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When compared to similar products available in the industry, Imperialmed offers a competitive cost/benefit structure that gives the employees of the Imperial Group access to rich benefits at a relatively low cost. The Scheme continues with the development of an additional benefit plan to make the Scheme accessible to more employees of the Imperial Group. There are distinct benefits to belonging to an in-house medical scheme in the current regulatory environment in South Africa and the envisaged healthcare reforms proposed by the Government. FROM THE PRINCIPAL OFFICER Continued overleaf > Inside: Day-to-Day Benefits (out-of-hospital expenses) Major Medical Expenses Wellness Benefits Prescribed Minimum Benefits (PMBs) BENEFITS 2013 This brochure contains the latest updates to the Imperial Group Medical Scheme benefits, which will be effective from 1 January 2013.

Transcript of Benefits 2013 - Imperial Motus Med - Home · » except for dental Gynaecological scopes » Minor...

Page 1: Benefits 2013 - Imperial Motus Med - Home · » except for dental Gynaecological scopes » Minor dermatological procedures » Dental procedures Refer to dental benefit for more details

When compared to similar products available in the industry, Imperialmed offers a competitive cost/benefit structure that gives the employees of the Imperial Group access to rich benefits at a relatively low cost. The Scheme continues with the development of an additional benefit plan to make the Scheme accessible to more employees of the Imperial Group.

There are distinct benefits to belonging to an in-house medical scheme in the current regulatory environment in South Africa and the envisaged healthcare reforms proposed by the Government.

from the PrinciPal officer

Continued overleaf >

Inside:Day-to-Day Benefits (out-of-hospital

expenses)

Major Medical Expenses

Wellness Benefits

Prescribed Minimum Benefits

(PMBs)

Benefits 2013

This brochure contains

the latest updates to the

Imperial Group Medical

Scheme benefits, which will

be effective from 1 January

2013.

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from the PrinciPal officer –

continued

The philosophy of Imperialmed is to provide a competitive benefit and contribution structure, which is based on providing comprehensive cover for large medical expenses such as hospitalisation and chronic medicine, to provide adequate cover for out-of-hospital benefits and to provide affordable benefits.

In addition to the unique benefit structure of the Scheme, a number of additional products are offered to enhance the benefits and complete the package for Employees of the Imperial Group:

» The Gap Cover scheme is offered as an additional short-term policy that does not form part of Imperialmed, but which covers the amount by which specialists’ accounts exceed the Scheme rate during hospitalisation – up to 300% of the Scheme rate.

» Scheme members also have access to the Health Saver product, a savings account that can be used to supplement the 15% co-payment for out-of-hospital benefits.

» Multiply is an incentivised wellness benefit.

The ultimate goal of the Trustees and Scheme Management is to use the in-house Scheme to enhance the health and wellness of the employees of the Imperial Group.

This 2013 marketing brochure contains a high-level summary of the latest updates to the Imperialmed benefits. For more detailed information, please consult the 2013 member guide, which also includes the Scheme rules.

Johan van der WaltPrincipal Officer

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Guide to terms used in this memBer Brochure

Board of Healthcare Funders The representative organisation for the majority of medical schemes throughout South Africa

DSP: Designated Service Provider A healthcare provider such as a doctor, pharmacist, hospital, etc., that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition

Generic reference price A cost-control mechanism whereby the Scheme bases its medicine benefits on the cost of generic medicines rather than brand-name medicines

National Reference Price List for Health Services

A price list for health services that is published by the Council for Medical Schemes and is used to reimburse service providers

PMBs: Prescribed Minimum Benefits

Minimum benefits that by law must be provided to all medical scheme members; includes the provision of diagnosis, treatment and care costs for a range of chronic conditions

Preferred provider A network of healthcare providers the Scheme has contracted to provide members with healthcare at reduced rates

Scheme rate The rate at which Imperialmed pays for medical products and services

Uniform Patient Fee Schedule The tariff that sets out the fees that patients are charged at government hospitals

imPerial GrouP medical scheme

day-to-day Benefits (out-of-hosPital exPenses)BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

1. General Practitioners (GP) and Specialists – out of hospital

a) Visits, consultations and treatment by a GP or SpecialistFor procedures in doctor’s rooms refer to Major Medical Expenses Benefit (page 5, 2(c))

