52nd Bestmed

Product Launch

Broker Launch 07 October 2016

© Bestmed Medical Scheme 2016. Bestmed Medical Scheme is a registered medical scheme (reg. no. 1252)
and an Authorised Financial Services Provider (FSP no. 44058).
Personally Yours

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Personally Yours

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Personally Yours
It means I
I value you help you be
your best It means I
as an
know your
individual not
I understand name
just a I recognise
what you number or your unique
need and resource worth and
strive to cater to your
satisfy your strengths
wants

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

 Let’s talk increase

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Reason increases exceed CPI
Basket of household goods excludes high-end healthcare products

Rise in cost of healthcare technologies

Fraudulent behaviour

Defensive medicines

Supply induced demand

NHI fear-mongering

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Average contribution increases 2009 - 2017
16.00

14.00

12.00

10.00

8.00

6.00

4.00

2.00

0.00
2009 2010 2011 2012 2013 2014 2015 2016 2017

Bestmed Average

Average calculated on Bonitas, Discovery, Fedhealth, MediHelp,

Momentum
© Bestmed Medical Scheme 2016
Source: Medical
Presentation Title goesscheme
here XXbrochures
Month 2016
Bestmed increase composition
0.42-0.46% 10.98%
2.33%

2%

6% 0.23%

CPI Price increases Utilisation Solvency build Residual risk Average Bestmed
increase

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Contribution Increases
12.35%
11.71% 11.80% 11.86% 11.86%
11.36%
10.66%
9.88% 9.88% 9.88% 9.88% 9.88% 9.88%

Beat 1 Beat 1 Netw Beat 2 Beat 2 Netw Beat 3 Beat 3 Netw Pace1 Beat 4 Pace 2 Pace 3 Pace 4 Pulse 1 Pulse 2

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Actual Increase is more important than % increase
2016 Contr Rand Increase for 2017

R 332

R 227
R 185 R 219

R 149
R 140
R 157

R 113 R 2 462

R 1 862 R 1 908 R 1 840

R 1 499
R 1 414
R 1 316
R 1 144

Beat 1 - Hosp (9,88%) Beat 2 - Saver (9,88%) Scheme 1 - Hosp (9,9%) Scheme 1 - Saver (9,9%) Scheme 2 - Hosp (11,9%) Scheme 2 - Saver Scheme 3 - Hosp (11.9%) Scheme 3 - Saver (13,5%)
(11,9%)

Source: medical scheme brochures

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Co-payments On Hospital and Savings options
Scheme 1 Scheme 2

Standard co-Pay per

hospitalisation O O P
Co – Pay 17 referral
procedures O P P
Gastroscopy in hospital
P P P
Gastroscopy out of
hospital O P O
© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

 How do we add value to
members despite the
annual increase?

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Wellness – Tale of 2 Paradigms
HRA Web Portal

Interventions

Activity - Biokineticist Nutrition - Dietician Disease Management - Support groups

Clinical

Reporting

Employee - personalised Employer – Consolidated

& Aggregated

Available to Individuals and Employer groups

© Bestmed Medical Scheme 2016 Free of charge
Presentation Title goes here XX Month 2016
Two Bestmed wellness stories
Mr C Company: tertiary Institution
Age: 44
Hypertensive
BMI 3 years
Inactive
Medication

1 year 1. Inactivity +40,1%

2. Cardiovascular risks -3,2%
3. Cholesterol risks -19%
Age: 45 4. Diabetes risks -18,8%
BMI – Normal 5. Hypertension risks -23,4%
No Hypertension 6. Nutrition +32,5%
Active 7. Stress management +37,7%
No medication 8. BMI -14,3%

No cost to member No cost to employer

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Healthcare service providers
Profiling & peer
management

Network tariffs Geo-mapping &

& PMBs SP footprint
Image area
High quality & accessible services
Sustainable with Cost containment
Minimal discomfort to the members Benefits, Claims &
Optimal interaction with providers Protocols & codes
Rules monitoring

Dedicated
provider
consultant
service

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Family Practitioner
Heatmap (Sept 2016)

Image area
3200 Family Practitioners

72% in Network spend

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Specialist Network
Heatmap (Sept 2016)

