Transcript Libcare
2010 Benefit Presentation Day-to-day Benefits Risk Benefits Emergency Benefit Crime Trauma Benefit Chronic Benefit Major Medical Benefit Preventative Care Benefit Medical Savings Facility (MSF) Out of Hospital Expenses Benefit (OHEB) Self-Payment Gap (SPG) Threshold Level (THL) MSF + OHEB + SPG RISK BENEFITS •In-Hospital Costs •Practitioners paid @ Libcare Rate + 100% OHEB Emergency Benefit Crime Trauma Benefit Preventative Care Benefit •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 Chronic Benefit •GP & Specialist consultations •Elective Dentistry (Incl basic den <8 & implants) •Paramedical Services •TTO’s (R 700 / +MSF) •Mental Health MSF SPG THB Chronic Benefit R 20 100 per beneficiary 36 stipulated chronic conditions enjoy limited cover Each beneficiary MUST register OHEB Emergency Benefit 25 stipulated chronic conditions will enjoy unlimited cover Crime Trauma Benefit Major Medical Benefit 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). MSF Preventative Care Benefit Prescribed Minimum Benefits (PMB) is: a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services SPG THB Preventative Care Benefit Benefit MSF Age 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 OHEB Emergency Benefit All Crime Trauma Benefit Chronic Benefit Major Medical Benefit First GP visit pb SPG THB Crime Trauma Benefit MSF Trauma – Police Case Number: •HIV Prophylaxis Emergency Benefit Preventative Care Benefit Chronic Benefit Major Medical Benefit •Hi-jacking •Attempted murder & assault •Rape victims OHEB SPG •Rehabilitation eg physiotherapy or speech therapy THB •Psychology Emergency Benefit & Physical Injuries MSF R1 200 per beneficiary Crime Trauma Benefit Preventative Care Benefit Chronic Benefit Major Medical Benefit 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 ward No admission Libcare must be notified within 48 hours and a valid pre-authorisation number obtained. OHEB SPG THB Day-to-day Benefits Practitioners paid @ Libcare Rate + 100%: Alternative Healthcare GP’s & Specialists (incl ante-natal classes) Dentists Psychologists Optometrists Paramedical Services Routine Medication Pathology & General Radiology Emergency Benefit Crime Trauma Benefit Preventative Care Benefit Chronic Benefit Major Medical Benefit Medical Savings Facility •20% of contribution & Depends on income band •Credit is granted upfront •Refunded 4 months after termination •Interest Out-of-Hospital Expenses Benefit •Principal: R 1400, Adult: R 600, Child: R 500 Self-Payment Gap Threshold Level – (MSF + OHEB) Threshold Level: not adjusted during the year should a member’s income band change or dependants be added, change status, or be withdrawn. Threshold Benefits •Limited per category •Pro-rated when joining later than 1 January Medical Savings Facility Out-of-Hospital Expenses Benefit Threshold Level How to calculate the SPG if a person earns R 7500: MSF 3360 + OHEB 1400 = 4760 THL SPG 5808 – 4760 = 1048 Contributions • SMS: sent when a claim refund is paid • Mini-Statement: an electronic statement is sent each time a claim is processed • Monthly Statement: is e-mailed or posted each month if you have submitted claims • Internet Registration: www.libcare.co.za • Webmail: Send a blank e-mail to [email protected] Contact Details Helpdesk at Liberty Life Centre Call Centre: 0800 12 CARE (2273) [email protected] Claims: Claims Boxes [email protected] +27 (21) 673 9582 Questions?