LA Health2012

Extent of cover and access

The LA Health benefit options cater for different medical and financial needs

Cos

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Members can rely on LA Health to look after their health

During 2010, LA Health

Welcomed 893 new babies, 26 of whom were premature and required extra care

Funded R61.4 million worth of medicine for 17 000 chronic members

Paid treatment costs of R28.4 million for the 583 LA Health members with cancer

Helped 1 376 HIV positive members manage their condition

Bringing healthcare to you

On all options LA Health provides access to very high levels of cover

Members can rely on LA Health to look after their health

Drivers of contribution increases

Medical price inflation

Increases in utilisation

Advancements in medical technology

Changes in demographic profile

Reserve funding and solvency requirements

Medical price and utilisation drivers

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Healthcare goods and services

Consumer goods

Medicine prices

Price inflation scale

Medical inflation : 5% to 7%

LA Health has achieved phenomenal levels of growth, which has improved the Scheme’s profile

For every year that the Scheme’s average age goes down, claims costs reduce by approximately 2%

LA Health has shown strong simultaneous growth in membership and reserves

Growth in reserves is needed to support membership growth and increasing utilisation

2012 contribution increases

Headline increase for 2012 = 8.9%

Benefit structures are unchanged in 2012All limits will were increased by 6%MSA levels will were increased in line with contributions, except on LA Comprehensive

2012 expected competitive positionLA KeyPlus

LA KeyPlus offers the greatest value for money in the market

Note : *Assumes an increase of 7% on competitor options

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2012 expected competitive positionLA Active and LA Focus

Risk

Note : *Assumes an increase of 7% on competitor options

MSA

LA Active and LA Focus are competitively priced compared to comparable options offered in the Local Government space

Scheme A Scheme AScheme B Scheme B Scheme B Scheme D

10 + 2 good reasons why LA Health

1. Comprehensive hospital cover on all Options: unlimited / managed

2. LA KeyPlus: in-hospital and GP network benefits unlimited and without co-payments in Networks

3. MSA enhanced by IPB / ATB and certain day-to-day Risk benefits

4. Unique emergency evacuation benefits through Discovery 911

5. Chronic Illness Benefit with CDA for non-formulary flexibility

6. Excellent dental benefits: flexibility ensures appropriate access

7. Screening benefits that help prevent serious illnesses

8. Best service and support

9. Amazing rewards and great savings when members improve their health through Vitality

10. Governance excellence, affordable contributions, reserves and growing membership

11. Registered 2012 Rules

12. Accredited by SALGBC

The benefit options meet member’s different needs

Overall benefit changes

•Increased all limits by 6% to keep pace with inflation•Implementing the Discovery Pharmacy Networks on all

Benefit Options

• Minimising member co-payments where pharmacies charge dispensing fees that are in line with Scheme Rate for Medicine

• Network includes all large corporate pharmacies (Dischem, Clicks, MediRite, etc) and courier pharmacies

• Scheme Rate for medicine at other pharmacies = 26% /R26

Benefit limits increased by 6%. Some higher increases on Trauma Recovery Benefit

Exclusions

In-hospital dentistry In-hospital management of hearing disorders

Obesity Spinal surgery for back and neck

Skin disorders Non-cancerous breast conditions

In-hospital diagnostic work-ups and investigative procedures

Refractive eye surgery

In-hospital conservative back treatment Incontinence

Functional and nasal surgery Brachytherapy for prostate cancer

All joint replacements, including hips and knees Sexual dysfunction

Cochlear implants, internal nerve stimulators and auditory brain implants

Elective caesarian section

Surgery for oesophageal reflux, hiatus hernia repair and nissen funduplication

Any claim incurred beyond the borders of South Africa

Removal of varicose veins Bunionectomy

Arthroscopy

Oncology Management Programme

Unless authorised to pay from this programme, normal day-to-day benefits apply

LA Active Day-to-day benefits

Risk benefits the same as LA Active

All day-today benefits subject to available MSA

Unless authorised to pay from this programme, normal day-to-day benefits apply

Medicine benefits

Family size Benefit

Member R 6 835

Member +1+ R 13 570

Day-to-day benefits

Limited day-to-day benefits

Information sessions organised by the Scheme (mainly for pensioners)

Town or Municipality

Date in 2011

Time Place

Buffalo City 4 Nov 12:0

0

Library Hall, King Williams Town

Buffalo City 4 Nov 12:0

0

City Hall, East London (Pensioners)

Buffalo City 4 Nov 15:0

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City Hall, East London (In-service)

Jeffreys Bay 10 Nov 10:0

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Newton Hall, Jeffreys Bay

Port Elizabeth 10 Nov 14:0

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Newton Park Library, Port Elizabeth

Uitenhage 11 Nov 10:0

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Sun Room, Town Hall, Uitenhage

Cape Town 15 Nov 10:3

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Civic Centre, Crush Hall, Cape Town

Johannesburg 21 Nov 10:0

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Marks Park Sport Club, Emmarentia

Johannesburg 21 Nov 14:0

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Klipriviersberg Recreation Centre, Kibler

Park

Seize the day!

Take the leapto good health

Thank you