography % Benefit 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates General Radiology/ Radiography Limit Required benefits for full year No Limit No Limit No Limit No Limit Specialised Radiology (Separate Limit for MRI/CT/Angiograms combined In and Out of Hospital) R6 360 per family R22 500 per family R16 630 per family R25 280 per family R33 260 per family IN-HOSPITAL BENEFITS Dental Hospitalisation GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE IN-HOSPITAL BENEFITS Pathology Benefits 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Subject to pre-authorisation and DSPs 21 days per beneficiary including psychiatric consultations and 6 in-hospital consultations by a Clinical or Counselling Psychologist. Subject to pre-authorisation and DSPs 21 days per beneficiary including psychiatric consultations and 6 in-hospital consultations by a Clinical or Counselling Psychologist. Subject to pre-authorisation and DSPs 21 days per beneficiary including psychiatric consultations and 6 in-hospital consultations by a Clinical or Counselling Psychologist. Subject to pre-authorisation and DSPs 21 days per beneficiary including psychiatric consultations and 6 in-hospital consultations by a Clinical or Counselling Psychologist. Subject to pre-authorisation and DSPs 21 days per beneficiary including psychiatric consultations and 6 in-hospital consultations by a Clinical or Counselling Psychologist. 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates 100% Sizwe Rates Psychiatric Hospitalisation IN-HOSPITAL BENEFITS % Benefit Specialists % Benefit Maternity Subject to registration on the maternity programme within 24 weeks of falling pregnant Delivery Pre-authorisation required. Pre-authorisation required Pre-authorisation required. Pre-authorisation required Pre-authorisation required Post Natal Services and Midwifery Subject to pre-authorisation and Hospital Benefit Management Programme. Subject to pre-authorisation and Hospital Benefit Management Programme. Subject to pre-authorisation and Hospital Benefit Management Programme. Subject to pre-authorisation and Hospital Benefit Management Programme. Subject to pre-authorisation and Hospital Benefit Management Programme. 100% Sizwe Rates Required benefits for full year 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit 100% Sizwe Rates No Limit 100% Sizwe Rates Limit per family R37 980 100% Sizwe Rates Limit per family R50 138 Provincial Hospitals % Benefit Limit Prosthesis Surgical % Benefit Limit 100% Sizwe Rates No Limit Subject to Pre-authorisation and PMBs 100% of Sizwe Rates PMBs apply Pre-authorisation required 100% Sizwe Rates R33 765 100% Sizwe Rates Limit per family R 22 790 GOMOMO SAVINGS PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE CARE CARE IN-HOSPITAL BENEFITS Alcoholism/Drug Addiction/Narcotism Benefit 3 days withdrawal treatment plus 21 days Rehabilitation at an appropriate facility Subject to Pre-authorisation and PMBs 3 days withdrawal treatment plus 21 days Rehabilitation at an appropriate facility 3 days withdrawal treatment plus 21 days Rehabilitation at an appropriate facility 3 days withdrawal treatment plus 21 days Rehabilitation at an appropriate facility 3 days withdrawal treatment plus 21 days Rehabilitation at an appropriate facility 100% Sizwe Rates R178 796 100% Sizwe Rates PMBs at DSPs 100% Sizwe Rates PMBs at DSPs 