Image area
1 589 Specialists since May 2016

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Most inclusive pharmacy network

1 215 Pharmacies

82% in Network spend

365 Independent Pharmacies

Essential Health
ML Manco Pharmacy Group

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Hospital & Clinic networks – Giving access
Scheme 1 Scheme 2
Gauteng 90 72 37

Western Cape 73 24 27

Eastern Cape 27 1 12

Kwa-Zulu Natal 46 15 19

Northern Cape 5 0 3

Limpopo 8 0 3

Mpumalanga 20 0 8

North West 15 0 5

Free state 18 6 6

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Solvency : Rand per Beneficiary
Bestmed Reserves per Beneficiary
5500
5445.3 5447.6

5400 43%
more than scheme 1
5300

5200
5165.5
23%
5111.3
more than scheme 2
5100

13%
5000
more than scheme 3
4900
Bestmed 2012 Bestmed 2013 Bestmed 2014 Bestmed 2015

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

New and improved administration system

EXISTING NEW
SYSTEM SYSTEM

• Social media friendly

• Electronic applications
• Member engagement
• Broker engagement
• Real time information
• Improved efficiency and effectiveness
© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 What do people say about
us?

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

 The view of members
Member views

Industry Bestmed
8.2
8.1

8 8 8 8
8
7.9

7.8 7.8 7.8

7.8
7.7

7.6
7.6

7.4 7.4
7.4

7.2

7
Professional Service Assist in solving queries Good claims Ideal medical aid Meet your needs Encourages you to look Offers good benefits Affordable contributions
Source: Specialist research procedures at wellness holistically

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 The view of Brokers
Broker views

Industry Bestmed
8.25
8.2 8.2 8.2
8.2

8.15
8.1 8.1 8.1 8.1
8.1

8.05
8 8
8

7.95
7.9 7.9 7.9
7.9

7.85

7.8

7.75
Professional Service Assist in solving Good claims Ideal medical aid Meet your needs Encourages you to look Offers good benefits Affordable contributions
Source: Specialist research queries procedures at wellness holistically

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 Plan Range

Source: Signal Model

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 Trends worth noting

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Bestmed’s positioning – open schemes
Bestmed moving into 4th Place
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015*
1

4th
5

11

13

15

17

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Membership growth
% Increase / Decrease 2015 vs 2012
35.00%

30.43%
30.00%

25.00% 24.05%

20.00%

15.00%

10.00% 9.02% 8.73%

5.00%

0.00%
Bestmed Discovery Momentum Bonitas Fedhealth Medihelp

-5.00% -3.99%

-10.00% -8.19%

-15.00%
Source: CMS & annual reports
© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Ageing of Options
Average Age Increase on most popular options (2015 vs 2012)
3.5

2.95
3

2.5

2 1.91

1.64

1.5
1.27

1 0.85

0.5
0.18

0
Beat 1 Beat 2 Beat 3 Beat 4 Pace 1 Pace 2

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 What additional value do
we add?

© Bestmed Medical Scheme 2016

Presentation Title goes here XX Month 2016

Apps
Broker login Page
Register broker account
Welcome Screen dashboard
Notification / Warnings
Capture broker details
Load company image
Access news articles
Download brochures
Download application forms
Download option change forms

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Value added products

Gap Cover Justrewards WorkCare Health Bucks

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

 Beat options
• Beat1 Young individual whom just started working – relatively healthy –
interested in cover for emergency high cost events

• Beat2 Higher income to afford a hospital plan with a savings benefit add-on –
Member with spouse seeking cover for emergency high cost events and
some day-to-day benefits

• Beat3 Starting to plan a family and now seeking maternity cover

• Beat4 Young family requiring more day-to-day cover – relatively

healthy but peace of mind of more cover in/out of hospital
 Pace options
• Pace1 Young individual or newly started family - relatively healthy –
interested in cover for emergency high cost events together with more
day-to-day benefits.

