Information and Benefit Guide2022

compcare.co.za

At CompCare we believe in giving you more.Complete Cover. Committed Care. CompCare.

NETWORXNetwork Plan from R405 Per Month

LIFEHEALTHCARE THAT BRINGS YOU MORE

CompCare Medical Scheme is administered by Universal Healthcare Administrators (Pty) Ltd.

Administered by

Hospital Benef ts (Network of hospitals)

*SCHEME PROTOCOLS APPLY

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Risk Benef ts

You’ve got your first job, have new responsibilities, and you want to make a success of your life. You or your employer have chosen a top-ranking medical Scheme option to look after you when you need medical care.

THE NETWORX OPTION

COMPCARE MEDICAL SCHEME

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Unlimited cover for essential benefits through the Universal network of service providers. Additional benefits through an Annual Flexi Benefit (AFB).

DAY-TO-DAY BENEFITS

1 2 (Network of hospitals)In-hospital and hospital related accounts subject to Overall Annual Limit (OAL).

HOSPITALISATION

01 CompCare Medical Scheme NETWORX ED 2022 compcare.co.za

27 Chronic Conditions Covered

KNOW YOUR OPTION

FIND OUT MORE on page 3

FIND OUT MORE on page 5

FIND OUT MORE on

page 7

FIND OUT MORE on

page 7All PMBs, Wellness and Preventative Care Benefits, Chronic Medicines, Ambulance Services (Netcare 911).

BENEFITS PAID FROM RISK

Let’s get started on explaining some of the basics of your cover. The NETWORX ED option is subject to an Overall Annual Limit (OAL) of R1 500 000 Per Member Family (PMF). You pay your contribution and based on that we pay your claims. Claims are incurred when you visit a doctor/dentist/optometrist/specialist or any other registered healthcare provider, or if you are hospitalised. The NETWORX ED option provides essential cover within the Universal

Provider Network. We have negotiated and contracted with private healthcare providers including general practitioners, pharmacies, optometrists, dentists, radiologists and pathologists to provide you with the best access and care at an affordable premium. In order for you to get the best care, you need to visit Universal Network Providers. The option also provides an Annual Flexi Benefit (AFB) which is a set amount that is available to you for specialist consultations, specialised

dentistry, optometry and radiology. Being a network plan, NETWORX ED gives you full access to a Network of Hospitals. In-hospital claims are paid from the Scheme’s risk pool. Hospital expenses are paid in full at the Scheme rate and is limited to the Overall Annual Limit (OAL).

Understanding Your Option

Always obtain pre-authorisation

Sign any documentation you submit

Take note of the appropriate contact details

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A referral is required from your Universal Network General Practitioner before seeking treatment from a specialist, failing which said specialist consultation could result in the non-payment of your specialist account (except in the case of a Prescribed Minimum Benefit).

Specialist referral process

PTO for hospital benefts

REMEMBER!

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MedicineAcute medicationPrescription medication – Schedule 3 and higher. Unlimited subject to the Universal Care medication formulary. Subject to referral from a Universal Care Network GP. Non-formulary medication limited to R395 PB.Over the counter medication (OTC)No benefit.

RadiologyBasic radiologyIncluding black and white x-rays and ultrasound. Unlimited subject to Universal Care approved codes.Referral from a Network GP required.Specialised radiologyMRI, CT, High resolution CT and PET scans.Subject to OAL and Universal Care approved codes.Contact 0860 111 090 or email preauthorisation@universal.co.za

PathologyUnlimited subject to Universal Care approved codes. Referral from a Network GP required.

DentistryBasic dentistryConservative and restorative.1 Consultation PB limited to R1 770 up to a maximum of R2 950 PMF. One set of plastic dentures every 36 months PB.A 20% co-payment applies.Specialised dentistryDentures, crowns, bridgework, metal fillings and inlays. PMBs and subject to AFB.Email address for dental authorisation dental@universal.co.za

Auxiliary servicesAudiologists, chiropractors, dietitians, homeopaths (consultations), naturopaths (consultations), speech and occupational therapists, chiropody, podiatry, social workers, physiotherapy and biokinetics.PMBs.

Optometry100% of SAOA rate. Benefit every second year. Benefits through Universal Network optometrists. Subject to AFB.Eye test: 1 Visit PB.Lenses and contact lenses: Clear, plastic single vision lenses limited to R980 PB or bi-focal lenses to R1 550 PB.No benefit for contact lenses.Frames: Included in lenses limit.

Surgical and medical appliancesWheelchairs, crutches, glucometers, hearing aids, artificial eyes, external fixators. PMBs. Pre-authorisation required.