85% of Medical Scheme Rate

Member family limit calculated as follows:R2 200 per memberR1 650 per adult dependantR1 380 per child dependant (maximum of 3 children)

b) PMB Care Plan ServicesConsultations as authorised on Care Plan

100% of Cost From Major Medical Expenses BenefitSubject to Care Plan authorisationServices in excess of the Care Plan will be paid from the GP/Specialist at 85% of Medical Scheme Rate

2. Diagnostic Services – out of hospital

a) Radiology (X-rays) and PathologyIncluding Bone Density Scans and Mammograms

85% of Medical Scheme Rate

Member family limit calculated as follows:R2 840 per memberR2 840 per adult dependantR500 per child dependant (maximum of 3 children)

b) PMB Care PlanRadiology and Pathology services as authorised on Care PlanIncluding Cardiac Ultrasounds

100% of Cost From Major Medical Expenses BenefitSubject to Care Plan authorisationServices in excess of the Care Plan will be paid from Radiology and Pathology at 85% of Medical Scheme Rate

3. Dentistry

a) Preventative dentistry » Scaling and/or polishing and fluoride treatment

» Fissure sealing

100% of Medical Scheme Rate

100% of Medical Scheme Rate

2 per beneficiary per annum

Once-off for permanent molars in persons under 18 years

Benefits 2013

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imPerial GrouP medical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

3. Dentistry – continued

b) Basic dentistry » Oral examination » Diagnostics (X-rays, etc.) » Restorations (fillings) » Extractions » Root canal treatment

85% of Medical Scheme Rate

R3 000 per beneficiary per annum

c) Advanced/specialised dentistry » Inlays, onlays, veneers, crowns and bridges » Study models » Dentures » Procedures related to placement of dental implants » Orthodontic retainers, space maintainers and biteplates

» Periodontal (“gum”) treatment

85% of Medical Scheme Rate

Member family limit calculated as follows: R4 290 per memberR2 070 per adult dependantR900 per child dependant(Maximum of 3 children)Pre-authorisation required

d) Dental ImplantsIncludes the cost of the implants only – the anaesthetist and hospital fees are covered as part of the Major Medical Expenses limitThe treating dental specialist fee subject to the Advanced/Specialist Dentistry limits above

100% of Medical Scheme Rate

R11 660 per beneficiaryPre-authorisation required

e) Orthodontic treatment 100% of Medical Scheme Rate

R6 000 per beneficiary per annumPre-authorisation required

4. Acute medicine

a) Acute medicines and injection material 100% of Generic Reference Price after deduction of R25 levy

Member family limit calculated as follows:R4 865 per memberR3 055 per adult dependantR920 per child dependant (maximum of 3 children)

b) Pharmacist-advised Therapy (PAT) refers to medicines supplied by a registered pharmacist without a doctor’s prescription

Childhood VaccinesRefer to the Wellness Benefit (page 11)

100% of Generic Reference Price, up to a maximum of R175 per prescription

R1 000 per family per annumSubject to acute medication limit

5. Medical Auxiliaries – out of hospital 85% of Medical Scheme Rate

R6 295 per family per annum for all services from 5.a) to 5.g)

a) Podiatry

b) Orthoptic Treatment

c) Audiometry/Audiology

d) Occupational Therapy

e) Therapeutic Dietician

f) Other registered Medical Auxiliaries: Remedial and speech therapy, clinical technology, chiropody, acupuncture, social work, biokinetics, kinesiology, ayurvedics and reflexology

g) Consultations, treatment and radiological examinations by chiropractors, homeopaths, naturopaths, osteopaths and herbalists

6. Physiotherapy – out of hospital 85% of Medical Scheme Rate

R3 980 per family per annum

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imPerial GrouPmedical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

7. Mental health – out of hospital

Includes Physiologist and Psychiatrist 85% of Medical Scheme Rate

R4 000 per beneficiary per annum

8. Optical Services

a) Eye test 85% of Medical Scheme Rate

1 test per beneficiary per annum from Major Medical Expenses Benefit

b) Spectacles, lenses, (replace, repair and adjust), contact lenses and fitting of contact lenses