• Pace2 The guarantee of benefits being covered like a possible joint

replacement surgery and the guarantee of comprehensive cover in/out
of hospital

• Pace3 Higher level of benefits required in/out of hospital – possible diagnosis

such as chronic diseases, oncology

• Pace4 Maximum cover required to reduce the risk of running out of benefits
 Pulse options
• Pulse1 An individual seeking medical cover that is adaptable to income level –
comfortable with providers practicing within a set network / designated
service providers

• Pulse2 Mature family with advanced healthcare needs providing unlimited

cover for hospitalization at a network of hospital and primary care
services at a network of providers
16 PMB conditions introduced
 2017 Overview of Changes on the Beat Range

Beat 1

 Adult dependant premiums is less than principal member premiums

 Prostheses sub-limits increased to 10%
 External prosthesis benefit changed to no benefit
 Exclusions sub-limits increased to 10%
 Dental and Oral surgery benefit changed to no benefit :only PMB’s covered at DSP hospitals only
 Maxilla – facial surgery changed to no benefit :only PMB’s covered at DSP hospitals only
 Refractive Eye surgery changed to no benefit
 CDL co-payment increased to 40%
 Paediatric immunisations changed to no benefit
 16 PMB conditions added to pay from Scheme Risk
 Oncology in-hospital changed to only PMB’s only at DSP: State hospitals
 Co-payments in-hospital increased to R3 000 from R2 400 for Endoscopic investigations
 Peritonial dialysis/Haemo dialysis changed to no benefit: only PMB's covered at DSP
 Female contraceptives increased to R1 800 from R1 550p/a
 2017 Overview of Changes on the Beat Range
Beat 2

 Savings benefit of 17%

 Maxilla – facial surgery changed to no benefit :only PMB’s covered at DSP only
 Dental and Oral surgery changed to no benefit: only PMB’s covered at DSP only
 Prosthesis sub-limits increased to 10%
 External prosthesis benefit changed to no benefit
 Exclusions sub-limits increased to 10%
 Oncology in-hospital changed to only PMB’s only at DSP: State hospitals
 Refractive Eye surgery changed to no benefit
 Paediatric immunisations changed to no benefit
 16 PMB conditions added to pay from Scheme Risk
 All medicine claims paid from savings will be subjected to MRP
 Co-payments in-hospital increased to R3 000 from R2 400 for Endoscopic investigations
 Peritonial dialysis/Haemo dialysis changed to no benefit: only PMB's covered at DSP
 Female contraceptives increased to R1 800 from R1 550p/a
 2017 Overview of Changes on the Beat Range

Beat 3

 Savings benefit of 17%

 Prostheses sub-limits increased to 10%
 External prosthesis benefit changed to no benefit
 Exclusions sub-limits increased to 10% (Joint Replacement Surgery): except for PMB’s
 Exclusions other minor joints is changed to R9 900 from R10 000
 Dental and Oral surgery benefit increased to R6 300 from R6 000
 CDL co-payment increased to 40% from 35%
 Non-CDL co-payment benefit changed to 75% from 85%
 16 PMB conditions added to pay from Scheme Risk
 Oncology in-hospital changed to only PMB’s only at DSP: State hospitals
 Co-payments in-hospital increased to R3 000 from R2 400 for Endoscopic investigations
 All medicine claims paid from savings is subjected to MRP
 Female contraceptives increased to R1 800 from R1 550p/a
 2017 Overview of Changes on the Beat Range

Beat 4

 Savings reduced from 17% to 15%

 Prostheses sub-limits increased to 10%
 Exclusions sub-limits introduced on Joint Replacement Surgery: except for PMB’s
 16 PMB conditions added to pay from Scheme Risk
 Non- CDL benefits 8 conditions funded
 Rehabilitation services after trauma will pay from vested savings and not savings.
 Stem cell storage from vested savings
 Female contraceptives increased to R1 800 from R1 550p/a
 All medicine claims paid from savings are subjected to MRP
 > Flu Vaccine
> Pneumonia Programme
> Back Rehabilitation Programme (DBC)
> Female Contraceptives
> Biometric screenings: Glucose,
Cholesterol, Blood pressure
measurement and Body Mass Index
calculation
> Pap smear – ages 18 and above every
24 months
Core -
Preventative
 Basic Dentistry part of > Flu Vaccine
preventative care or paid from MSA > Pneumonia Programme

