Benefit Schedule 2016

Transcription

1 Benefit Schedule 2016

2 At the heart of healthcare.

3 CONTENTS WHY CHOOSE Bomaid? EMERGENCY MEDICAL SERVICES MATERNITY PROGRAM PREMIUM WAIVER FUNERAL BENEFIT SEVERE ILLNESS BENEFIT SCREENING AND PREVENTION BENEFIT THE SCHEMES DREAD DISEASE BENEFIT MANAGED CARE PROGRAM HOSPITAL CASH PLAN FUNERAL BENEFIT TOP UP ADDITIONAL NOTES WHY CHOOSE Bomaid? Bomaid always aligns its products and services to meet the changing needs of its members. With over 40 years of existence, we are a truly tried and tested medical aid with leading products and innovative funding solutions. 3

4 Value Add Benefit As part of the package, all our schemes include the Emergency Medical Services as a value add benefit. We have out-sourced this service to MRI Botswana (MRI). All Bomaid members can call MRI on 992 for emergency services throughout Botswana, Lesotho, Namibia, South Africa, Swaziland and Zimbabwe. Services offered: Remote medical advice & information Emergency medical assistance Emergency response to scene Pre hospital medical transportation Inter hospital transfer Upgrade transfer Downgrade transfer Medical repatriation Repatriation of mortal remains Emergency transportation of medical products Liaison with next of kin Escorted returns of minors In hospital medical monitoring 4

5 Value Add Benefit Through Bombaby, we share with the expectant family the excitement and experience brought about by the new life we are waiting for. What the program offers: Support, education & advice from the 14 th week of pregnancy Open discussions with an experienced midwife during the various stages of the baby s development Tailor made information on any medical conditions in relation to the pregnancy Early identification of high risk pregnancy to enable the family to access medical assistance where necessary A hamper with handy supplies for baby & mom in the 3 rd trimester Cover for antenatal classes So if you re expecting this is the program for you! To register please call

6 Value Add Benefit when you are gone. Premium Waiver The Bomaid Premium Waiver is an that ensures dependants remain covered for 12 months after the passing of the main member. Bomaid provides additional value to the member by: Providing freedom for the dependants to assist with their circumstances Ensuring dependants do not have to make monthly contributions themselves Providing medical cover for dependants with no additional cost to the main member Guaranteeing medical cover for all Bomaid members with dependants T s & C s Apply Administered by 10 Underwritten by SouthView

7 Funeral Benefit Value Add Benefit The last thing you need to worry about are funeral expenses. As a Bomaid member, you get up to P funeral cover. This is a benefit which comes at no additional cost to the member and is available to the member and their dependants. 10 Underwritten by Administered by 7 Healthier, Happier SouthView Lives.

8 Value Add Benefit Severe Illness Benefit This benefit is designed to provide a 100% cash payout to the life assured on 1 st diagnosis of any of the pre-defined severe illnesses regardless of actual medical expenses incurred. The cash payout can be used among other things to: a) Assist members with additional medical costs which might be above the allocated scheme limits b) Pay for alternative care or rehabilitation therapies not covered by the scheme c) Fund lifestyle changes that might be required following diagnosis and/or treatment of a severe illness. The following conditions are covered under this benefit: Cancer Coronary Artery Bypass Graft Heart Attack Kidney Failure (Chronic) Major Organ Transplant (Kidney, Lung, Liver, Heart, Pancreas) Stroke The benefit has a termination age of 65 years. Note: Policy Terms and Conditions will apply. 8 Underwritten by Administered by SouthView

9 Screening and Prevention Benefit This benefit is designed to help members with prevention and early detection of certain illnesses/ medical conditions. The benefit covers the following: Value Add Benefit 1. Women s Health: Breast cancer Mammogram for woman aged years once in two years. Cervical HIV cancer Mammogram HIV rapid test for woman members aged aged years and once above in once two a years. year. 2. Men s Health: 3. Young Children and Aged Adults: Breast cancer two Prostate years. cancer Mammogram for woman aged years once in two years. Prostate Specific Antigen (PSA) for man aged 40 years and above once in two years. Cervical cancer Mammogram for woman aged years once in two years. 4. Cardiac Diseases: 5. Diabetes: 6. HIV/AIDS: Flu Prostate cancer Flu vaccine once a year for members aged 5 years and below. Flu Prostate vaccine Specific once a Antigen year for (PSA) members for man aged aged 65 years 40 years and above. and above once in two years. Heart diseases Blood cholesterol test for members aged 35 years and above once a year. Diabetes Blood glucose test for members aged 18 years and above once a year. Flu HIV Flu vaccine once a year for members aged 5 years and below. Flu HIV vaccine rapid test once for a members year for members aged 18 year aged and 65 above years and above. once a year. Breast cancer Notes: Benefits available only Mammogram where service for woman aged is given years by once Bomaid in approved service two years. providers. Managed care, clinical protocols and scheme rules apply. 100% payout by scheme. Bomaid tariffs strictly apply. Cervical cancer Mammogram for woman aged years once in two years. Tel Gaborone (+267) /101 and Francistown (+267) Website BOMaid-Botswana Medical Aid Society Prostate cancer Prostate Specific Antigen (PSA) for man aged 40 years and above once in two years. 9

