Bona Plus 2011

Document Sample
Bona Plus 2011 Powered By Docstoc
					Bona Plus
2011
Quality healthcare at affordable prices
Bona Plus is a network option which has enhanced hospitalisation and radiology benefits.
It is a specifically designed option for members in the lower income segment of the market
which allows for access to all day-to-day medical services within a network of providers.

Benefit highlights                                                       Specialist Designated Service Provider Network
CareCross Health                                                         LMS has contracted with a group of specialists to provide in and
                                                                         out-of-hospital benefits at the LMS rate. Scheme rules and benefits
Liberty Medical Scheme (LMS) has contracted with CareCross               apply. Services obtained outside of the network may incur a penalty
to provide access to a national network of primary healthcare            (a co-payment of 40%). Please contact the LMS Contact Centre for
providers for the delivery of the benefits and services to members.      more detail or visit the LMS website.

The Bona Plus option offers quality, affordable primary care benefits
through this network. The chosen CareCross general practitioner (GP)
                                                                         Contact Centre
becomes the key to accessing out-of-hospital benefits.                   For all hospital authorisations, please call the LMS Contact Centre
                                                                         0n 0860 002 163.
The big advantage of choosing the Bona Plus option is that you will
                                                                         For all CareCross enquiries, please call the CareCross Contact
enjoy unrestricted access to your CareCross GP throughout the year.
                                                                         Centre on 0860 103 491.
The benefits on the option have been formulated in such a way that
                                                                         The Contact Centres are open Monday to Friday from 08h00 to
the member may have as many medically necessary visits to the
                                                                         17h00 (closed on public holidays).
CareCross GP as he/she will need to remain healthy and the member
will never have to worry about “running out” of doctor visits.
                                                                         Email Communication
In treating the member, the GP may also:                                 webmail@libertyhealth.co.za
•	 Perform minor surgical procedures                                     Our direct email service empowers you to keep up to date at the
•	 Call for listed blood tests and X-rays                                click of a button, even without Internet access. As long as we have
•	 Provide you with acute and chronic medication according to a          your email address loaded on our database, accessing your personal
   formulary                                                             data, at any time day or night, is easy.
•	 Offer pre- and post-natal care including two ultrasound scans per
   pregnancy                                                             You send us a blank email and our system immediately generates
                                                                         a reply that includes membership details, *claims history, benefits
The member will be entitled to basic dental benefits such as fillings,   used to date, contributions to date, a copy of your latest *claims
extractions and cleaning. In addition, he/she will have access to an     statement and a copy of your current tax letter.
optical benefit that is available to each beneficiary every 24 months.

It is important to note however, that all primary care benefits
are only available via CareCross contracted providers. Visit the
CareCross website on www.carecross.co.za for details of the
CareCross providers.
SMS Facility                                                               Walk-in Branches
39372                                                                      You can hand in claims at any of our walk-in branches, where
                                                                           friendly and capable staff will assist in resolving your queries.
Our SMS facility allows you anytime access to important
                                                                           Walk-in branches are located in Katherine Street, Sandton;
information. Simply ensure that your cellphone number is loaded on
                                                                           city centre in Durban as well as Century City in Cape Town.
our database before sending through your request for information.

                                                                           Walk-in facilities are open Monday to Friday from 08h30 to 16h00.
Only SMS the corresponding letter for the information you require:
                                                                           For additional regional walk-in branches call the Contact Centre.
BN for benefits, CL for *claims, DE for membership information, BR
for your broker’s details, TX to request a copy of your current tax
letter, or send a blank sms for a list of self-help instructions. Within   Scheme Option Summary
seconds you will receive a return SMS containing the detailed and
real-time information you requested.                                        Bona Plus
                                                                                 Major Medical Benefits                 Day-to-Day Benefits
Interactive Member Website
                                                                                     Hospital Benefit
www.libmed.co.za                                                                                                   Primary Care         Day-to-Day
                                                                                                                    Benefit by         Benefits from
Our user-friendly and practical website puts you in control, enabling                                               CareCross              Risk
                                                                                      Disease Benefit
you to resolve most simple queries at your own convenience. With
access to the same real-time systems used by our Contact Centre,
                                                                            More expensive and generally
you can be confident that the information is relevant and up to date.       unforeseeable items. This includes
                                                                                                                 Less expensive and generally more
                                                                                                                 manageable day-to-day items
                                                                            chronic benefits
Some of the online functions include tracking the status of
submitted *claims, checking what benefits are still available,
                                                                           Monthly Contribution
viewing your contributions history, determining tax information
when completing your income tax returns and even finding a                  Principal member                                                    R 954
medical service provider in a specific area. Although password
                                                                            Spouse or adult dependant                                           R 730
controlled (to ensure complete confidentiality), registration is easy
and the website is available 24 hours a day.                                Child dependant                                                     R 279
                                                                            Contribution will be payable in terms of the first three child
Acknowledgement of *Claims                                                  dependants only.
If your email address is registered on our database, the Liberty            Full-time students up to and including the age of 26 pay child rates.
Medical Scheme will send you a mini-claims statement via email as
soon as your claim has been processed.

This means you do not have to wait for your emailed or printed
statement to arrive in the mail.


