SUMMARY OF BENEFITS LIMIT CHANGES FOR 2017 GOMOMO CARE OPTION. Plan Option Service Type 2016 Limit L2017 Limit
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1 SUMMARY OF BENEFITS LIMIT CHANGES FOR 2017 GOMOMO CARE OPTION 6.5% Average Increase GOMOMO CARE OPTION Plan Option Service Type 2016 Limit L2017 Limit Gomomo Care -Out Advanced radiology limited to a combined in and out benefit Over the counter medication Chronic medication Optical (M) -subject to 24-month cycle Optical (M + 1) -subject to 24-month cycle Optical (M + 2) -subject to 24-month cycle Optical (M + 3) -subject to 24-month cycle Dentistry (M) Dentistry (M+1) Dentistry (M+2) Dentistry (M+3) Dentistry (M+4) Dentistry (M+5) Dentistry (M+6) Other services (Includes physiotherapists, speech therapists, clinical psychologists, podiatrists, equipment and external prostheses) per family subject to PMBs Gomomo Care Option -In-hospital Overall Prosthesis benefit sub-limit- per beneficiary per annum
2 SAVINGS CARE OPTION SAVINGS CARE OPTION Savings Care Option - Out of Hospital Savings Care Option - In-Hospital Specialised Radiology (Combined limit in and out per family per annum) Private nursing (per family per annum) Appliances (Memb without a dependant) Appliances (Memb with one or more dependant) Prosthesis (per family per annum) Mental Health (per family per annum) Preventative care Preauthorisation required) Blood transfusions and blood replacement products Prosthesis (Surgical and non-surgical prosthesis) Oncology Specialised Radiology (MRI/CAT scan/angiogram) subject to an overall combined in and out limit Organ Transplant and Renal Dialysis (per family per annum)
3 PRIMARY CARE OPTION PRIMARY CARE OPTION Primary Care Option - Specialised Radiology (MRI/CAT scan/angiogram) subject to an overall combined in and Out out limit) per family per annum Private nursing (per family per annum) Auxiliary services ( Member without dependant ) Auxiliary services ( Member with 1 or more dependant ) Acute meds ( M) Acute meds meds (M+1) Acute meds (M+2) Acute meds ( M+3) Acute meds ( M+4) Acute meds ( M+5) Acute meds(m+6 and more) Appliances(Member with one or more dependant ) Mental Health ( per family per annum) Preauthorisation required) Other screening tests (Mamogram, pap smear, PSA (Limited to one test per beneficiary per annum) subject to family limit as stated here Hearing Aids ( per family ) every 4 years Non-motorised wheelchairs (Member with or without dependants) Primary Care Inhospital Prosthesis (per family within hospital limit as stipulated) Specialised Radiology ((MRI/CAT scan/angiogram) per family per annum, preauthorisation Oncology
4 AFFORDABLE CARE OPTION Affordable Care Specialised Radiology MRI/CAT scan/angiogram) subject to an overall combined in and Option -Out out hospital limit Private nursing ( per family per annum) Clinical & Medical technology services ( memb without a dependant ) Clinical & Medical technology services ( memb with 1 or more a dependants ) AFFORDABLE CARE OPTION Auxiliary services ( Member without dependant ) Auxiliary services ( Member with 1 or more dependant ) Non-PMB Chronic meds ( M)- (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+1) - (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+2) - (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+3) - (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+4) - (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+5) - (Subject to a maximum of R5 261 per beneficiary) Non-PMB Chronic meds ( M+6 and more) - (Subject to a maximum of R5 261 per beneficiary) 580 All Non-PMB meds are subject to a maximum of this amount per beneficiary Appliances (Member without a dependant) Appliances( Member with one or more dependant ) Mental Health ( per family per annum) Wellness screening - One consultation visit in doctors rooms (per beneficiary per annum at a Preferred Provider facility; Preauthorisation required) Other screening tests (Mamogram, pap smear, PSA (Limited to one test per beneficiary per annum) subject to family limit as stated here Hearing Aids (per family) every 4 years Non-motorised wheelchairs (Member with or without dependants) Affordable Care Option -In-hospital Prosthesis (per family within hospital limit as stipulated) Specialised Radiology ((MRI/CAT scan/angiogram) per family per annum, preauthorisation Refractive surgery including Radial Keratotomy (per family per annum) Oncology
5 FULL BENEFIT CARE OPTION FULL BENEFIT CARE OPTION Full Care Option -Out Specialised Radiology ( MRI/CAT scan/angiogram ) subject to an overall combined in and out limit ) per family per annum Private nursing ( per family per annum) Clinical & Medical technology services ( memb without a dependant ) Clinical & Medical technology services ( memb with 1 or more a dependants ) Auxiliary services ( Member without dependant ) Auxiliary services ( Member with 1 or more dependant ) Non-PMB Chronic meds ( M) Non-PMB Chronic meds ( M+1) Non-PMB Chronic meds ( M+2) Non-PMB Chronic meds ( M+3) Non-PMB Chronic meds ( M+4) Non-PMB Chronic meds ( M+5) Non-PMB Chronic meds ( M+6 and more) All Non-PMB meds are subject to a maximum of this amount per beneficiary Appliances (Member without a dependant) Appliances( Member with one or more dependant ) Mental Health ( per family per annum) Preauthorisation required ) Other screening tests( Mamogram, pap smear,psa (Limited to one test per beneficiary per annum) subject to family limit as stated here Hearing Aids ( per family ) every 4 years Non-motorised wheelchairs (Member with or without dependants ) Full Care Option -Out Prosthesis ( per family within hospital limit as stipulated ) Specialised Radiology ((MRI/CAT scan/angiogram) per family per annum, pre-authorisation Refractive surgery including Radial Keratotomy (per family per annum) Oncology
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