10 Scheme A Standard SINGLE OVERALL SCHEME BENEFIT LIMIT 37,790 44,568 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases 1.2 Hospitalisation maximum * (daily maximum room rate at agreed tariff **) (within the above, the following sub-limits will apply) Professionals fees Doctors and Other Professionals Laboratory fees excluding HIV monitoring Radiology fees Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) Prosthesis ^ (external and internal) Sub-acute care (post admission step down - maximum 30 days) Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) Birthing unit delivery global fee (by a registered unit/facility) Caesarian section delivery hospitalisation fees Normal delivery professional fees (includes post natal care) Caesarian section professional fees (includes post natal care) Anaesthetist fees (for Caesarian Section) Neonatal hospitalisations (from 0 to 28 days of age) Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 1.3 Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) Renal dialysis for chronic renal failure ** (pre-authorisation required) Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) FAMILY No Benefit 2.1 Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 3,129 4, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 3,491 4, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 2,625 3, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 10,500 12, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12, Diagnostic/Investigative Procedure Limit 4,589 6, Laboratory investigations/tests excluding HIV monitoring 1,139 1, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 1,034 1, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 3,150 4, Infertility diagnostic procedures no benefit no benefit 2.5 Medical/Surgical Procedure Limit 4,673 6, Approved specialist major diagnostic procedure** 2,888 4, Minor medical procedure 893 1, Minor surgical procedure 893 1, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 2,268 3, In-patient Dentistry * (the following sub-limits will apply) no benefit no benefit Hospital fees no benefit no benefit Dentist fees no benefit no benefit Anaesthetist fees no benefit no benefit 3.2 Specialised Dental Treatment and Oral Surgery ** no benefit no benefit Simple maxillo-facial surgery: acute or chronic no benefit no benefit Orthondontic treatment (braces, retainers and related appliances) no benefit no benefit Orthognatic surgery (once-off benefit) no benefit no benefit 3.3 Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) 2,268 3, Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, incision and drainage, root canal treatment) up to limit 3.3 up to limit Specialised Dentistry (includes crowns, bridges and dentures)** up to limit 3.3 up to limit **Pre-authorisation required Refers to treatment every 2 years

11 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Comprehensive cover in accordance with scheme rules, managed care protocols, benefit limits and agreed tariffs. Reduced levels of co-payments. Settlement discount on frame claims. 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) to the value of bifocal lenses Frame and/or any lens enhancements Contact lenses (only claimable as an alternative to frame and lenses) APPLIANCES OVERALL LIMIT 5,250 6, General appliances 2,625 3, Medical appliances (including glucometers, nebulisers) 1,025 1, Surgical appliances (for non-permanent disability) ( to be recommended by surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required 1,025 1, Wheel chairs, crutches and walking frames (for permanent disability) up to limit 5.1 up to limit Hearing aid (prescription required) (maximum 1 pair of appliances per 2 year cycle) up to limit 5.0 up to limit CPAP machines, home oxygen, stoma products up to limit 5.0 up to limit 5.0 (CPAP machines and home oxygen cover subject to pre-authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 2,909 4, REHABILITATION THERAPY (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) 2,121 3, Occupational therapy 1,061 1, Speech therapy 1,061 1, Clinical psychology 1,061 1, Clinical dietetics (consultation only) - maximum 5 sessions 1,061 1, ALTERNATIVE TREATMENT Homeopathic treatment 788 1, Chiropractic treatment 788 1, Naturopathic treatment 788 1, Acupuncture treatment 788 1, Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 788 1, Podiatry 788 1,181 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) No benefit No benefit (Tests covered as per scheme plan) 10 SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 11