85% of Cost R3 000 per beneficiary over a 2-year cycle

c) Frames R700 per beneficiary per 2-year cycle; subject to the overall Optical limit above

d) Sunglasses No benefit No benefit

major medical exPensesBENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

All Major Medical Expenses are subject to pre-authorisation

1. Hospitalisation – Private and Provincial

a) A deductible of R500 applies if the following procedures are done in hospital or day clinics: » Scopes• Gastroscopies• Gastro-intestinal endoscopies

– Gastroscopies – Colonoscopies – Sigmoidoscopies

» Urological scopes and cystoscopies » Gynaecological scopes » Minor dermatological procedures » Dental procedures

Refer to dental benefit for more details on in-hospital dentistry (point 18)

100% of Medical Scheme Rate A deductible will not apply if done in doctor’s rooms; services in rooms will be paid at 100% of Medical Scheme Rate, except for dental procedures which is still paid as day-to-day dental benefits

From Major Medical Expenses BenefitSubject to pre-authorisation

b) Accommodation in general ward, recovery room, intensive care unit or high care ward

100% of Medical Scheme Rate

From Major Medical Expenses Benefit

c) Theatre fees 100% of Medical Scheme Rate

From Major Medical Expenses Benefit

d) Medicines used in hospital/theatre 100% of Medicine Price

From Major Medical Expenses Benefit

2. General Practitioners (GPs) and Specialists – in hospital

a) Visits and consultations 100% of Medical Scheme Rate

From Major Medical Expenses Benefit

b) Surgical procedures and anaesthetics 100% of Medical Scheme Rate

From Major Medical Expenses Benefit

c) All procedures (including those procedures listed in 1a above), will be paid from Major Medical Expenses and not the Day-to-Day limits when done in doctor’s rooms, except for dental procedures, which are still paid at 85% as per the Day-to-Day Benefit

100% of Medical Scheme Rate

From Major Medical Expenses Benefit

3. Diagnostic Services

a) Radiology (X-rays) and Pathology (in hospital) 100% of Medical Scheme Rate

From Major Medical Expenses Benefit

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imPerial GrouP medical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

3. Diagnostic Services – continued

b) MRI, CAT and radio-isotope scans (in and out of hospital) 100% of Medical Scheme Rate

R14 600 per beneficiary per annum – subject to pre-authorisation

c) Ultrasound scans (in and out of hospital) 100% of Medical Scheme Rate

R4 350 per beneficiary per annum – subject to pre-authorisation

d) PET Scans (in and out of hospital) 100% of Medical Scheme Rate

R22 540 per beneficiary per annum – subject to pre-authorisation

e) Sleep StudiesDiagnostic PolysomnogramsIn and out of hospital

100% of Medical Scheme Rate

From Major Medical Expenses Benefit – subject to pre-authorisation

4. To-take-out (TTO) medicine

Medicines dispensed on discharge from hospital will be covered under the Major Medical Expenses Benefit

100% of Medicine Price

From Major Medical Expenses Benefit, subject to R370 per beneficiary per admission

5. Out-patient services

a) Private hospital » Consultation paid at 85% from the GP/Specialist Benefit

» Procedure and related materials paid 100% from Major Medical Expenses

85% of Medical Scheme Rate

b) Provisional » Consultation paid 100% from the GP/Specialist Benefit

» Procedure and related materials pays 100% from Major Medical Expenses

100% of Medical Scheme Rate

6. Blood Transfusions 100% of Cost From Major Medical Expenses Benefit

7. Nursing Services, Sub-acute Care and Hospice Services, including medicines, dressings, ointment, etc.

100% of Medical Scheme Rate or Cost, whichever is the lesser

From Major Medical Expenses BenefitSubject to pre-authorisation

8. Ambulance Services 100% of Cost R7 400 per beneficiary per annumSubject to approval by preferred providerEmergency air ambulance not subject to the above limit, subject to Scheme approval

9. Internal Prostheses

Including all accompanying temporary or permanent devices used to assist with the guidance, alignment or delivery of these internal prostheses and devices

100% of CostSub-limits subject to PMBs

All Internal Prostheses are per beneficiary per annum » Cardiac stents (including carrier) subject to a limit of R22 000 per stent and a maximum of 3 stents

» Cardiac stent – drug eluting, subject to a limit of R19 000 per stent and a maximum of 3 stents