Consultations, procedures and materialsGPs and SpecialistsIn-Network: Unlimited.Out-of-Network: 2 visits PB.Limited to R1 250 per event including medicines, pathology, radiology (all related costs).A 20% co-payment applies.Member to pay at point of service and claim back from the Scheme.Specialist: Paid at 100% of the Scheme rate.Subject to referral from a Universal Care Network GP. Limit to 2 visits PB and 3 visits PMF. Subject to AFB. Once benefit is depleted, PMB rules apply.

Benefits are paid @ 100% of the Scheme rate unless otherwise specified.

DAY-TO-DAY BENEFITS

UNLIMITED ESSENTIAL CARE THROUGH THE UNIVERSAL NETWORK

Contact 0861 222 777 or email compcare@universal.co.za

or visit our Mobi App.

Please ensure that you have a referral from your Universal Network GP for all specialist visits.

Annual Benefit Amounts for 2022

Per Beneficiary Per Member Family

Annual Flexi Benefit (AFB) R3 450 R5 150

PLEASE NOTE: Treatment subject to pre-authorisation, case management, specialist programmes and Scheme protocols.

Benefits are unlimited and paid @ 100% of the Scheme rate unless otherwise specified. Overall Annual Limit (OAL) R1 500 000 PMF.

HOSPITALBENEFITS

MAJOR MEDICAL EXPENSES

It’s the member’s responsibility to make sure that all non-emergency hospital admissions are authorised by either phoning 0860 111 090 or by sending an email to preauthorisation@universal.co.za. These must be authorised at least 48 hours prior to admission. The member, doctor

or hospital must contact the scheme for this authorisation. The hospital utilisation management team will need the following details: Name of the patient being admitted, medical aid number, hospital name, date of admission, name and practice number of admitting practitioner, ICD 10 and

procedural codes. A penalty will apply for late requests for authorisations. Emergency admissions must be authorised on the first working day after admission. A penalty will apply, should the member not obtain authorisation. This also applies to oncology treatment.

Hospital pre-authorisation process

HospitalisationCover in a network of hospitals.Specified elective procedures may have a co-payment (excluding PMBs). Please refer to our website (compcare.co.za) for a list of co-payments and exclusions.

Hospital related accountsGP visits, specialists, radiology, surgical procedures blood transfusions.

Medicine in hospital

Medicine upon discharge (TTO)7 days’ supply and up to a maximum of R320.

Auxillary services in hospitalPhysiotherapy, biokinetics, dietitians etc.Limited to R2 700 PMF in-and-out of hospital.Email casemanagement@universal.co.za for pre-authorisation.

Surgical prosthesesPMBs

Basic and specialised radiologyIncluding black and white x-rays and ultrasound, MRI, CT, High resolution CT and PET scans. Subject to OAL and Universal Care approved codes.

PTO for risk

benefts

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PathologySubject to OAL and Universal Care approved codes.

Organ transplantsPMBs.

Surgical Procedures out-of-hospitalPMBs.

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Contact 0860 111 090, email preauthorisation@universal.co.za

or visit our Mobi App for pre-authorisation.

For hospital account queries email

hospitalaccounts@ universal.co.za

WHAT DOES 100% OF SCHEME RATE MEAN?

SCHEME RATE refers to the maximum amounts that a medical Scheme will pay for specific treatments and procedures.100% OF SCHEME RATE means the Scheme will pay 100% of what is specified in the Scheme Rules.Please note that some providers might charge more than what the Scheme will pay for and the member is liable for that shortfall.

RISK BENEFITSBENEFITS PAID BY THE SCHEME (UNLESS OTHERWISE INDICATED)

*Scheme protocols apply

PTO for what you need

to know

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Conditions covered:Addison’s disease*Asthma*Bipolar mood disorder*Bronchiectasis*Cardiac arrhythmias*Cardiomyopathy*Chronic renal failure*Congestive cardiac failure*Chronic obstructive pulmonary disease*Coronary artery disease*Crohn’s disease*Diabetes insipidus*Diabetes mellitus type 1 and 2*Emphysema

Epilepsy*Glaucoma*Haemophilia*HIV/AIDS*Hypercholesterolemia / hyperlipidaemia*Hypertension*Hypothyroidism*Multiple sclerosis*Parkinson’s disease*Rheumatoid arthritis*Schizophrenia*Systemic lupus erythematosus*Ulcerative colitis*

Please see emergency events below*:• Emergency roadside assistance and

ambulance transportation.• Hospital emergency room/Casualty

emergency visits resulting in a hospital admission will be paid from the in-hospital benefit - PMBs only.

• Hospital emergency room/Casualty emergency visits as a result of physical injury caused by an external force - PMBs only.

• Hospital emergency room/Casualty emergency visits not requiring admission will be paid as an out of area GP visit.