12 Scheme A SINGLE FAMILY OVERALL SCHEME BENEFIT LIMIT 274, ,772 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT 236, ,000 (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases up to limit 1.0 up to limit Hospitalisation maximum * (daily maximum room rate at agreed tariff **) 89, ,000 (within the above, the following sub-limits will apply) Professionals fees 10,500 12, Doctors and Other Professionals up to limit up to limit Laboratory fees excluding HIV monitoring up to limit up to limit Radiology fees up to limit up to limit Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 15,750 15, Prosthesis ^ (external and internal) 6,300 6, Sub-acute care (post admission step down - maximum 30 days) 14,280 14, Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) 3,675 3, Birthing unit delivery global fee (by a registered unit/facility) Caesarian section delivery hospitalisation fees 6,825 6, Normal delivery professional fees (includes post natal care) 3,368 3, Caesarian section professional fees (includes post natal care) 3,186 3, Anaesthetist fees (for Caesarian Section) 2,393 2, Neonatal hospitalisations (from 0 to 28 days of age) up to limit 1.2 up to limit Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 2,646 3, Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) 31,500 42, Renal dialysis for chronic renal failure ** (pre-authorisation required) 31,500 42, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 10,500 12, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12,600 ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) 16,790 23, Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 3,129 4, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 3,491 4, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 2,625 3, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit Diagnostic/Investigative Procedure Limit 7,949 10, Laboratory investigations/tests excluding HIV monitoring 1,139 1, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 1,034 1, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 5,250 6, Infertility diagnostic procedures no benefit no benefit 2.5 Medical/Surgical Procedure Limit 4,673 6, Approved specialist major diagnostic procedure** 2,888 4, Minor medical procedure 893 1, Minor surgical procedure 893 1, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 14,343 20, In-patient Dentistry * (the following sub-limits will apply) no benefit no benefit Hospital fees no benefit no benefit Dentist fees no benefit no benefit Anaesthetist fees no benefit no benefit 3.2 Specialised Dental Treatment and Oral Surgery ** 10,500 15, Simple maxillo-facial surgery: acute or chronic up to limit 3.2 up to limit Orthondontic treatment (braces, retainers and related appliances) up to limit 3.2 up to limit Orthognatic surgery (once-off benefit) up to limit 3.2 up to limit Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) 3,843 4, Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, up to limit 3.3 up to limit 3.3 incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** up to limit 3.3 up to limit **Pre-authorisation required Refers to treatment every 2 years

13 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Comprehensive cover in accordance with scheme rules, managed care protocols, benefit limits and agreed tariffs. Reduced levels of co-payments. Settlement discount on frame claims. 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) to the value of bifocal lenses Frame and/or any lens enhancements Contact lenses (only claimable as an alternative to frame and lenses) APPLIANCES OVERALL LIMIT 5,250 6, General appliances 2,625 3, Medical appliances (including glucometers, nebulisers) 1,025 1, Surgical appliances (for non-permanent disability) ( to be recommended by surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required 1,025 1, Wheel chairs, crutches and walking frames (for permanent disability) up to limit 5.1 up to limit Hearing aid (prescription required) (maximum 1 pair of appliances per 2 year cycle) up to limit 5.0 up to limit CPAP machines, home oxygen, stoma products up to limit 5.0 up to limit 5.0 (CPAP machines and home oxygen cover subject to pre-authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 2,909 4, REHABILITATION THERAPY (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) 2,121 3, Occupational therapy 1,061 1, Speech therapy 1,061 1, Clinical psychology 1,061 1, Clinical dietetics (consultation only) - maximum 5 sessions 1,061 1, ALTERNATIVE TREATMENT Homeopathic treatment 788 1, Chiropractic treatment 788 1, Naturopathic treatment 788 1, Acupuncture treatment 788 1, Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 788 1, Podiatry 788 1,181 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) No benefit No benefit (Tests covered as per scheme plan) 10 SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 13

14 Scheme B SINGLE FAMILY OVERALL SCHEME BENEFIT LIMIT 866,532 1,009,686 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT 813, ,350 (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases up to limit 1.0 up to limit Hospitalisation maximum * (daily maximum room rate at agreed tariff **) 393, ,350 (within the above, the following sub-limits will apply) Professionals fees 157, , Doctors and Other Professionals up to limit up to limit Laboratory fees excluding HIV monitoring up to limit up to limit Radiology fees up to limit up to limit Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 42,000 52, Prosthesis ^ (external and internal) 31,500 42, Sub-acute care (post admission step down - maximum 30 days) 14,280 14, Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) 9,450 9, Birthing unit delivery global fee (by a registered unit/facility) 2,100 2, Caesarian section delivery hospitalisation fees 13,650 13, Normal delivery professional fees (includes post natal care) 3,368 3, Caesarian section professional fees (includes post natal care) 3,186 3, Anaesthetist fees (for Caesarian Section) 2,393 2, Neonatal hospitalisations (from 0 to 28 days of age) up to limit 1.2 up to limit Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 4,725 5, Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) 136, , Renal dialysis for chronic renal failure ** (pre-authorisation required) 136, , Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 37,800 44, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12,600 ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) 30,255 43, Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 5,460 8, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 5,460 7, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) 788 1, Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 3,938 5, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit Diagnostic/Investigative Procedure Limit 14,490 20, Laboratory investigations/tests excluding HIV monitoring 2,100 3, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 1,890 2, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 7,350 9, Infertility diagnostic procedures 2,625 3, Medical/Surgical Procedure Limit 8,400 12, Approved specialist major diagnostic procedure** 5,775 7, Minor medical procedure 1,313 1, Minor surgical procedure 1,313 1, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 50,661 74, In-patient Dentistry * (the following sub-limits will apply) 23,100 27, Hospital fees 12,600 15, Dentist fees 5,775 6, Anaesthetist fees 4,725 5, Specialised Dental Treatment and Oral Surgery ** 21,000 36, Simple maxillo-facial surgery: acute or chronic up to limit 3.2 up to limit Orthondontic treatment (braces, retainers and related appliances) up to limit 3.2 up to limit Orthognatic surgery (once-off benefit) up to limit 3.2 up to limit Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) 6,561 10, Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, up to limit 3.3 up to limit 3.3 incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** up to limit 3.3 up to limit **Pre-authorisation required Refers to treatment every 2 years