» Cardiac pacemakers subject to a limit of R52 500 » Cardiac valves subject to a limit of R31 000 per valve, limited to 2 valves

» Cardiac pacemaker with Defibrillator subject to a limit of R90 000

» Aortic stents subject to a limit of R89 800 per stent (including the delivery system), limited to 1 stent

» Carotid stents limited to R14 950 » Detachable platinum coils limited to R37 200 » Embolic protection devices limited to R37 100 » Peripheral arterial stent grafts limited to R30 750 » EVAR (Endovascular repair)/Anaconda subject to a limit of R60 000

» Hernia Mesh – subject to a limit of R5 000

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imPerial GrouPmedical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

9. Internal Prostheses – continued

» Hernia Mesh – Umbilical repair subject to a limit of R10 500

» Total hip replacement subject to a limit of R40 150 per hip, including cement and antibiotic

» Total knee replacement subject to a limit of R41 470 per knee, including cement and antibiotics

» Total shoulder replacement subject to a limit of R37 400 per shoulder, including cement and antibiotics

» Spinal instrumentation subject to a limit of R28 700

» Other approved spinal implantable devices and intervertebral discs limited to R37 200

» Bone lengthening devices limited to R33 400 » Neuro-stimulation/abalation devices for Parkinson’s disease limited to R33 900

» Vagal stimulator for intractable epilepsy limited to R28 600

» Intraocular Lens limited to R4 000 per lens » Any other prosthesis will be subject to a limit of R40 150

10. Renal Dialysis

(inclusive of all related costs)Benefit is subject to the submission of a treatment plan by the treating specialist to the Care Manager and approval of the treatment plan before treatment starts

Subject to 100% of the negotiated rate

From Major Medical Expenses Benefit

11. Organ Transplants

a) Hospital accommodation and surgically related services and procedures

PMBs covered in full at 100% of negotiated rate

From Major Medical Expenses BenefitSubject to pre-authorisation

b) DonorIncluding organ search, harvesting and transportation; the benefit covers the cost of the donor if the recipient is an Imperialmed member

100% of Cost Subject to pre-authorisationLimited to R18 550 for a cadaver or limited to R89 000 for live donors per beneficiary per annum

c) Anti-rejection drugs 100% of Medicine Price to be obtained from a DSP pharmacy

From Major Medical Expenses BenefitSubject to pre-authorisation

12. HIV and AIDS

All consultations, pathology and medicine related to diagnoses and treatment of the disease

Normal percentage benefits for applicable services payable100% of Cost, unlimitedThe DSPs include Clicks, Dis-Chem and Scriptnet

From Major Medical Expenses BenefitSubject to pre-authorisation and clinical guidelines and protocolsHIV resistance tests provided only if pre-authorised by a relevant Case Manager on the HIV YourLife programmePolymerase chain reaction funded from Major Medical Expenses Benefit for babies 18 months and younger where the diagnosis relates to HIV testing

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imPerial GrouP medical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

13. Maternity Benefits

a) Labour and ward accommodationNormal delivery limited to 3 days

Elective Caesarean delivery limited to 4 daysAdditional days are subject to submission of a motivation by the attending doctor and approval by the case manager

100% of Cost

100% of Scheme rate

From Major Medical Expenses Benefit – Subject to pre-authorisation

From Major Medical Expenses Benefit – Subject to pre-authorisation

b) MidwifeDelivery by a midwife, confinement in a registered birthing unit or home delivery, including birth attendant and birth bathMidwife must be registered with the Board of Healthcare Funders and Nursing CouncilIf a gynaecologist is not used, benefit covers pre- and post-confinement costs

100% of Medical Scheme Rate

From Major Medical Expenses Benefit – Subject to pre-authorisation4 consultations with a post-natal midwife per event

Benefits listed below are subject to enrolment on Maternity Programme

c) Antenatal classes – only registered midwives 100% of Medical Scheme Rate

R1 000 per beneficiary per annum

d) Ultrasound scans (pregnancy) 100% of Medical Scheme Rate

2 two-dimensional scans per pregnancy

e) Antenatal vitamins during pregnancy 100% of Generic Reference Price

R75 per month

f) Gynaecologist Consultations during pregnancy – as per Care Plan

100% of Medical Scheme Rate

From Major Medical Expenses Benefit

14. Rehabilitation

The benefit covers beneficiaries who are acutely disabled as a result of strokes, spinal cord injuries or brain injuriesThe condition must be non-progressiveAll associated accounts will be paid subject to this limit