Dentistry
> Back Rehabilitation Programme (DBC)
> Female Contraceptives
> Biometric screenings: Glucose,
Cholesterol, Blood pressure
measurement and Body Mass Index
calculation
> Pap smear – ages 18 and above every
24 months
Core -
Preventative CDL = 27 / PMB = 16

Subject to funds available in MSA

Non-Network Network
PM R3168 PM R2856
AD R2460 AD R2220
CD R1332 CD R1200
Medical Savings
Preventative Dentistry
Optical
according to Bestmed
protocol

Pap smear
Core -
Preventative
CDL = 27 / Non-CDL = 5 / PMB = 16
Subject to funds available in MSA
Non-Network Network
PM R4812 PM R4332
AD R3420 AD R3084
Medical savings CD R1860 CD R1668
 Optical

Acute

Dentistry
Medicine

Pap smear
Specialised
Radiology
GP &
Specialist
consulting

Mammogram
Maternity

Dietician
Radiology &
Pathology

Core -

HPV Vaccine
Supplementary Preventative
Services CDL = 27 / Non-CDL 8 / PMB 16

Dentistry

Medical savings
 Day-to-day benefits paid from
savings first, then subject to
overall limit Optical

Specialised
Acute Radiology

Dentistry
Medicine 100% of Bestmed

Pap smear
M : R2 250 tariff, limited to
M1+ : R4 550 R13 200 pfpa

GP &
Specialist Maternity
consulting 2 Sonars and up to 12

Mammogram
M : R2 550 antenatal consultations
M1+ : R4 550

Dietician
Radiology & CDL = 27 / Non-CDL 8 / PMB 16
Pathology
M : R2 550 Dentistry
M1+ : R5 200
M : R4 300
Core - M1+ : R8 650

HPV Vaccine
Supplementary Preventative
Services
M : R3 900 Subject to funds available in MSA
M1+ : R7 900 PM R6516
AD R5376
CD R1608

Medical savings Overall day-to-day limit

M – R10 000
M1 – R20 000
Overall

Any private ER24 International Infant Care

hospital or 084 124 travel insurance
network
hospital
applicable to
network
option (except
Beat4

Exclusions are applicable to joint replacements (except PMB)

• Co-payment R3 000 on Endoscopic investigations except on Beat4
• Co-payment R 3 000 on specialised diagnostic imaging done in hospital on Beat1and 2
• Co payment of R10 000 applicable for hospital admission to non-DSP hospital
Beat3/4 – PPN Optical Benefit

 Benefit cycle: Each beneficiary is entitled to either spectacles or contact lenses in a 24 month
benefit cycle

 Consultation R350
 Frame R550
 Single-vision lenses R165 or
 Bifocal lenses R360 or
 Multifocal lenses R660 or
 Contact lenses R1 000 (Beat4 R1 210)
Beat3 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 75% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL – 40%
Limited to M – R2 700, M1 – R5 450

Non-CDL = 5 conditions

1. ADD / ADHD
2. Acne – severe
3. Eczema
4. Allergic Rhinitis
5. Migraine Prophylaxis
Beat4 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 85% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL – 30%
Limited to M – R5 900, M1 – R11 800

Non-CDL = 8 conditions

1. ADD / ADHD
2. Acne – severe
3. Eczema
4. Allergic Rhinitis
5. Migraine Prophylaxis
6. Gout Prophylaxis
7. Major Depression
8. Obsessive Compulsive Disorder
 Beat Beat
Network

CD CD CD CD CD CD CD
R476 R589 R820 R529 R655 R911 R895
(Increased R43) (Increased R53) (Increased R74) (Increased R59) (Increased R82) (Increased R94)
(Increased R84)

AD AD AD AD AD
AD R1087 AD R1208
R879 R1 509 R976 R1 676 R2 988
(Increased R98) (Increased R109) (Increased R313)
(Increased R79) (Increased R136) (Increased R88) (Increased R151)

PM PM PM PM PM
PM PM R1 554
R1131 R1 399 R2 123 R1 257 R2 359 R3 618
(Increased R126) (Increased R140) (Increased R212) (Increased R379)
(Increased R102) (Increased R191) (Increased R113)