15 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Comprehensive cover in accordance with scheme rules, managed care protocols, benefit limits and agreed tariffs. Reduced levels of co-payments. Settlement discount on frame claims. 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) to the value of bifocal lenses Frame and/or any lens enhancements Contact lenses (only claimable as an alternative to frame and lenses) 1,103 5 APPLIANCES OVERALL LIMIT 9,450 11, General appliances 4,725 5, Medical appliances (including glucometers, nebulisers) 1,235 1, Surgical appliances (for non-permanent disability) ( to be recommended by surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required 1,235 1, Wheel chairs, crutches and walking frames (for permanent disability) up to limit 5.1 up to limit Hearing aid (prescription required) (maximum 1 pair of appliances per 2 year cycle) up to limit 5.0 up to limit CPAP machines, home oxygen, stoma products up to limit 5.0 up to limit 5.0 (CPAP machines and home oxygen cover subject to pre-authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 7,881 11, REHABILITATION THERAPY (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) 6,831 9, Occupational therapy 3,416 5, Speech therapy 3,416 5, Clinical psychology 3,416 5, Clinical dietetics (consultation only) - maximum 5 sessions 3,416 5, ALTERNATIVE TREATMENT Homeopathic treatment 1,050 2, Chiropractic treatment 1,050 2, Naturopathic treatment 1,050 2, Acupuncture treatment 1,050 2, Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 1,050 2, Podiatry 1,050 2,100 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) No benefit No benefit (Tests covered as per scheme plan) 10 SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 15

16 Scheme C SINGLE FAMILY OVERALL SCHEME BENEFIT LIMIT 1,351,121 1,785,000 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT 1,249,500 1,485,750 (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases up to limit 1.0 up to limit Hospitalisation maximum * (daily maximum room rate at agreed tariff **) 724, ,750 (within the above, the following sub-limits will apply) Professionals fees 168, , Doctors and Other Professionals up to limit up to limit Laboratory fees excluding HIV monitoring up to limit up to limit Radiology fees up to limit up to limit Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 52,500 63, Prosthesis ^ (external and internal) 42,000 52, Sub-acute care (post admission step down - maximum 30 days) 14,280 14, Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) 9,450 9, Birthing unit delivery global fee (by a registered unit/facility) 2,100 2, Caesarian section delivery hospitalisation fees 14,700 14, Normal delivery professional fees (includes post natal care) 3,368 3, Caesarian section professional fees (includes post natal care) 3,430 3, Anaesthetist fees (for Caesarian Section) 2,992 2, Neonatal hospitalisations (from 0 to 28 days of age) up to limit 1.2 up to limit Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 5,775 6, Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) 157, , Renal dialysis for chronic renal failure ** (pre-authorisation required) 157, , Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 50,400 67, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12,600 ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) 43,798 60, Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 7,161 9, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 8,799 12, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) 1,498 2, Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 6,986 9, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit Diagnostic/Investigative Procedure Limit 19,808 27, Laboratory investigations/tests excluding HIV monitoring 3,323 4, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 3,098 4, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 8,663 11, Infertility diagnostic procedures 4,200 5, Medical/Surgical Procedure Limit 11,733 17, Approved specialist major diagnostic procedure** 7,088 10, Minor medical procedure 2,323 3, Minor surgical procedure 2,323 3, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 67,326 92, In-patient Dentistry * (the following sub-limits will apply) 27,300 31, Hospital fees 15,750 18, Dentist fees 6,300 6, Anaesthetist fees 5,250 5, Specialised Dental Treatment and Oral Surgery ** 31,500 47, Simple maxillo-facial surgery: acute or chronic up to limit 3.2 up to limit Orthondontic treatment (braces, retainers and related appliances) up to limit 3.2 up to limit Orthognatic surgery (once-off benefit) up to limit 3.2 up to limit Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) 8,256 14, Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, up to limit 3.3 up to limit 3.3 incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** up to limit 3.3 up to limit **Pre-authorisation required Refers to treatment every 2 years

17 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Comprehensive cover in accordance with scheme rules, managed care protocols, benefit limits and agreed tariffs. Reduced levels of co-payments. Settlement discount on frame claims. 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) to the value of bifocal lenses Frame and/or any lens enhancements Contact lenses (only claimable as an alternative to frame and lenses) 1,418 5 APPLIANCES OVERALL LIMIT 10,500 13, General appliances 5,250 6, Medical appliances (including glucometers, nebulisers) 1,550 1, Surgical appliances (for non-permanent disability) ( to be recommended by surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required 1,550 1, Wheel chairs, crutches and walking frames (for permanent disability) up to limit 5.1 up to limit Hearing aid (prescription required) (maximum 1 pair of appliances per 2 year cycle) up to limit 5.0 up to limit CPAP machines, home oxygen, stoma products up to limit 5.0 up to limit 5.0 (CPAP machines and home oxygen cover subject to pre-authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 10,924 17, REHABILITATION THERAPY (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) 9,349 14, Occupational therapy 4,675 7, Speech therapy 4,675 7, Clinical psychology 4,675 7, Clinical dietetics (consultation only) - maximum 5 sessions 4,675 7, ALTERNATIVE TREATMENT Homeopathic treatment 1,575 3, Chiropractic treatment 1,575 3, Naturopathic treatment 1,575 3, Acupuncture treatment 1,575 3, Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 1,575 3, Podiatry 1,575 3,150 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) (Tests covered as per scheme plan) 3,500 3, SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 17

