COMPARATIVE G U I D E 2017 #caring4life
WHY SIZWE? We offer a range of medical aid products, starting with a network healthcare product ideal for lower-income earners right up to premium medical aid products for high-income earners. To assist you in making an informed choice on our various benefit options, have a look at what each option offers. DISCLAIMER: Our 2017 benefits and contributions are subject to approval by the Registrar of Medical Schemes. This brochure is for information purposes only and does not supersede the rules of the Fund. A full set of the rules is available on our website: www.sizwe.co.za
2017 HEALTH OFFERINGS HOSPITAL The Hospital Care Option offers peace of mind knowing that in the event of hospitalisation, extensive cover is available at any private hospital. In addition, the Hospital Care Option provides cover for 27 Chronic Disease List (CDL) conditions. This is our entry-level option. Gomomo Care Options provides excellent value for money. GPs, specialists and acute medicines are accessible through a selected network provider. Dentistry, radiology and pathology are also available from a network provider. No overall limit for hospitalisation at any private hospital. Covers the 27 Chronic Disease List (CDL) conditions. Savings Care Option is our new generation option which offers comprehensive in-hospital benefits and out-of-hospital benefits paid from a 15% portion available upfront for the year. There are no overall in-hospital limits, with the freedom to go to any private hospital and it also covers 27 Chronic Disease List (CDL) conditions. This option is suitable for young and healthy individuals. Primary Care Option offers good value for money with unlimited hospitalisation at any private hospital. This traditional option has generous day-to-day benefits which cover acute medicines, GPs, specialists, radiology, pathology and more to meet the needs of any family. Our Affordable Care Option offers generous comprehensive cover with unlimited hospitalisation in any private hospital. It also covers additional chronic conditions with specialised dentistry and preventative benefits. This option is suitable for young and healthy individuals. Our Full Care Option offers comprehensive cover and generous benefits to cover families and individuals who need access to unlimited hospitalisation at any private hospital. This option also offers additional chronic conditions, specialised dentistry, GPs, specialists, acute medication, preventative care benefits and more rich benefits. This is the only option which offers Top-up cover when in hospital up to 200% of the Sizwe rate. 2
OUT OF HOSPITAL BENEFITS Prescribed Minimum s (PMBs) are paid at cost.
HOSPITAL OPTION STRUCTURE Major Medical only Major Medical; Day-to-day through Network Major Medical; Day-to-day through Major Medical; Day-to-day Major Medical; Day-to-day Major Medical; Day-to-day OUT OF HOSPITAL BENEFITS - Prescribed Minimum s (PMBs) are paid at cost. OVERALL DAY-TO-DAY LIMIT 100% Sizwe rates, subject to managed care rules, formulary and clinical protocols of the DSP s are covered subject to accrued saving benefit M: R5 390 M+1: R7 980 M+2: R9 330 M+3: R10 670 M+4: R12 020 M+5: R13 370 M+6: R14 720 M: R9 330 M+1: R13 370 M+2: R15 390 M+3: R16 740 M+4: R18 760 M+5: R20 790 M+6: R22 690 M: R15 390 M+1: R20 790 M+2: R23 370 M+3: R26 060 M+4: R28 770 M+5: R31 460 M+6: R34 150 GENERAL PRACTITIONERS Pre-authorisation required, select a GP as your chosen doctor for all GP visits Out of area: 4 per beneficiary. Subject to pre-authorisation Limited number of visits M: 4 M+1: 9 M+2: 12 M+3: 14 M+4: 15 M+5: 16 M+6: 17 Limited number of visits M: 7 M+1: 14 M+2: 16 M+3: 18 M+4: 20 M+5: 21 M+6: 22 Limited number of visits M: 12 M+1: 20 M+2: 25 M+3: 29 M+4: 30 M+5: 31 M+6: 32 SPECIALISTS (EXCLUDING PSYCHIATRISTS), ACUTE MEDICINE, PATHOLOGISTS, RADIOLOGISTS AND PHYSIOTHERAPISTS All visits subject to mandatory referral from a GP All visits subject to mandatory referral from a GP All visits subject to mandatory referral from a GP Non-referral will result in a co-payment M: 2 M+1: 6 M+2: 7 M+3: 8 M+4: 9 M+5: 10 M+6+: 11 M: 4 M+1: 8 M+2: 9 M+3: 10 M+4: 11 M+5: 12 M+6+: 13 M: 7 M+1: 12 M+2: 15 M+3: 16 M+4: 17 M+5: 19 M+6+: 20 4