Beat1 Beat2 Beat3 Beat1 Beat2 Beat3 Beat4

2017 Overview of changes on the Pace range

Pace 1
 Savings benefit of 20%
 Prostheses sub-limits increased to 10%
 Exclusions sub-limits increased to 10% (Joint Replacement Surgery): except for PMB’s
 16 PMB conditions added to pay from Scheme Risk
 Stem cell storage from vested savings
 Female contraceptives increased to R1 800 from R1 550p/a
 Oncology in-hospital benefit changed to PMB’s only: State Hospitals
 Oncology out of hospital changed to PMB’s only
 Peritoneal and Haemo dialysis benefit changed to PMB’s only: DSP only
 Organ Transplant PMB’s only
 All medicine claims paid from savings is subjected to MRP
 Non- CDL benefits 7 conditions funded

Pace 2
 Savings increase 15%
 Prostheses sub-limits increased to 10%
 Exclusions sub-limits increased to 10% (Joint Replacement Surgery): except for PMB’s
 16 PMB conditions added to pay from Scheme Risk
 Non-CDL benefit 18 conditions funded
 Stem cell storage from vested savings
 Female contraceptives increased to R1 800 from R1 550p/a
 All medicine claims paid from savings is subjected to MRP
2017 Overview of changes on the Pace range

Pace 3
 Savings benefit of 15%
 Prostheses sub-limits increased to 10%
 Exclusions sub-limits increased to 10% (Joint Replacement Surgery): except for PMB’s
 16 PMB conditions added to pay from Scheme Risk
 Non-CDL benefit18 conditions funded
 Stem cell storage from vested savings
 Female contraceptives increased to R1800 from R1550p/a
 All medicine claims paid from savings is subjected to MRP

Pace 4
 Savings benefit of 3%
 Prostheses sub-limits increased to 10%
 16 PMB conditions added to pay from Scheme Risk
 Non-CDL conditions benefit of 26 conditions funded
 Stem cell storage from vested savings
 Female contraceptives increased to R1800 from R1550p/a
 All medicine claims paid from savings is subjected to MRP
Core >
>
>
HPV Vaccine
Flu Vaccine
Pneumonia Programme
> Pediatric Immunisations
Pace1 >
>
>
Back Rehabilitation Programme (DBC)
Female Contraceptives
Preventative Dentistry
> Haemophilius Infuenzae Type B Vaccine (HIB)
> Mammogram
> Pap Smear
> Biometric screenings: Glucose, Cholesterol,
Core - Blood pressure measurement and Body Mass
Preventative Index calculation (Health Check)

CDL = 27 / Non-CDL = 7 / PMB = 16

Subject to funds available in MSA

PM R7332
Medical Savings AD R5148
CD R1848

Overall day-to-day limit

M – R8 500
M1 – R17 000
 Maternity

Specialised Dentistry
Radiology

GP & Specialist
Radiology &
Pathology Pace1 consulting

Supplementary
Services CDL = 27 / Non-CDL = 7 / PMB = 16
Core -
Preventative Acute
Medicine

Optical

Medical Savings
 Day-to-day benefits paid from
savings first, then subject to
overall limit

Maternity
2 Sonars and up to 12
antenatal consultations
Specialised
Radiology Dentistry
100% of Bestmed M : R3 150
tariff, limited to M1+ : R6 400
R11 450 pfpa

GP & Specialist
Radiology &
M
Pathology
: R2 550
Pace1 consulting
M : R1 750
M1+ : R3 550
M1+ : R5 100

Supplementary
Services CDL = 27 / Non-CDL = 7 / PMB = 16
Core -
M : R3 450 Preventative Acute
M1+ : R7 150
Medicine
M : R1 850
Optical M1+ : R3 800

Medical Savings
 Maternity

Dentistry
Specialised
Radiology

Radiology &
Core GP & Specialist
consulting
Pathology
Pace2

PSA, Dietician
CDL = 27 / Non-CDL = 18 / PMB = 16
Supplementary
Services Acute
Medicine
Core -
Preventative