18 Scheme DS SINGLE FAMILY OVERALL SCHEME BENEFIT LIMIT 274, ,772 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT 236, ,000 (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases up to limit 1.0 up to limit Hospitalisation maximum * (daily maximum room rate at agreed tariff **) 89, ,000 (within the above, the following sub-limits will apply) Professionals fees 10,500 12, Doctors and Other Professionals up to limit up to limit Laboratory fees excluding HIV monitoring up to limit up to limit Radiology fees up to limit up to limit Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 15,750 15, Prosthesis ^ (external and internal) 6,300 6, Sub-acute care (post admission step down - maximum 30 days) 14,280 14, Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) 3,675 3, Birthing unit delivery global fee (by a registered unit/facility) Caesarian section delivery hospitalisation fees 6,825 6, Normal delivery professional fees (includes post natal care) 3,368 3, Caesarian section professional fees (includes post natal care) 3,186 3, Anaesthetist fees (for Caesarian Section) 2,393 2, Neonatal hospitalisations (from 0 to 28 days of age) up to limit 1.2 up to limit Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 2,646 3, Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) 31,500 42, Renal dialysis for chronic renal failure ** (pre-authorisation required) 31,500 42, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 10,500 12, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12,600 ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) 16,790 23, Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 3,129 4, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 3,491 4, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 2,625 3, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit Diagnostic/Investigative Procedure Limit 7,949 10, Laboratory investigations/tests excluding HIV monitoring 1,139 1, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 1,034 1, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 5,250 6, Infertility diagnostic procedures no benefit no benefit 2.5 Medical/Surgical Procedure Limit 4,673 6, Approved specialist major diagnostic procedure** 2,888 4, Minor medical procedure 893 1, Minor surgical procedure 893 1, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 3.1 In-patient Dentistry * (the following sub-limits will apply) Hospital fees Dentist fees Anaesthetist fees 3.2 Specialised Dental Treatment and Oral Surgery ** Simple maxillo-facial surgery: acute or chronic Orthondontic treatment (braces, retainers and related appliances) Orthognatic surgery (once-off benefit) 3.3 Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** Benefits See Add on 18 Refers to treatment every two years

19 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) Frame and/or any lens enhancements Contact lenses 5 APPLIANCES OVERALL LIMIT 5.1 General appliances Medical appliances (glucometers, nebulisers) Surgical appliances (to be recommended by surgeon/orthopaedic surgeon) (for non - permanent disability) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorization required 5.2 Wheel chairs, crutches and walking frames (for permanent disability) 5.3 Hearing aid (prescription required) 5.4 CPAP machines, home oxygen, stoma products (CPAP machines and home oxygen cover subject to pre - authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 6.1 REHABILITATION THERAPY (Medical Referral Needed for Sub - Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) Occupational therapy Speech therapy Clinical psychology Clinical dietetics (consultation only) - maximum 5 sessions 6.2 ALTERNATIVE TREATMENT Homeopathic treatment Chiropractic treatment Naturopathic treatment Acupuncture treatment Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) Podiatry See Add on Benefits 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) No benefit No benefit (Tests covered as per scheme plan) 10 SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 19