HOSPITAL OUT OF HOSPITAL BENEFITS - Prescribed Minimum s (PMBs) are paid at cost. ACUTE MEDICINES AND PHARMACY ADVISED THERAPY (PAT) - FALLS WITHIN DAY-TO-DAY BENEFIT WITH THE FOLLOWING SUB-LIMITS R280 over-the-counter medcation per family within DSP Within day-to-day with sub-limits: M: R1680 M+1: R3030 M+2: R3370 M+3: R3820 M+4: R3930 M+5: R4150 M+6: R4490 Within day-to-day with sub-limits: M: R3 250 M+1: R4 940 M+2: R5 840 M+3: R6 290 M+4: R7 190 M+5: R7 420 M+6: R7 640 Within day-to-day with sub-limits: M: R4 380 M+1: R7 750 M+2: R8 990 M+3: R10 230 M+4: R10 890 M+5: R11 460 M+6: R12 020 RADIOLOGY AND RADIOGRAPHY Reimbursement Rate GENERAL Risk benefit, Subject to protocols, Managed care rules, Formulary, Pre-authorisation Risk benefit, within day to day limit Combined limit with pathology Risk benefit, within day to day limit Combined limit with pathology Risk benefit, within day to day limit Combined limit with pathology SPECIALISED Combined In-Hospital and Out of Hospital R6 770 per family Combined In-Hospital and Out of Hospital R23 960 per family Combined In-Hospital and Out of Hospital R17 710 per family Combined In-Hospital and Out of Hospital R26 920 per family Combined in and out of hospital R35 420 per family per annum PHYSIOTHERAPHY ; Limit R2 400 per family subject to PMBs ; PATHOLOGY Risk benefit, within day-to-day limit Risk benefit, within day-to-day limit Risk benefit, within day-to-day limit
HOSPITAL OUT OF HOSPITAL BENEFITS - Prescribed Minimum s (PMBs) are paid at cost. PATHOLOGY Subject to designated service provider (DSP), Protocols, Managed care, Pre-authorisation Combined limit with basic radiology M: R1000 M+1+1: R1 900 Combined limit with basic radiology M: R1 100 M+1+: R2 200 Combined limit with basic radiology M: R1 300 M+1+: R2 750 DENTISTRY Conservative Dentistry: Subject to Dental Management Programme - 0860 109 556 Limit per beneficiary or family per annum M: R2 630 M+1: R3 030 M+2: R3 290 M+3: R3 560 M+4: R3 810 M+5: R4 070 M+6+: R4 470 R2 800 per family 2 general check ups a year per beneficiary, subject to managed care protocols on restorative work R3 200 per family 2 general check ups a year per beneficiary, subject to managed care protocols on restorative work R3 600 per family 2 general check ups a year per beneficiary, subject to managed care protocols on restorative work Subject to managed care rules formulary and protocols of the DSP Root Canal, Clinical protocols apply Root Canal, Clinical protocols apply Specialised Dentistry Plastic dentures s 1 set full or partial per beneficiary in a 4 year period 1 set full or partial per beneficiary in a 4 year period 1 set full or partial per beneficiary in a 4 year period Metal dentures s s 2 Partial metal frames per beneficiary every 5 years (limited to 1 family member per annum) 2 Partial metal frames per beneficiary every 5 years (limited to 2 family member per annum) Orthodontic treatment s s Limited to individuals from age 9-18 years; 35% co-payment Limited to individuals from age 9-18 years Crowns s s 1 crown per family per annum 3 crowns per family per annum 6