100% of Medical Scheme Rate

R65 000 per beneficiary per annumSubject to pre-authorisation

15. Psychiatric Institutions and Substance and Alcohol Abuse

100% of Medical Scheme Rate

Maximum of 21 days per beneficiary per annumSubject to pre-authorisation

16. Stoma Care Products 100% of Medical Scheme Rate

From Major Medical Expenses BenefitSubject to pre-authorisation

17. Cochlear Implants

All requests are subject to approval by the Clinical Advisory Committee

100% of Cost R250 000 per ear per beneficiary per annumSubject to pre-authorisation

18. Dentistry

a) Dental Alveolar SurgerySurgical procedures involving the teeth and supporting jawbone ridges, such as: » Basic dental procedures in children under the age of 8 » Surgical dental procedures in exceptional clinical scenarios in children older than 8 and adults

» Surgical removal of multiple/impacted teeth or roots » Apicectomies » Tooth exposures » Corticotomies, surgical preparation of mouth for dentures, etc.

Hospital and Anaesthetist’s fee100% of Medical Scheme Rate for hospitalisation, operating theatre, sedationist and anaesthetist’s fee

From Major Medical Expenses BenefitSubject to pre-authorisation

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imPerial GrouPmedical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

18. Dentistry – continued

Dental ProceduresNote that the associated dental procedures will still be funded at 85% of the Medical Scheme Rate from the respective Dental benefit categories, as indicated under Day-to-Day benefits

b) Orthodontic Related SurgerySurgical procedures of: » the jaw, facial bones, mouth and its various internal and surrounding structures, where required as part of an orthodontic treatment plan to improve the orthodontic malocclusion and related functional discrepancies; and/or

» to complement the non-surgical portion of the orthodontic treatment plan

Hospital and Anaesthetist’s fee100% of Medical Scheme Rate for hospitalisation, operating theatre and anaesthetist’s feeSurgical fee100% of Medical Scheme Rate

From Major Medical Expenses BenefitSubject to pre-authorisation

R10 000 per beneficiary per annum; applies to surgeon’s fee

c) Maxillo-facial surgery » Oral/facial trauma, such as fractured jaw or facial bones for which hospitalisation is required

» Oral cancer and similar aggressive oral pathologies » Cleft lip/palate repair » Salivary gland pathology » Serious life threatening infection of dental origin » Internal Temperomandibular joint (“jaw-joint”) pathology

100% of Medical Scheme RateRegarding the surgical procedures and related hospitalisation

From Major Medical Expenses BenefitSubject to pre-authorisation

19. Excimer Laser, Radial Keratotomy, Holmium Procedures, LASIK, Phakic lenses and intra-stromal rings (surgically related services and procedures)

Subject to South African Optometric Association guidelines

Normal percentage benefits for applicable services payableAnaesthetist and hospital cost to be paid from Major Medical Expenses Benefit

R5 300 per beneficiary per annum

20. Breast Reduction, Mammoplasty and other cosmetic surgery if deemed medically essential

Prior approval by Medical Advisor Normal percentage benefits for applicable services payable

Normal annual limits for applicable services payableSubject to pre-authorisation

21. Prosthetic Limbs and Eyes

The submission of a quotation prior to purchase is required

100% of Cost All Prosthetics are per beneficiary and subject to pre-authorisation » Prosthetic leg subject to a limit of R61 800 per leg » Prosthetic arm subject to a limit of R61 800 per arm

» Prosthetic eye subject to a limit of R21 300 per eyeAbove limits are available every 2 to 5 years, as per clinical protocol

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imPerial GrouP medical scheme

BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

22. Infertility

Benefit limited to the treatment guidelines applied by State hospitals

100% of Cost PMBs only

23. Oncology

Subject to a treatment plan and enrolment on the Oncology Programme

100% of Medical Scheme RateSubject to PMBs

Overall Oncology Limit R260 000 per beneficiary per annumSubject to pre-authorisation

Brachytherapy materials (including seeds and disposables) and equipment

100% of Medical Scheme Rate

Limited to R33 920 per beneficiary per annum and included in the Overall Oncology LimitSubject to pre-authorisation