20 Scheme DH SINGLE FAMILY OVERALL SCHEME BENEFIT LIMIT 841, ,795 1 IN-PATIENT AND MANAGED CARE BENEFITS OVERALL LIMIT 813, ,350 (within the above, the following limits apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread disease cover * - strictly in accordance with the Bomaid list of approved dread diseases up to limit 1.0 up to limit Hospitalisation maximum * (daily maximum room rate at agreed tariff **) 393, ,350 (within the above, the following sub-limits will apply) Professionals fees 157, , Doctors and Other Professionals up to limit up to limit Laboratory fees excluding HIV monitoring up to limit up to limit Radiology fees up to limit up to limit Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 42,000 52, Prosthesis ^ (external and internal) 31,500 42, Sub-acute care (post admission step down - maximum 30 days) 14,280 14, Confinement * (the following sub-limits will apply) Normal delivery hospitalisation fees (include forceps delivery and vacuum extraction) 9,450 9, Birthing unit delivery global fee (by a registered unit/facility) 2,100 2, Caesarian section delivery hospitalisation fees 13,650 13, Normal delivery professional fees (includes post natal care) 3,368 3, Caesarian section professional fees (includes post natal care) 3,186 3, Anaesthetist fees (for Caesarian Section) 2,393 2, Neonatal hospitalisations (from 0 to 28 days of age) up to limit 1.2 up to limit Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist) 4,725 5, Managed Care Benefits Chemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required) 136, , Renal dialysis for chronic renal failure ** (pre-authorisation required) 136, , Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 37,800 44, ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED 12,600 ** Where fixed fee arrangement has been entered into, those fees will apply Guaranteed ^ Cover on assessment *Pre-authorisation required 2 MEDICAL/SURGICAL OUT-PATIENT OVERALL LIMIT (Consultations, Drugs, Investigations and Procedures) (within the above overall limit, the following sub-limits will apply i.e. 2.1 to 2.5) 30,255 43, Consultations* (GPs and Specialists. Includes ante-natal visits, examination and two subsequent follow-up appointments of the newborn baby) 5,460 8, Antenatal Classes (by a contracted/approved service provider) REGISTRATION WITH THE Bomaid BOMBABY PROGRAM REQUIRED Drugs/Prescribed Medicine Limit 5,460 7, Self medication (prescribed by pharmacist) Doctor dispensing (for acute cases only) 788 1, Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications) 3,938 5, Chronic medications (supplied through the Managed Care Program in accordance with the Bomaid list of approved chronic conditions) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit ARV therapy per beneficiary (supplied through the Managed Care Program) REGISTRATION WITH THE Bomaid MANAGED CARE PROGRAM REQUIRED up to limit up to limit Diagnostic/Investigative Procedure Limit 14,490 20, Laboratory investigations/tests excluding HIV monitoring 2,100 3, X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal pregnancy) 1,890 2, Obstetric ultrasound (maximum 2 scans in a normal pregnancy, motivation and pre-authorisation required for high risk cases needing more than two scans) MRI/CT scan** 7,350 9, Infertility diagnostic procedures 2,625 3, Medical/Surgical Procedure Limit 8,400 12, Approved specialist major diagnostic procedure** 5,775 7, Minor medical procedure 1,313 1, Minor surgical procedure 1,313 1, Major procedure (ambulatory) up to limit 2.5 up to limit 2.5 *Refers to rates at agreed tariffs **Pre-authorisation required 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 3.1 In-patient Dentistry * (the following sub-limits will apply) Hospital fees Dentist fees Anaesthetist fees 3.2 Specialised Dental Treatment and Oral Surgery ** Simple maxillo-facial surgery: acute or chronic Orthondontic treatment (braces, retainers and related appliances) Orthognatic surgery (once-off benefit) 3.3 Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** Benefits See Add on 20 Refers to treatment every two years

21 SINGLE FAMILY 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) Frame and/or any lens enhancements Contact lenses 5 APPLIANCES OVERALL LIMIT 5.1 General appliances Medical appliances (glucometers, nebulisers) Surgical appliances (to be recommended by surgeon/orthopaedic surgeon) (for non - permanent disability) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorization required 5.2 Wheel chairs, crutches and walking frames (for permanent disability) 5.3 Hearing aid (prescription required) 5.4 CPAP machines, home oxygen, stoma products (CPAP machines and home oxygen cover subject to pre - authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 6.1 REHABILITATION THERAPY (Medical Referral Needed for Sub - Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) Occupational therapy Speech therapy Clinical psychology Clinical dietetics (consultation only) - maximum 5 sessions 6.2 ALTERNATIVE TREATMENT Homeopathic treatment Chiropractic treatment Naturopathic treatment Acupuncture treatment Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) Podiatry 7 SAFE MALE CIRCUMCISION 1,600 (SUBJECT TO MANAGED CARE PROTOCOLS) Global fee includes related costs of pre-operative testing and post-operative care within 1 month of procedure See Add on Benefits 8 SEVERE ILLNESS BENEFIT (100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses) 20,000 4,000 Refers to main member and spouse Refers to child dependant 9 EXECUTIVE ANNUAL MEDICAL EXAMINATION (PER BENEFICIARY - LIMITED TO 2 FAMILY MEMBERS) No benefit No benefit (Tests covered as per scheme plan) 10 SCREENING AND PREVENTION BENEFIT Subject to defined scheme rules, managed care and clinical protocols. 11 FUNERAL BENEFIT 11.1 Member/ Spouse/ Parent 10, Child dependant years 10, Child dependant 6-13years 5, Child dependant 1-5 years 2, Child dependant under 1 year 1, WAIVER OF PREMIUMS ON DEATH Cover for medical aid contributions for registered dependants after death of main member. Refer to Page HOSPITAL INSURANCE Cash payout per night of hospitalisation. Refer to Page EMERGENCY MEDICAL SERVICES Full cover through a contracted service provider. Refer to Page 4. 21