HOSPITAL OUT OF HOSPITAL BENEFITS - Prescribed Minimum s (PMBs) are paid at cost. Specialised Dentistry Implants s s s s R3 500 per implant per annum, subject to 2 implants per beneficiary in a 5 year period OPTICAL BENEFITS ACCESSED THROUGH PPN Limits M: R1 080 M+1: R1 240 M+2: R1 370 M+3: R1 970 No Limit No Limit No Limit No Limit Eye test Subject to managed care rules, formulary and clinical protocols of the DSP 1 Test per beneficiary every 24 months at any PPN Optometrist 1 Test per beneficiary every 24 months at any PPN Optometrist 1 Test per beneficiary every 24 months at any PPN Optometrist 1 Test per beneficiary every 24 months at any PPN Optometrist Frames Limited to R465 per beneficiary for frames per 24-month cycle at DSP R300 per beneficiary every 24 months. R300 per beneficiary every 24 months R300 per beneficiary every 24 months R300 per beneficiary every 24 months Single Focus Lenses every two years Subject to managed care rules, formulary and clinical protocols of the DSP R165 per lens per beneficiary every 24 months. Subject to available R165 per lens per beneficiary every 24 months R165 per lens per beneficiary every 24 months R165 per lens per beneficiary every 24 months Bi-Focal Lenses Subject to managed care rules, formulary and clinical protocols of the DSP R360 per lens per beneficiary every 24 months. Subject to available R 360 per lens per beneficiary every 24 months R360 per lens per beneficiary every 24 months R360 per lens per beneficiary every 24 months Multi-Focal Subject to managed care rules, formulary and clinical protocols of the DSP R360 per lens per beneficiary every 24 months. Subject to available R450 per lens per beneficiary every 24 months R660 per lens per beneficiary every 24 months R660 per lens per beneficiary every 24 months Contact Lenses Refractive surgery incl. Radial Keratotomy Subject to managed care rules, formulary and clinical protocols of the DSP R525 per beneficiary. R525 per beneficiary R525 per beneficiary R5 980 per family per annum R525 per beneficiary R11 490 per family per annum
HOSPITAL OUT OF HOSPITAL BENEFITS - Prescribed Minimum s (PMBs) are paid at cost. MENTAL HEALTH Psychiatrists, Clinical and Counselling Psychologists - only if related to mental health, excludes Educational Psychologists, Social Workers and Registered Counsellors ; Subject to PMBs Subject to pre-authorised and managed care rules R7 190 per family Risk benefit R4 910 per family Risk benefit R8 140 per family Risk benefit R15 680 per family AUXILIARY SERVICES Audiologists, Chiropractors, Dieticians, Homeopaths, Occupational Therapists, Podiatrists, Speech Therapists, Social Workers, Educational Psychologists, Biokinetics and Registered Counsellors. PMB benefit R 2 400 per family unless PMB Risk benefit M: R960 M+1+: R1 550 Risk benefit M: R1 440 M+1+: R2 510 Risk benefit M: R2 630 M+1+: R4 420 MATERNITY Subject to registration on the Sizwe Baby Programme within 24 weeks of falling pregnant, subject to registration on to the programme, subject to available Ante-Natal Consultations Subject to clinical protocols/care plans Limited to 9 ante-natal visits by either GP or 2 Obstetrician visits per referral by GP or Midwife Subject to managed care rules, formulary and clinical protocol of the DSP 9 GP/Midwife visits 2 Specialist visits 9 GP/Midwife visits 2 Specialist visits 9 GP/Midwife visits 4 Specialist visits 9 GP/Midwife visits 6 Specialist visits Pregnancy Scans 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy 2 x 2D scans per pregnancy. 8
CHRONIC BENEFITS
HOSPITAL CHRONIC BENEFITS: Subject to pre-authorisation. CHRONIC MEDICINES: subject to registration on the Chronic Medicine Programme - 0860 10 34 55. PMBs subject to pre-authorisation, preferred providers and treatment protocols. PMB At Cost At Cost At Cost At Cost At Cost At Cost Non-PMB Cover for 27 PMB chronic conditions R7 460 per beneficiary. Cover for 27 PMB chronic conditions Cover for PMB chronic conditions and 11 additional conditions Cover for 27 PMB chronic conditions R4 940 per beneficiary. Cover for 27 PMB chronic conditions and 13 additional conditions R10 400 per beneficiary. Cover for 27 PMB chronic conditions and 33 additional conditions HIV/AIDS Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for monitoring purposes s Subject to treatment protocols and PMBs No limit but subject to treatment protocols. Subject to PMBs No limit but subject to treatment protocols. Subject to PMBs No limit but subject to treatment protocols. Subject to PMBs No limit but subject to treatment protocols. Subject to PMBs No limit but subject to treatment protocols. Subject to PMBs 10
