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2010 Benefit Presentation
Risk Benefits
Majo
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Ch
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Ben
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Pre
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B
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Em
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Crim
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Day-to-day Benefits
Threshold Level (THL)MSF + OHEB + SPG
Self-Payment Gap (SPG)
Out of Hospital Expenses Benefit (OHEB)
Out of Hospital Expenses Benefit (OHEB)
Medical Savings Facility (MSF)
RISK BENEFITS
•In-Hospital Costs •Practitioners paid @ Libcare Rate + 100%
•GP & Specialist consultations•Elective Dentistry (Incl basic den <8 & implants)•Paramedical Services•TTO’s (R 700 / +MSF)•Mental Health
•HIV Prevention, Treatment & Medication •Oncology & Associated Diagnostics•Renal Failure•Hospice Services• Private Nursing & Rehabilitation • External Appliances •Internal Prosthesis•MRI / CT scans (OOH) 2 per family•MRI / CT Scans in hospital – R 21 200 pf•Emergency Transport•CDE
RISK BENEFITS
•In-Hospital Costs •Practitioners paid @ Libcare Rate + 100%
•GP & Specialist consultations•Elective Dentistry (Incl basic den <8 & implants)•Paramedical Services•TTO’s (R 700 / +MSF)•Mental Health
•HIV Prevention, Treatment & Medication •Oncology & Associated Diagnostics•Renal Failure•Hospice Services• Private Nursing & Rehabilitation • External Appliances •Internal Prosthesis•MRI / CT scans (OOH) 2 per family•MRI / CT Scans in hospital – R 21 200 pf•Emergency Transport•CDE
Ch
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t
Pre
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Ben
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Em
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Crim
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t THBTHB
SPG
OHEB
MSF
Majo
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Majo
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Chronic BenefitR 20 100 per beneficiary
Prescribed Minimum Benefits (PMB) is:
a set of defined benefits to ensure that all medical scheme members have access to certain minimum
health services
Schemes cover the costs related to the diagnosis, treatment and care
of: • any emergency medical condition; • a limited set of medical conditions• 25 chronic conditions (Chronic
Disease List).
25 stipulated chronic conditions will enjoy unlimited cover
36 stipulated chronic conditions enjoy limited cover
Each beneficiary MUST register
Pre
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Ben
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Em
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Crim
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t THBTHB
SPG
OHEB
MSF
Majo
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Majo
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Ch
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Preventative Care Benefit
Em
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Crim
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Benefit Age
First GP visit pb All
First dental visit pb All
Pap smear (pathology) 16+
Mammogram (radiology)
40+
Bone Density (radiology)
50+
Cholesterol (lipogram) 15+
Blood Glucose (pathology)
All
Prostate (pathology) 50+
Adult vaccination: Flu All
Immunisations 0 – 5yrs
Pneumonia Vaccination 65+
2D Pregnancy Scans (3 & 6 months)
All
THBTHB
SPG
OHEB
MSF
Majo
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Majo
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Ch
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Pre
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B
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Em
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Crime Trauma Benefit
Trauma – Police Case Number:
•Hi-jacking•Attempted murder & assault•Rape victims
•HIV Prophylaxis
•Rehabilitation eg physiotherapy or speech therapy
•Psychology
THBTHB
SPG
OHEB
MSF
Majo
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Majo
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Ch
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Pre
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B
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Emergency Benefit & Physical Injuries
R1 200 per beneficiary
The benefit is intended to cover events after hours and where
the member is away from their normal residence.
Covers the facility fee for defined events
Member utilises a hospital casualty wardNo admission
Libcare must be notified within 48 hours
and a valid pre-authorisation number
obtained.
Crim
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t THBTHB
SPG
OHEB
MSF
Majo
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Majo
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Ch
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Pre
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B
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Em
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Crim
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Out-of-Hospital Expenses Benefit•Principal: R 1400, Adult: R 600, Child: R 500
Out-of-Hospital Expenses Benefit•Principal: R 1400, Adult: R 600, Child: R 500
Medical Savings Facility•20% of contribution & Depends on income band •Credit is granted upfront •Refunded 4 months after termination•Interest
Self-Payment GapThreshold Level – (MSF + OHEB)
Self-Payment GapThreshold Level – (MSF + OHEB)
Threshold Benefits•Limited per category •Pro-rated when joining later than 1 January
Practitioners paid @ Libcare Rate + 100%:Alternative Healthcare GP’s & Specialists (incl ante-natal classes)Dentists PsychologistsOptometrists Paramedical ServicesRoutine Medication Pathology & General Radiology
Practitioners paid @ Libcare Rate + 100%:Alternative Healthcare GP’s & Specialists (incl ante-natal classes)Dentists PsychologistsOptometrists Paramedical ServicesRoutine Medication Pathology & General Radiology
Day-to-day BenefitsDay-to-day Benefits
Threshold Level: not adjusted during the year should a member’s income band change or dependants be
added, change status, or be withdrawn.
Medical Savings Facility
Out-of-Hospital Expenses BenefitOut-of-Hospital Expenses Benefit
Threshold Level
How to calculate the SPG if a person earns R 7500:
MSF 3360 + OHEB 1400 = 4760
THL 5808 – 4760 = SPG 1048
Contributions
Contact Details
Helpdesk at Liberty Life Centre
Call Centre:0800 12 CARE (2273)
Claims: Claims Boxes
[email protected]+27 (21) 673 9582
Questions?