Emotional wellness*• Psychiatric treatment in hospital – cover

for PMBs subject to pre-authorisation and protocols.

• Alcoholism, drug dependence and narcotics – PMBs only.

• Psychosocial counselling benefit – Paid from risk. Unlimited telephonic counselling sessions through the Universal Wellness Care Centre, with an option for referral to one-on-one sessions with qualified psychologists, social workers or registered counsellors to a maximum of 3 referral sessions PB per year.

Emergency careWhat to do in the event of an emergency:Call the emergency medical services provider, Netcare 911 on 082 911.Please note: To avoid a 25% co-payment, authorisation needs to be obtained at the time of the emergency, or within 24 hours thereafter.

Prescribed minimum benefts (PMBs)*All Prescribed Minimum Benefits, or PMBs, are paid for as defined in the Medical Schemes Act No 131 of 1998 including:• PMB organ transplants, PMB renal

dialysis and PMB plasmapheresis.• Step-down nursing facilities, hospice and

rehabilitation (PMB only) - subject to OAL.• Terminal care (Imminent death, regardless

of diagnosis).• Oncology, including chemotherapy and

radiotherapy at our oncology DSP (PMB only) - subject to OAL.

• Surgical Prostheses (e.g. artificial joints, stents, artificial limbs) and electronic/nuclear devices (e.g. pacemaker, defibrillators, nerve stimulators and cochlear implants) are subject to pre-authorisation.

• Specialised radiology including MRI, CT scans and high resolution PET scans are limited to OAL. Pre-authorisation is required for all MRI and CT Scans. High resolution CT Scans/PET Scans are subject to special medical motivation and also requires pre-authorisation. PMBs only.

Preventative care*• Health check: Blood pressure, blood sugar,

cholesterol, BMI and waist circumference – One measurement PB over the age of 18 years, limited to R230 per event. Only at DSP pharmacy.

• Rapid HIV tests.• Flu vaccine: One PB.

Oncology and speciality care*Benefits for the following Prescribed Minimum Benefits:• Unlimited oncology including

chemotherapy and radiotherapy at the Scheme’s oncology DSP.

• Biological agents and specialised medication.

• Wound care in lieu of hospitalisation.• Oxygen home ventilation.• Home nursing visits.• Step-down nursing facilities, hospice

and rehabilitation.

Women’s health• Oral contraceptives limited to R150 PB

per month.

Emergency medical transport services: Netcare 911 - 082 911

Chronic medication*27 Chronic conditions (Chronic Disease List - CDL) are covered. Once you have registered there is an unlimited benefit with no co-payments or levy if the medicine is listed on the Scheme’s formulary and the price of the medicine is equal to or less than the reference price of the product.A 25% co-payment will apply if medicine is not on the formulary.

Chronic condition and medicine registration processIn order to receive the chronic medication benefit, members must register their chronic medicine prescriptions with Universal. To register your chronic medicine prescription with Universal, either you, your doctor or your pharmacist will be required to contact Universal telephonically on 0861 222 777 or send an email to chronicmedicine@universal.co.za. The completion of chronic medication application forms are no longer a requirement.

GLOSSARYA Adult DependantAFB Annual Flexi BenefitATB Above Threshold BenefitC Child DependantCDL Chronic Disease ListDSP Designated Service ProviderMMAP Maximum Medical Aid PriceOTC Over the Counter MedicineP Principal MemberPB Per BeneficiaryPMB Prescribed Minimum BenefitsPMF Per Member FamilyPP Preferred ProviderRP Reference PricingSAOA South African Optometric AssociationTTO To Take Out (Medicine taken on discharge from hospital)

Choosing CompCare gives you access to market-leading preventative and wellness benefits that guarantee maximum value that meet your budget. Here’s some more reasons to choose CompCare...

COMPCARE MEDICAL SCHEME

MEDICAL COVER WITHOUT THE CO-PAYS:

You can get more with CompCare by using our extensive network of Healthcare providers.

Avoid co-payments and out of pocket payments by using one of the following

Universal Healthcare Networks:

• GP• Optometry• Dental• Hospital• Oncology

• Pharmacy• Biokineticists

• Dietitians• Psychosocial counsellors

The power of your medical Scheme is in your hands. Our NEW and IMPROVED Member App is your mobile gateway to information,

allowing you to view and edit your medical Scheme

option, benefits and claims anywhere, anytime!MEDICAL

SCHEME GONE MOBILECLAIMSSubmit new claims and view your claims history.

HOSPITAL PRE-AUTHORISATIONSubmit new pre-auth requests and view your hospital pre-auth history.

QUERYSubmit queries and view important contact details.

MEMBERSHIP CARDSee a digital version of your Membership Card so you’re never caught without it again! You can even send it on as and when needed.