IN-HOSPITAL BENEFITS
HOSPITAL IN-HOSPITAL BENEFITS %BENEFITS Top-up cover (must be applied for within 3 months of hospitalisation) Sizwe negotiated tariff Rates + 200% AMBULANCE SERVICES Cost as authorised by EUROP ASSIST SA (Telephone number: 0860 11 77 99) PRIVATE HOSPITALS AND NURSING HOMES Subject to Treatment and Case Management Protocols and PMBs. Pre-authorisation required unless it is a medical emergency Accommodation A co-payment of R1 500 will apply to all unauthorised admissions unless it is an emergency A co-payment will apply to all unauthorised admissions unless it is an emergency A co-payment will apply to all unauthorised admissions unless it is an emergency A co-payment will apply to all unauthorised admissions unless it is an emergency A co-payment will apply to all unauthorised admissions unless it is an emergency A co-payment will apply to all unauthorised admissions unless it is an emergency Clinical Limitations and Exclusions None PMB s Advanced Laparoscopic, Reconstructive & Cardiac Surgery including Stents, Joint Replacements, Spinal Surgery, Breast Reconstructions and Augmentations None Advanced Laparoscopic, Reconstructive & Cardiac Surgery including Stents, Joint Replacements, Spinal Surgery, Breast Reconstructions and Augmentations None None DENTAL HOSPITALISATION Subject to pre-authorisation and Dental Management Programme and Clinical Protocols Subject to R1 500 co-payment on some options 100% Sizwe Dental Tariff (SDT) Rate General Anaesthetic Pre-authorisation is required, subject to managed care protocols Pre-authorisation is required, subject to managed care protocols and limited to PMB level of care Pre-authorisation is required, subject to managed care protocols Pre-authorisation is required, subject to managed care protocols Pre-authorisation is required, subject to managed care protocols Pre-authorisation is required, subject to managed care protocols Laughing gas in dental rooms 12
HOSPITAL IN-HOSPITAL BENEFITS DENTAL HOSPITALISATION (continued) Subject to pre-authorisation and Dental Management Programme and Clinical Protocols Subject to R1 500 co-payment on some options Conscious sedation in rooms Subject to pre-authorisation and managed care protocols Subject to pre-authorisation and limited to PMB level of care Subject to pre-authorisation and managed care protocols Subject to pre-authorisation and managed care protocols Subject to pre-authorisation and managed care protocols GENERAL PRACTITIONER AND MEDICAL SPECIALIST for consultations and visits in-hospital for consultations and visits in-hospital for consultations and visits in-hospital for consultations and visits in-hospital for consultations and visits in-hospital for consultations and visits in-hospital AUXILIARY SERVICES Dietician, Speech therapy, Occupational therapy Subject to PMB, Clinical Protocols and Pre-authorisation Subject to Clinical Protocols and Pre-authorisation Subject to PMB, clinical Protocols and Pre-authorisation Subject to pre authorisation and PMBs Limited to dieticians, speech therapy, occupational therapy and clinical technology Subject to pre authorisation and PMBs Subject to Pre-authorisation and PMBs PHYSIOTHERAPY Pre-authorisation and managed care protocols apply MATERNITY Subject to registration on the Sizwe Baby Programme within 24 weeks of falling pregnant Hospitalisation (Public or private hospitals; Delivery, Post-natal services and midwifery