22 Scheme DS Scheme DH ADD ON Benefits SINGLE FAMILY 3 DENTAL AND ORAL BENEFIT OVERALL LIMIT 50,661 74, In-patient Dentistry * (the following sub-limits will apply) 23,100 27, Hospital fees 12,600 15, Dentist fees 5,775 6, Anaesthetist fees 4,725 5, Specialised Dental Treatment and Oral Surgery ** 21,000 36, Simple maxillo-facial surgery: acute or chronic up to limit 3.2 up to limit Orthondontic treatment (braces, retainers and related appliances) up to limit 3.2 up to limit Orthognatic surgery (once-off benefit) up to limit 3.2 up to limit Out-patient Dental Overall Limit (Subject to Managed Care and Clinical Protocols) 6,561 10, Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishing, up to limit 3.3 up to limit 3.3 incision and drainage, root canal treatment) Specialised Dentistry (includes crowns, bridges and dentures)** up to limit 3.3 up to limit 3.3 Refers to treatment every two years * No inpatient dental cover for Scheme DS 4 OPTICAL BENEFIT (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Comprehensive cover in accordance with scheme rules, managed care protocols, benefit limits and agreed tariffs. Reduced levels of co-payments. Settlement discount on frame claims. 4.2 Non-Designated Service Providers (MANAGED CARE PROTOCOLS APPLY) Consultation Clear aquity single vision lenses (per lens) Clear aquity bifocal lenses (per lens) Clear aquity multifocal lenses (per lens) to the value of bifocal lenses Frame and/or any lens enhancements Contact lenses (only claimable as an alternative to frame and lenses) 1,103 5 APPLIANCES OVERALL LIMIT 9,450 11, General appliances 4,725 5, Medical appliances (including glucometers, nebulisers) 1,235 1, Surgical appliances (for non-permanent disability) ( to be recommended by surgeon/ orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required 1,235 1, Wheel chairs, crutches and walking frames (for permanent disability) up to limit 5.1 up to limit Hearing aid (prescription required) (maximum 1 pair of appliances per 2 year cycle) up to limit 5.0 up to limit CPAP machines, home oxygen, stoma products up to limit 5.0 up to limit 5.0 (CPAP machines and home oxygen cover subject to pre-authorisation and scheme protocols) 6 ALLIED HEALTH SERVICES OVERALL LIMIT 7,881 11, REHABILITATION THERAPY (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivational report needed for cases requiring more than 20 treatment sessions) 6,831 9, Occupational therapy 3,416 5, Speech therapy 3,416 5, Clinical psychology 3,416 5, Clinical dietetics (consultation only) - maximum 5 sessions 3,416 5, ALTERNATIVE TREATMENT Homeopathic treatment 1,050 2, Chiropractic treatment 1,050 2, Naturopathic treatment 1,050 2, Acupuncture treatment 1,050 2, Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 1,050 2, Podiatry 1,050 2,100 22

23 This ONCE OFF IN A LIFETIME COVER is offered in terms of rule 15 (1) of the Society rules and in accordance with the levels defined below. Dread diseases covered under this benefit are as outlined below: Dread Disease Benefit 1 CORONARY ARTERY DISEASE 2 VALVULAR HEART DISEASE 3 HEART FAILURE 4 CEREBROVASCULAR ACCIDENT/STROKE 5 END STAGE RENAL FAILURE 6 LEUKAEMIA 7 CANCER/MALIGNANT NEOPLASM 8 CEREBRAL ANEURYSM (GRADE III TO V) 9 ORGAN TRANSPLANT Dread disease benefit will ONLY be considered where the coronary arteries are severely narrowed resulting in a need for coronary artery bypass surgery or open heart surgery. Dread disease benefit will ONLY be considered where there is medical proof of severe cardiac vulvular dysfunction needing a surgical intervention such as valve repair or replacement. Dread disease benefit will ONLY be considered where there is medical proof that the member requires major surgical intervention. Dread disease benefit will ONLY be considered where there is medical proof that the member requires major surgical intervention such as craniotomy. This cover also includes rehabilitation therapy at an agreed daily or global tariff for a period not exceeding 36 days. Dread disease benefit will ONLY be considered where there is medical proof that the member requires kidney transplant. The benefit covers only the recipient Bomaid member. Dread disease benefit will ONLY be considered where there is medical proof that the member requires bone marrow transplant. The benefit covers only the recipient Bomaid member. Any other related treatments fall within benefit 1.0 Dread disease benefit will ONLY be considered where there is medical proof that the member has a malignant type of cancer and requires a major surgical intervention. Dread disease benefit will ONLY be considered where there is medical proof that the aneurysm is of grade III or above and that the member requires a major surgical intervention such as craniotomy or ligation of blood vessels. The benefit also covers rehabilitation therapy at an agreed daily or global tariff for a period not exceeding 36 days. The benefit covers transplantation of the following conditions only: Heart, Bone Marrow and Kidney. Cover is only for the recipient Bomaid member. NOTE: IN ALL THE ABOVE, COVER IS FOR SURGICAL INTERVENTION AND OPERATION RELATED PROCEDURES. MAINTENANCE THEREAFTER AND/OR TREATMENT BEFORE SURGERY FALL WITHIN BENEFIT