Optical

Subject to funds available in MSA

PM R7764
Medical Savings AD R7608
CD R1716

Overall day-to-day limit

M – R12 000
M1 – R24 000
 Day-to-day benefits paid from
savings first, then subject to
overall limit

Maternity
2 Sonars and up to 12
antenatal consultations
Specialised Dentistry
Radiology
100% of Bestmed M : R5 300
tariff, MRI/CT M1+ : R10 600
scans max of 3
pb, PET scan 1 pb

GP & Specialist
Radiology &
Pace2 consulting

PSA, Dietician
Pathology
M : R3 450
M : R2 550 M1+ : R6 950
M1+ : R5 200

Supplementary
Services CDL = 27 / Non-CDL = 7 / PMB = 16
Core -
M : R4 300 Preventative Acute
M1+ : R8 650 Medicine
M : R3 800
Optical M1+ : R7 600

Medical Savings
 Maternity
2 Sonars and up to 12
antenatal consultations
Specialised Dentistry
Radiology

Prostate Screening PSA, Bone Densitometry, Dietician

GP & Specialist
Radiology &
Pathology Pace3 consulting

Supplementary
Services CDL = 27 / Non-CDL = 18 / PMB = 16
Core -
Preventative Acute
Medicine

Optical

Medical Savings Subject to funds available in MSA

<98 500p.a >98 500p.a
PM R7764 R9168
AD R6108 R7320
CD R1416 R1536
Overall day-to-day limit
M – R15 000
M1 – R31 000
 Maternity
2 Sonars and up to 12
antenatal consultations
Specialised Dentistry
Radiology

Prostate Screening PSA, Bone Densitometry, Dietician

100% of Bestmed M : R5 700
tariff, MRI/CT M1+ : R10 600
scans max of 3
pb, PET scan 1 pb

GP & Specialist
Radiology &
Pathology Pace3 consulting
M : R3 450
M : R2 850
M1+ : R5 500 M1+ : R7 150

Supplementary
Services CDL = 27 / Non-CDL = 18 / PMB = 16
Core -
M : R2 100 Preventative Acute
M1+ : R4 200 Medicine
M : R1 200
Optical M1+ : R3 000

Medical Savings
 Maternity
2 Sonars and up to 12
antenatal consultations
Specialised Dentistry
Radiology

Prostate Screening PSA, Bone Densitometry, Dietician

GP & Specialist
Radiology &
Pathology Pace4 consulting

Supplementary
Services CDL = 27 / Non-CDL = 26 / PMB = 16
Core -
Preventative Acute
Medicine

Optical

Medical Savings Subject to funds available in MSA

PM R2196
AD R2196
CD R516
Overall day-to-day limit
M – R28 000
M1 – R45 100
 Subject to overall day-to-day
limits first, when depleted,
annual savings apply

Maternity
2 Sonars and up to 12
antenatal consultations
Specialised Dentistry
Radiology

Prostate Screening PSA, Bone Densitometry, Dietician

100% of Bestmed M : R9 500
tariff, MRI/CT M1+ : R16 100
scans max of 3
pb, PET scan 1 pb

GP & Specialist
Radiology &
Pathology Pace4 consulting
M : R4 400
M : R4 400 M1+ : R7 150
M1+ : R8 650

Supplementary
Services CDL = 27 / Non-CDL = 26 / PMB = 16
Core -
M : R4 400 Preventative Acute
M1+ : R8 650 Medicine
M : R6 950
Optical M1+ : R10 800

Medical Savings
Overall

Any private ER24 International Infant Care

hospital 084 124 travel insurance

Joint replacements covered (only excluded on Pace1)

Pace1/2/3 – PPN Optical Benefit

 Benefit cycle: Each beneficiary is entitled to either spectacles or contact lenses in a 24 month
benefit cycle

 Consultation R350
 Frame R550
 Single-vision lenses R165 or
 Bifocal lenses R360 or
 Multifocal lenses R660 or
 Contact lenses R1 000 (Pace2 R1 210, Pace3 R1 400)
Pace4 – PPN Optical Benefit

 Benefit cycle: Each beneficiary is entitled to either spectacles or contact lenses in a 24 month
benefit cycle