HOSPITAL IN-HOSPITAL BENEFITS BLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTS subject to annual limit of R75 350 per family subject to PMBs subject to PMBs subject to annual limit of R75 350 per family subject to PMBs 100% of the cost of blood transfusions and blood replacement products, limited to PMBs 100% of the cost of blood transfusions and blood replacement products, limited to PMBs subject to pre authorisation and PMBs PROSTHESIS % limit: Pre-authorisation and managed care protocols apply ; Subject to an annual limit of R35 950 per family; Maximum of 3 cardiac stents per family; 2 vuscular stents per family per annum ; Subject to an annual limit of R26 625 per beneficiary per annum ; Subject to an annual limit of R35 950 per family; Maximum of 3 cardiac stents per procedure subject to pre-authorisation, treatment protocols and PMBs annual limit of R24 270 per family for both surgical and non-surgical prostheses 100% of the cost of prosthesis subject to an annual limit of R40 450 per family within hospital limit 2 vuscular stents per family per annum 3 cardiac stents per family per annum 100% of the cost of prosthesis subject to an annual limit of R53 400 per family within hospital limit 2 vuscular stents per family per annum 3 cardiac stents per family per annum ONCOLOGY Overall limit R121 920 per family from annual hospital benefit 100% of the costs of materials used in radiotherapy and chemotherapy subject to PMBs Overall limit R121 920 per family from annual hospital benefit Overall limit R106 500 per family from annual hospital benefit Overall limit R266 250 per family from annual hospital benefit Overall limit R319 500 per family from annual hospital benefit RADIOLOGY AND RADIOGRAPHY Specialised Radiology (MRI/CAT scan/ Angiogram) Limited to R23 960 per family per annum Limited to PMB level of care Limited to R23 960 per family per annum subject to an overall combined in and out of hospital limit Limit of R17 710 per family per annum Subject to an overall combined in and out of hospital limit of R26 920 per family per annum Subject to the overall combined in and out of hospital limit of R35 422 per family per annum Interventional Radiology Payable from hospital limit, subject to pre-authorisation and clinical protocols Payable from hospital limit, subject to pre-authorisation and clinical protocols Payable within hospital limit, subject to pre-authorisation and clinical protocols Payable within hospital limit, subject to pre-authorisation and clinical protocols Payable from hospital limit, subject to pre-authorisation and clinical protocols 14
HOSPITAL IN-HOSPITAL BENEFITS RADIOLOGY AND RADIOGRAPHY (continued) Specialised Radiology (MRI/CAT scan/ Angiogram) Pre-authorisation and managed care protocols Limited to a combined limit in and out of hospital R6 770 per family Payable within hospital limit, subject to pre-authorisation and clinical protocols Payable from hospital limit, subject to pre-authorisation and clinical protocols PATHOLOGY MENTAL HEALTH Psychiatry hospitalisation Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologist subject to PMBs Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologist subject to PMBs Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologists subject to PMBs Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologists subject to PMBs Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologists subject to PMBs Limited to 21 days per beneficiary per annum Psychiatrist consultations and 6 in-hospital Clinical Psychologists subject to PMBs Alcoholism, drug addiction, narcotism: Subject to PMBs, subject to Pre-Authorisation, Minimum 3 days withdrawal treatment and up to 21 days rehabilitation at an appropriate facility 3 days withdrawal treatment and up to 21 days rehabilitation 3 days withdrawal treatment and up to 21 days rehabilitation 3 days withdrawal treatment and up to 21 days rehabilitation 3 days withdrawal treatment and up to 21 days rehabilitation 3 days withdrawal treatment and up to 21 days rehabilitation ORGAN TRANSPLANT AND RENAL DIALYSIS s: Organ Transplant / Renal Dialysis treatment Limited to R190 420 per family per annum No limit and restricted to PMB level of care Limited to R190 420 per family per annum Subject to PMBs Subject to PMBs Subject to PMBs