Pathology, X-rays, MRI and CAT Scans and radio-isotope scans

100% of Medical Scheme Rate

Limit of R21 000 per beneficiary per annum; not subject to the Overall Oncology LimitSubject to pre-authorisation

24. Services Rendered Abroad by a foreign supplier

No benefit for beneficiaries travelling outside the borders of the Republic of South Africa for more than 90 consecutive days

Normal percentage benefits for applicable services payableProvided that medicines will be limited to the Medicine Price in South Africa

R1 000 000 per beneficiary per annum

25. Home Oxygen cylinders, concentrators and ventilation expenses

100% of cost R12 830 per beneficiary per annum, subject to PMBs and pre-authorisation

26. External Medical Appliances

Permanent or temporary devices that are not surgically implanted and are seen to improve the function of a diseased organ, e.g. wheelchair, crutches, CPAP machine, Baumanometer and all orthopaedic bracesIncontinence diapers, which are required as part of a chronic condition, are included

100% of Cost R11 000 per beneficiary per annum

Motivation and pre-authorisation required for devices and appliances above R1 000

27. Hearing Aids

Subject to an audiology report and pre-authorisation 100% of Cost R13 150 per beneficiary per ear over a 2-year cycle

28. Prescribed Medicines

Chronic medicine: Prescribed for a PMB and/or additional chronic condition

100% of Generic Reference PriceTo be obtained from a DSPA 25% co-payment will apply if not obtained from a DSP

R20 500 per beneficiary per annumOnce limit is depleted, authorised PMB medication will still be paid.

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imPerial GrouPmedical scheme

Wellness BenefitsBENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

1. Screening tests

a) This benefit will be accessible via the Scheme’s DSPs – ScriptPharm, Dis-Chem and Clicks Directmedicines

100% of negotiated rate at 1 of the DSPs

1 visit per beneficiary per annum

b) Childhood Vaccine Benefit 100% of SEP According to Scheme formulary from ages birth to 18 monthsVaccines outside the formulary will be paid from the Acute Medicine limit; see table below

REqUIRED AGE VACCINE

BirthBacilles Calmette Guerin (TB) Vaccine

Oral Polio Vaccine

6 Weeks 

Oral Polio Vaccine

Rotavirus Vaccine

Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b

Hepatitis B

Pneumococcal Conjugated Vaccine

10 WeeksDiphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b

Hepatitis B

14 Weeks

Rotavirus Vaccine

Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b

Hepatitis B

Pneumococcal Conjugated Vaccine

9 MonthsMeasles

Pneumococcal Conjugated Vaccine

18 MonthsDiphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b

Measles

Please note that it is a requirement that the ages be adhered to for the specific injections. If the specific injection is obtained after the age mentioned in the left column (subject to a leeway of four weeks) it will not be paid for by the Scheme.

PrescriBed minimum Benefits (PmBs)BENEFIT DESCRIPTIoN % BENEFIT PAyABLE ANNUAL LIMITS FoR 2013

Any service that falls under the State’s PMBs 100% of cost Unlimited

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contact details

chronic medication and medical manaGement

Phone: 0860 467 374Fax: 0860 111 788E-mail: [email protected]

euroP assistance emerGency services

Phone: 0861 RESCUE (0861 737 283)

hiv and aids manaGement ProGramme

Phone: 0861 888 300Fax: 0860 888 301Address:HIV and AIDS Management ProgrammeImperialmedPO Box 15468Vlaeberg8018E-mail: [email protected]

memBer care line – medi call

Toll free: 0860 105 221Fax: 0866 889 411E-mail: [email protected]

contriButions

Contact your company’s payroll/human resources department

the administrator’s WeBsite:

www.mhg.co.za

the scheme’s WeBsite:

www.imperialgroupmed.co.za

KPmG fraud hotline:

Tel: 0800 200 564

claims enquiries, memBershiP confirmations and reGistrations

Phone: 0860 467 374Fax: 0860 111 788E-mail address: [email protected]

manaGed care services – hosPital Pre-certification and oncoloGy Benefit manaGement ProGramme

Phone: 0860 467 374Fax: 0860 111 788E-mail: [email protected]

11/12 L3558