 Consultation R350
 Frame R550
 Single-vision lenses R165 or
 Bifocal lenses R360 or
 Multifocal lenses R660 or
 Contact lenses R1 710
Pace1 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 85% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL – 35%
Limited to M – R5 200, M1 – R10 450

Non-CDL = 7 conditions

1. ADD / ADHD
2. Acne – severe
3. Eczema
4. Allergic Rhinitis
5. Migraine Prophylaxis
6. Gout Prophylaxis
7. Major Depression
Pace2/3 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 85% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL Pace2 – 30%, Pace3 – 25%
Limited to Pace2 M – R7 150, M1 – R14 300 and Pace3 M – R11 500, M1 R23 000

Non-CDL = 18 conditions

1. ADD / ADHD
2. Acne – severe
3. Eczema
4. Allergic Rhinitis
5. Migraine Prophylaxis
6. Gout Prophylaxis
7. Major Depression
8. Obsessive Compulsive Disorder
9. Osteoporosis
10. Psoriasis
11. Urinary incontence
12. Paget’s disease
13. GORD
14. Ankylosing Spondylitis
15. Osteoarthritis
16. Alzheimer’s disease
17. Collagen disease
18. Dermatomyositis
Pace4 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 85% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL - 20%
Limited to M – R15 550, M1 – R31 150

Non-CDL = 26 conditions

1. ADD / ADHD 19. Hypopituitarism

2. Acne – severe 20. Motor Neuron disease
3. Eczema 21. Neuropathy
4. Allergic Rhinitis 22. Polyarteritis Nodosa
5. Migraine Prophylaxis 23. Scleroderma
6. Gout Prophylaxis 24. Sjogren’s disease
7. Major Depression 25. Trigeminal Neuralgia
8. Obsessive Compulsive Disorder 26. Psoriatic Arthritis
9. Osteoporosis
10. Psoriasis
11. Urinary incontinence
12. Paget’s disease
13. GORD
14. Ankylosing Spondylitis
15. Osteoarthritis
16. Alzheimer’s disease
17. Collagen disease
18. Dermatomyositis
 Pace

CD CD CD CD
CD
R771 R951 R 787 R 853
(Increased R100) (Increased R80) R1 428
(Increased R74) (Increased R87) (Increased R157)

AD AD AD AD
R2 145 R4 231 R3 394 R4 066 AD
(Increased R207) (Increased R415) (Increased R346) R6 096
(Increased R447)
(Increased R670)

PM PM PM PM PM
R3 055 R4 315 R4 243 R5 097 R6096
(Increased R294) (Increased R670)
(Increased R455) (Increased R520) (Increased R433)

Pace1 Pace2 Pace3 Pace3 Pace4

<R98 500 >R98 500
2017 Overview of changes on the Pulse range
Pulse1

Out of Hospital Network changes to In-House Network

 Prostheses sub-limits increased to 10%
 Exclusions sub-limits increased to 10% (Joint Replacement Surgery): except for PMB’s
 CDL- Chronic meds formulary co-payment increased to 40% from 35%
 16 PMB conditions added to pay from Scheme Risk
 OTC limit R300 per family per annum
 Female contraceptives introduced of R1800
 Oncology out of hospital changed to PMB’s only: State facility
 All medicine claims paid from savings is subjected to MRP
 Income category changed
 Oncology in-hospital reduced to only PMB’s only at DSP: State hospitals
 Dialysis/Haemo dialysis reduced to no benefit: only PMB's covered at DSP
 Co-payment increase for endoscopic and other clinically approved procedures
2017 Overview of changes on the Pulse range
Pulse2

Out of Hospital Network changes to In-House Network

 Prostheses sub-limits increased to 10%

 Non-CDL benefit reduced to 16 conditions from 25 conditions
 16 PMB conditions added to pay from Scheme Risk
 OTC limit R525 per family per annum
 Female contraceptives increased to R1800 from R1550p/a
 All medicine claims paid from savings is subjected to MRP
  Pneumonia Vaccine
 Pediatric Immunisations
 Flu Vaccine
Core  Biometric screenings: Glucose,
Cholesterol, Blood pressure
measurement and Body Mass
Index calculation (Health
Check)
 Female contraceptive R1 800
pfpa
Core -
Preventative
Acute Medicine Optical
Subject to network PPN capitation provider
formulary at 100%
scheme tariff Basic
Dentistry