HOSPITAL IN-HOSPITAL BENEFITS ORGAN TRANSPLANT AND RENAL DIALYSIS (continued) Renal Dialysis Restricted to PMBs Restricted to PMBs Restricted to PMBs Restricted to PMBs Restricted to PMBs Restricted to PMBs, subject to, subject to, subject to, subject, subject, subject Pre-authorisation, Minimum Pre-authorisation, Minimum pre-authorisation, Minimum to pre-authorisation, to pre-authorisation, to pre-authorisation, Package, treatment Package, treatment Package, treatment Minimum Package, Minimum Package, Minimum Package, protocols and Designated protocols and Designated protocols and Designated treatment protocols and treatment protocols and treatment protocols and Service Providers Service Providers Service Providers Designated Service Designated Service Designated Service Providers Providers Providers REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY Limited to R5 980 per Limited to R11 490 family per annum per family per annum OVERALL ANNUAL LIMIT Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited HOSPITAL REIMBURSEMENT RATE with top-up cover PROVIDER NETWORK Any Any Any Any Any Any 16
PREVENTATIVE BENEFITS 18
HOSPITAL PREVENTATIVE BENEFITS WELLNESS SCREENING CONSULTATION Subject to family limit of R1 920; Flu Vaccine, Pneumococcal, Vaccine, Mammograms, Pap smears and PSA Access through HIP (Health Improvement Programme) R1 920 Flu Vaccine, Pneumococcal, Vaccine, Mammograms, Pap smears and PSA R1 920 Flu Vaccine, Pneumococcal, Vaccine, Mammograms, Pap smears and PSA R1 920 Flu Vaccine, Pneumococcal, Vaccine, Mammograms, Pap smears and PSA R2 500 Flu Vaccine, Pneumococcal, Vaccine, Mammograms, Pap smears and PSA BLOOD SUGAR, CHOLESTEROL, BLOOD PRESSURE, BMI AND HIV R300 Access through HIP (Health Improvement Programme) R300 R255 R255 R255 ORAL CONTRACEPTIVES R2 490 per family per annum R2 490 per family per annum R2 490 per family per annum OTHER BENEFITS: IN OR OUT OF HOSPITAL Appliances M: R1 240 M+1+: R2 160 M: R960 M+1+: R1 550 M: R1 440 M+1+: R2 510 M: R2 510 M+1+: R4 180 Wheelchair Hearing aids Subject to PMBs R1 790 per family R5 500 per family R2 990 per family R8 600 per family R4 170 per family R12 700 per family Private nursing R5 750 per family R4 310 per family R6 430 per family R8 610 per family
IMPORTANT CONTACT DETAILS CHRONIC MEDICATION PROGRAMME: Tel: 0860 10 34 55 011 353 0030 Fax: 011 353 0352/0076 Email: chronic@sizwemedfund.co.za HOSPITAL PRE-AUTHORISATION, HOSPITAL BENEFIT MANAGEMENT PROGRAMME: Tel: 0860 10 11 76 DENTAL BENEFIT MANAGEMENT: Tel: 0860 10 95 56 Fax: 0866 77 03 36 Email: sizweenq@denis.co.za WELLNESS PROGRAMME HELPLINE FOR ASTHMA, CARDIOVASCULAR DISEASE, DIABETES AND MENTAL HEALTH: Tel: 0860 10 34 55 Fax: 011 221 5238 Email: wellnessqueries@sizwemedfund.co.za HIV/AIDS MANAGEMENT PROGRAMME: Tel: 0860 10 34 54 Fax: 011 221 5235/56 EUROP ASSISTANCE SA, MEDICAL EMERGENCIES, 24-HOUR AMBULANCE SERVICES AND MEDICAL ADVICE: Tel: 0860 11 77 99 SIZWE BABY PROGRAMME Fax: 011 221 5218 Email: sizwebaby@healthichoices.com TIP-OFFS ANONYMOUS FRAUD LINE: Tel: 0800 20 47 02 Fax: 0800 00 77 88 Email: sizwemedical@tip-offs.com CHRONIC MEDICATION PROGRAMME: Tel: 0860 10 34 55 011 353 0030 Fax: 011 353 0352/0076 Email: chronic@sizwemedfund.co.za 20
2017 CONTRIBUTIONS EFFECTIVE FROM 01 JANUARY 2017
EFFECTIVE FROM 01 JANUARY 2017 INCOME CODE INCOME BRACKET PRINCIPAL MEMBER ADULT DEPENDANT CHILD O 480 490 R0 - R10 112 R10 113 + R1 666 R2 060 R1 546 R1 623 R410 R420 HOSPITAL 650 All R1 700 R1 300 R400 580 590 R0 - R15 052 R15 053 + R2 015 R2 800 R1 742 R2 243 R490 R555 160 170 180 R0 - R530 R531 - R8 766 R8 767 + R407 R1 907 R2 326 R407 R1 488 R1 519 R407 R480 R480 280 290 R0 - R15 052 R15 053 - R18 444 R2 733 R2 843 R2 511 R2 610 R630 R660 300 R18 445 + R3 657 R3 251 R730 380 390 R0 - R18 879 R18 880 + R4 210 R4 885 R3 825 R4 441 R860 R960 22
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