* Please Note: Claims relating to primary care services will be
  managed by CareCross and will not reflect on your Liberty
  Medical Scheme Claims Statement.
Bona Plus Benefits (Primary care by CareCross)

  1. Medicines                                      2. HIV/Aids Prevention                    3A. In-Hospital (at any hospital)
     Acute and Chronic medication:                     Provided and managed                        GP’s and **Specialists 100% of LMS rate*
     Unlimited, subject to                             by AfA                                      Radiology R19 000 per family, general and
     CareCross formulary at DSP’s                      Subject to registration                     specialised radiology, 100% of Scheme rate*
                                                       and PMB protocols                           Physiotherapy, Clinical Technologist, Occupational
                                                                                                   Therapy, 100% of Scheme rate*

  6. Optical                                                                                       Pathology R19 000 per family, 100% of LMS rate*

      1 pair of standard lenses
      in a standard frame, per                                                                3B. In-Hospital (at any hospital)
      beneficiary every 2 years
                                                                                                   Oncology R138 400 per family* via ICON as DSP
      1 eye test per beneficiary
                                                                                                   Organ Transplants, 100% of LMS rate*
      Contact lenses up to the value                    Bona Plus
                                                                                                   Renal dialysis R138 400 per family, 100% of LMS rate*
      of R395                                         Overall Annual
                                                                                                   Blood Transfusions, blood products and blood
                                                          Limit                                    substitutes* 100% of LMS rate
  5. Radiology and Pathology                            R915 000
     (out-of-hospital prescribed by
                                                                                             3C. In-Hospital (at any hospital)
     specialists)
                                                                                                  Hospice Services R12 700 per family*
     Radiology R4 580 per family, including
     MRI and CT scans*                                                                            Take out medication R1 500 per admission, max of
                                                                                                  7 days’ supply* subject to Maximum Medicine
     Pathology 100% of LMS rate*
                                                                                                  Reference Price
                                                                                                  Internal Prosthesis R23 800 per family*
  4. GP’s and Specialists (out-of-hospital)                                                       External Appliance R12 700 per family*
      GP’s Unlimited for medically necessary visits, Subject to
      CareCross providers
      Out-of-network/emergency visits R1 000 per family 3 visits per family
      **Specialists R1 150 per beneficiary limited to R1 835 per family 100% of LMS rate*
      Unlimited pathology and radiology according to approved list of codes and prescribed by CareCross GP

 * Subject to Overall Annual Limit
 ** Subject to DSP Specialist network, a 40% co-payment applies for services obtained at non-DSP providers will apply
Member support and contact details


 Liberty Medical Scheme Contact Centre
 A dedicated contact centre to assist with enquiry resolution and information         Tel:                       0860 002 163
 requested by current and prospective Liberty Medical Scheme members and              Fax:                       +27 (21) 657-7571
 healthcare service providers                                                         Email:                     enquiries@libertyhealth.co.za
 (8:00 -17:00, Monday to Friday).                                                     Postal address             Liberty Medical Scheme
                                                                                                                 Private Bag X35, Claremont, 7735

 Intermediary Contact Centre
 A dedicated Intermediary contact centre to assist with enquiry resolution and        Tel:                       0860 002 168
 information requests                                                                 Fax:                       +27 (21) 657-7581
 (8:00 -17:00, Monday to Friday).                                                     Email:                     intermediaries@libertyhealth.co.za
                                                                                      Escalation (>24hr):        teamleader.intermediaries@libertyhealth.co.za
                                                                                      Escalation (>72hr):        teammanager.intermediaries@libertyhealth.co.za
                                                                                      Postal address             Liberty Medical Scheme
                                                                                                                 Private Bag X35, Claremont, 7735

 CareCross Contact Centre
 Contact numbers and support services                                                 Member Contact Centre:     0860 103 491
                                                                                      Chronic Contact Centre:    0860 102 182
                                                                                      Enquiries:                 liberty@carecross.co.za
                                                                                      Website:                   www.carecross.co.za

 Web Service
 24hr access to all linked membership and commission information. Registration        Website:                   www.libmed.co.za
 for web service by Members and Healthcare Professionals is facilitated via Liberty                              Under Login tab, you will find process for on-line login
 Medical Scheme Contact Centre (details above) and Intermediaries may register                                   registration and other helpful information.
 via the Vcommissions Contact Centre.                                                 Vcommisions Contact
                                                                                      Centre:                    0860 266 647
                                                                                      Vcommisions email:         commissions@uniquepay.co.za

 Hospital Authorisations and/or Specialist Referral programme
 Admission to hospitals and registered medical institutions.                          Tel:                       0860 002 163
                                                                                      Fax:                       +27 (21) 657-7711
                                                                                      Email:                     approvals@libertyhealth.co.za

 Oncology Management Programme
 Requests for the registration and approval of treatment plans related                Tel:                       0860 002 163
 to oncology.                                                                         Fax:                       +27 (21) 657-7621
                                                                                      Email:                     oncology@libertyhealth.co.za

 HIV Management Programme
 Administered by AfA.                                                                 Tel:                       0860 100 646
                                                                                      Fax:                       0800 600 773
                                                                                      Email:                     afa@afadm.co.za
                                                                                      Website:                   www.aidforaids.co.za
                                                                                      sms (call me)              083 410 9078

 Emergency Transport Services:
 ER24                                                                                 SA Tel:                    084 124
                                                                                      Outside SA Tel (Lesotho,
                                                                                      Swaziland, Namibia,
                                                                                      Mozambique, Botswana):     +27 (0) 10 205 3081
                                                                                      Website:                   www.er24.co.za




05064Bona_1110

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:385
posted:2/18/2011
language:English
pages:4