Pulse Specialists
Subject to Bestmed
1 Pulse dental network

Core - CDL = 27 / PMB = 16

Preventative
GP & Specialist consulting
Unlimited GP visits subject
to Bestmed Pulse1 GP
network
Acute Medicine Optical
Subject to network PPN capitation provider
formulary at 100% Specialised
scheme tariff Radiology

Flu vaccination, Back Rehabilitation Contraceptives

Basic and
Specialised
Dentistry
Pulse Specialists
Subject to Bestmed

Radiology &
Pathology
2 Pulse dental network

Core - CDL = 27 / PMB = 16

Preventative
Supplementary GP & Specialist consulting
Services Unlimited GP visits subject
to Bestmed Pulse1 GP
network
Acute Medicine Optical
PPN capitation provider
M : R3 600
M1+ : R7 200
Specialised
Radiology

Flu vaccination, Back Rehabilitation Contraceptives

Subject to pre-authorization.
Basic and MRI/CT scan: 3 scans pb. PET
scans; 1 scan pb
Specialised
Dentistry
M
M1+
: R5 700
: R7 250
Pulse Specialists
M : R2 350

Radiology &
Pathology
2 M1+ : R4 800

Subject to overall
day-to-day limit CDL = 27 / PMB = 16
Core -
Preventative
Supplementary GP & Specialist consulting
Services Unlimited GP visits subject
M : R3 350 to Bestmed Pulse1 GP
M1+ : R6 600 network.Out-of –network GP
visits limit to R1200 pfpa
Pulse2 - Non-CDL conditions

Reimbursement for CDL and PMB – 100% scheme tariff

Reimbursement for Non-CDL – 85% Bestmed scheme tariff
Non-formulary co-payment for CDL, PMB and Non-CDL - 25%
Limited to M – R5 450, M1 – R10 800

Non-CDL = 16 conditions

1. ADD / ADHD
2. Acne – severe
3. Eczema
4. Allergic Rhinitis
5. Migraine Prophylaxis
6. Gout Prophylaxis
7. Major Depression
8. Obsessive Compulsive Disorder
9. Osteoporosis
10. Psoriasis
11. Urinary incontinence
12. Paget’s disease
13. GORD
14. Osteoarthritis
15. Alzheimer’s disease
16. Neuropathy
Overall

Any private ER24 International Infant Care

hospital 084 124 travel insurance

• Co payment of R10 000 per event for voluntary use of a non-DSP hospital
 CD
0-R5 500 p/m R760 (increased R81) CD
R1 037
R5 501-R8 501 p/m R911 (increased R87) (increased R110)
>R8 501 p/m R911 (increased R97)

AD
0-R5 500 p/m R1 202 (increased R127) AD
R5 501-R8 501 p/m R1 443 (increased R153) R4 365
>R8 501 P/M R1 640 (increased R174) (increased R463)

PM
0-R5 500 p/m R1 265 (increased R134) PM
R5 501-R8 501 p/m R1 518 (increased R161) R4 365
>R8 501 R1 823 (increased R193) (increased R463)

Pulse1 Pulse2
What is our message to?

Existing Prospective
Brokers
members members

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Message to existing members
We grow reserves per beneficiary for a more sustainable future

We attract new members

We retain our benefit structure

We avoided enforcing increased co-payments, condition specific co-payments and self

payment gaps on members

We provide excellent value for money

We ensure appropriate contribution increases

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Message to prospective members
We provide affordable contributions
We provide excellent value for money
We cater for all life stages
We resist co-payments
We don’t believe in self payment gaps
We are self-administered
Your individual needs matter to us

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016

Message to our brokers

Firstly, we want to thank you

for your loyalty in serving
our joint clients.

Secondly, can you afford not

to offer Bestmed to your
clients? Our brokers say
NO!

© Bestmed Medical Scheme 2016

Broker Launch 07 October 2016