24 Managed Care Program The program is for management of chronic conditions and includes both benefit management and clinical advice. The following conditions are covered under the program: 1 Allergic Rhinitis (only if associated with asthma) 16 Gout 2 Arthritis 17 HIV/AIDS 3 Ankylosing Spondylitis 18 Hypercholesterolaemia 4 Asthma 19 Hypertension 5 Benign Prostate Hypertrophy 20 Inflammatory Bowel Disease 6 Bipolar Disorder 21 Migraine (Excludes acute attacks) 7 Chronic Anxiety 22 Multiple Sclerosis 8 Chronic Depression 23 Osteopoenia 9 Chronic Bronchitis 24 Osteoporosis 10 Chronic Heart Diseases 25 Parkinson s Disease 11 Chronic Renal Failure 26 Peptic Ulcer Disease 12 Chronic Obstructive Lung Disease 27 Psoriasis 13 Diabetes 28 Schizophrenia 14 Epilepsy 29 Systemic Lupus Erythematosus 15 Glaucoma 30 Thyroid Dysfunction NOTE: HIV/AIDS IS A CHRONIC CONDITION MANAGED UNDER THE SPECIAL BENEFIT FUND (SBF). PLEASE READ THE FOLLOWING REGARDING ASSISTANCE FROM THIS FUND: 1 The assistance is: a) For Bomaid members who have HIV and have enrolled in the Bomaid Managed Care Program b) Over and above the normal benefits shown in the different schemes c) For cover of ARV drugs and laboratory monitoring. 2 Each individual enrolled on the program will be assisted with up to P1, per month for 1 c) above 3 ARV drugs are provided through the Bomaid Managed Care Program only 4 Hospitalisation cover for HIV/AIDS related conditions is only available to members enrolled onto the program. 24

25 Hospital Cash Plan Optional Benefit The Bomaid Hospital Cash Plan provides you and your family with money to take care of your daily living expenses should any of you be hospitalised. You can use the money to pay for anything from groceries to transportation. More reasons why you should have a Bomaid Hospital Cash Plan Enjoy cover for the whole family you, your spouse and up to 4 children Get up to P 2000 for each day should any covered person be hospitalised for more than 3 days Enjoy multiple claims for up to 105 days you or the covered member is in hospital, for each person covered Enjoy double pay-out for each covered person hospitalised in the Intensive Care Unit (ICU) Get a CashBack reward every 3 years whether you have claimed on the policy or not 10 Underwritten by Administered by 25 Healthier, Happier SouthView Lives.

26 Optional Benefit Funeral Benefit Top Up The Bomaid Funeral Benefit Top Up is an optional benefit that allows the member to choose a cover that meets their needs. This cover is in addition to the basic funeral benefit the member already receives. Purchase additional cover with our NEW Funeral Top Up Plan. Choose from two cover options Enjoy cover for the whole family Main member/ Spouse/Parents Child (14-21) Child (6-13) Child (0-5) Get up to P from as little as P38 per month Get up to P from as little as P54 per month P P P P 100% of the cash benefit on the cover selected 100% of the cash benefit on the cover selected 50% of the cash benefit on the cover selected 25% of the cash benefit on the cover selected 26 Underwritten by Administered by SouthView

27 Additional Notes 1. In - patient and Managed Care Benefits: Pre-authorisation is required for all cases. Scheme and/or managed care protocols will be applied Post - admission step down cover includes sub - acute care, hospice, private nursing and physical rehabilitation for approved clinical conditions. Excludes old age homes and frail care. Chronic medicines will be covered under benefit only if supplied through the Bomaid Managed Care Program. Medicine supplied outside the Bomaid Managed Care Program will be covered under benefit No cover for ARVs supplied outside the Bomaid Managed Care Program. 2. Medical/Surgical Out - patient Benefit: No cover for infertility treatment procedures. 3. Dental Benefit: Maximum 2 preventative treatments per beneficiary per annum (e.g. cleaning, scaling and polishing). Re - treatment (e.g. filling) of a tooth in under 1 year will be subjected to managed care and clinical protocols. Cover excludes: professionally applied fluoride, dental bleaching. 4. Optical Benefit: Reduced levels of member co - payments for services obtained from the Bomaid Designated Service Providers. 5. Appliances Benefit: 1 wheel chair per beneficiary over a 3 year cycle 1 pair of hearing aids per beneficiary over a 2 year cycle. 6. Allied Health Services Benefit: Occupational therapy, speech therapy and clinical psychology benefits exclude therapy for social, educational and developmental problems Alternative treatment claim payments will only be made to members and not service providers. 7. Safe Male Circumcision: Cover includes pre - operative consultation/ counselling, physical examination, HIV test and post - operative care within 1 month of operation. 8. Executive Annual Medical Examination: Covers principal member plus one (1) adult dependant per year. Cover includes consultation, physical examination including cancer screening, blood work up, ECG, and non - invasive radiology. Excludes blood tumour markers and mammograms. IN ALL BENEFIT CATEGORIES, ANY ONE FAMILY MEMBER CANNOT CLAIM IN EXCESS OF THE SINGLE MEMBER S LIMIT. 27