BENEFITSView all your benefits, annual limits and your available balances.

AND MUCH MORERequest your Tax or Member Certificates. See all your registered Chronic Conditions, register new conditions, update your scripts and apply for an extended supply. Access your personal details, your dependant details and your Scheme details. You can also search for Network Specialists in your area.

OUR NEW APP IS ON ITS WAY!

Keep in control of your medical Scheme with the CompCare App. Simple, seamless and super convenient, the App makes it quick and easy for you to check anything from claims to benefits, and where your closest doctor is. Download the Mobi App on your smart device using the

Google Play Store (Android users) or the Apple App Store (IOS users).

Watch out for up and coming communications regarding the

launch date!

NEW and

IMPROVED

MEDICAL SCHEME GONE MOBILE

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COMING SOON!

THE BENEFITS...

TOPREASONS

to choose CompCare.

THE BENEFITS...

*Scheme protocols apply

01 WE’RE ONE OF THE TOP SCHEMES IN SOUTH AFRICAThis is proven by our solid 43-year track record and solvency levels of more than 49%, which makes us one of the most financially stable Schemes in SA.

02 WIDE RANGE OF OPTIONSGet the value you deserve and choose the perfect option to fit not only your personal lifestyle, needs and budget, but also that of your employees. Our efficiency discounted options ensure savings on contributions of up to 25% when choosing Dis-Chem pharmacies for chronic medication and Netcare hospitals for planned, elective procedures.

03 WOMEN’S HEALTH*Contraceptives, Blood Pressure, Blood Sugar, Cholesterol, BMI and waist circumference.

04 MEN’S HEALTH*Prostate checks, PSA blood test.

05 THE SCHEME FOR ADVENTURE SEEKERS*In addition to solid healthcare cover we bring you total peace of

mind when participating in extreme and adventure sports.

06 UNLIMITED ONCOLOGYWe’ve got you covered with our unlimited cancer

treatment programme, subject to our treatment protocols at our designated service provider (DSP) for oncology, for PMBs.

07 MENTAL HEALTH*Unlimited professional telephonic emotional health and wellbeing support, around-the-clock, and referrals for one-on-one counselling should this be required.

8 SUPERIOR SERVICES AND BENEFITS

Delivered through our partnership with leading Healthcare Administrator, Universal

Healthcare Administrators.

This brochure is a summary of the benefits of CompCare Medical Scheme. All information relating to the 2022 CompCare Medical Scheme benefits and contributions are subject to formal approval by the Council for Medical Schemes. On joining the Scheme, all members will receive a detailed member brochure, as approved. The final registered Rules of the Scheme will apply.

All limits are pro-rated when a member or a beneficiary joins the Scheme during the year, calculated from the date of registration to the end of that financial year. If you leave the Scheme before the year is up and have used all the funds in your savings account, you will owe the Scheme the advanced portion of the Medical Savings Account you have used as it is a pro-rated benefit allocated in advance for the full benefit year. This summary is for information purposes only and does not supersede the rules of the Scheme. In the event of a discrepancy between the summary and the rules, the rules will prevail.

CompCare Medical Scheme is administered by Universal Healthcare Administrators (Pty) Ltd.

THE NETWORX OPTION

COMPCARE MEDICAL SCHEME

CompCare:Universal Place, 15 Tambach Road, Sunninghill Park, Sandton

PO Box 1411, Rivonia, 2128

Tel: 0861 222 777Email: compcare@universal.co.zaWebsite: compcare.co.za

Complaints escalated to the Council for Medical Schemes:

Tel: 0861 123 267Email: complaints@medicalschemes.comWeb: medicalschemes.com

Contact details

compcare.co.za

Network PlanNetwork Plan

Administered by

Contributions Effective from 1 January 2022Income bands Principal

MemberAdult

DependantChild

DependantR0 – R500 R405 R396 R217R501 – R4 000 R583 R575 R287R4 001 – R5 000 R745 R715 R357R5 001 – R6 000 R745 R715 R357R6 001 – R8 000 R892 R847 R427R8 001 – R9 000 R892 R847 R427R9 001 – R10 000 R948 R901 R450R10 001 – R12 000 R1 023 R973 R485R12 001 – R14 000 R1 125 R1 071 R535R14 001 – R16 000 R1 237 R1 177 R588R16 001 – R18 000 R1 385 R1 318 R658R18 001 – R20 000 R1 552 R1 477 R737R20 001+ R1 864 R1 678 R831

A child dependant is a dependant who is under the age of 21 years or a full time student up to the age of 27 years. An adult dependant is a dependant who is 21 years or older. These rates are only applicable to the main member and a maximum of three child dependants.

Contributions Effective from 1 January 2022