100% Sizwe Rates PMBs at DSPs Organ Transplants & Renal Dialysis 100% Sizwe Rates PMBs at DSPs Stents Subject to PMB’s CARDIAC STENTS %Benefit Limit 100% Sizwe Rates 3 per family 100% Sizwe Rates 3 per family 100% Sizwe Rates 3 per family 100% Sizwe Rates 3 per family VASCULAR STENTS %Benefit Limit 100% Sizwe Rates 2 per family 100% Sizwe Rates 2 per family 100% Sizwe Rates 2 per family 100% Sizwe Rates 2 per family 100% Sizwe Rates R 250 000 100% Sizwe Rates R 300 000 Oncology %Benefit Limit Subject to PMB’s 100% Sizwe Rates Subject to PMBs 100% Sizwe Rates R114 480 100% Sizwe Rates R 100 000 IN-HOSPITAL BENEFITS % Benefit Limit #caring4life GOMOMO CARE SAVINGS CARE PRIMARY AFFORDABLE FULL BENEFIT CARE CARE CARE WELLNESS BENEFITS % Benefit Limit 100% Sizwe Rates Within GP, Pathology limit Wellness Screening Consultation % Benefit Limit 100% Sizwe Rates R1 802 100% Sizwe Rates R1 802 100% Sizwe Rates R1 802 100% Sizwe Rates R1 802 Blood sugar, cholesterol, blood pressure, BMI & HIV 100% Sizwe Rates Within GP, Pathology limit 100% Sizwe Rates R286 100% Sizwe Rates R244 100% Sizwe Rates R244 100% Sizwe Rates R244 No Benefit 100% Sizwe Rates Subject to available savings 100% Sizwe Rates R2 364 per family per annum 100% Sizwe Rates R2 364 per family per annum 100% Sizwe Rates R2 364 per family per annum % Benefit Limit WELLNESS BENEFITS Oral Contraceptives CONTRIBUTIONS 2016 GOMOMO CARE Income Bracket Income Category Principal Member Adult Dependant Child Dependant R0 - R6 360 R6 361 - R7 420 R7 421 - R9 540 R9 541 + 460 470 480 490 R700 R1 030 R1 530 R1 890 R690 R1 020 R1 420 R1 490 R290 R370 R370 R380 Income Bracket Income Category Principal Member Adult Dependant Child Dependant R0 – R14 200 R14 201 + 580 590 R1 850 R2 570 R1 600 R2 060 R450 R510 15 % of total contribution paid to savings account. PRIMARY CARE Income Bracket Income Category Principal Member Adult Dependant Child Dependant R0 - R500 R500 - R8 270 R8 271 + 170 180 R376 R1 730 R2 160 R376 R1 350 R1 410 R376 R430 R430 Income Bracket Income Category Principal Member Adult Dependant Child Dependant R0 - R14 200 R14 201 + 280 290 R2 470 R3 430 R2 270 R3 050 R570 R680 Income Bracket Income Category Principal Member Adult Dependant Child Dependant R0 - R17 810 380 R3 830 R3 480 R780 R17 811 + 390 R4 530 R4 120 R890 AFFORDABLE CARE FULL BENEFIT CARE CONTRIBUTIONS 2016 SAVINGS CARE #caring4life IMPORTANT CONTACT DETAILS CHRONIC MEDICATION PROGRAMME: Tel: 0860 10 34 55 | 011 353 0030 Fax: 011 353 0352/0076 [email protected] HOSPITAL PRE-AUTHORISATION, HOSPITAL BENEFIT MANAGEMENT PROGRAMME: Tel: Tel: 0860 10 11 76 DENTAL BENEFIT MANAGEMENT: Tel: 0860 10 95 56 | Fax: 0866 77 03 36 [email protected] WELLNESS PROGRAMME–HELPLINE FOR ASTHMA, CARDIOVASCULAR DISEASE, DIABETES AND MENTAL HEALTH: Tel: 0860 10 34 55 | Fax: 011 221 5238 [email protected] HIV/AIDS MANAGEMENT PROGRAMME: Tel: 0860 10 34 54 | Fax: 011 221 5235/56 EUROP ASSISTANCE SA, MEDICAL EMERGENCIES, 24-HOUR AMBULANCE SERVICES AND MEDICAL ADVICE: Tel: 0860 11 77 99 MATERNITY Fax: 011 221 5218 Email: [email protected] TIP-OFFS ANONYMOUS FRAUD LINE: Tel: 0800 20 47 02 | Fax: 0800 00 77 88 Email: [email protected] CHRONIC MEDICATION PROGRAMME: Tel: 0860 10 34 55 | 011 353 0030 Fax: 011 353 0352/0076 [email protected] www.sizwe.co.za [email protected] 0860 100 871
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