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Platinum Focus 2010 Enhancing your life choices Platinum Focus from Liberty Medical Scheme is the healthcare plan you need to enhance your choices in later life. Benefit highlights • Cover for extreme and professional sports. • Chronic medication covered for PMB conditions plus additional In addition to providing unlimited cover in the event of trauma, the non-PMB conditions. Platinum Focus option also provides generous cover for medical • Treatment of HIV/AIDS through Optipharm; an exceptional treatments in hospital and for the management of an extended list programme hailed as an industry benchmark. of chronic illnesses. • Generous cover for diagnostic scans, such as MRI and CAT scans. The plan offers a range of preventative measures intended to • The Oncology Benefit covers post active treatment for 12 maintain your good health, thereby saving you the expense of months after the completion of active treatment. treating what could be an avoidable illness. • Recognition of previous credible medical cover for ex-patriots and immigrants, when determining late-joiner penalties. • Major Medical Benefit Up to 300% of Scheme rate. Contact Centre • Chronic Benefit 0860 002 163 Provides cover for all Prescribed Minimum Benefits (PMB’s), and certain non-PMB chronic conditions. In other words, if you have The Liberty Medical Scheme has a one-stop Contact Centre for a chronic condition and need to take medicine on a daily basis, immediate resolution of queries. Our qualified agents offer friendly the cost of this treatment will be paid for. No co-payment is and efficient service in record-breaking response times. applicable provided you obtain the formulary medicine, which is usually a generic substitute. The Contact Centre is open Monday to Friday from 08h30 to 17h00 (closed on public holidays). • Preventative Care Benefit You and your family have access to health programmes, certain Email Communication tests and immunisations. This enables you to monitor your email@example.com health, thereby helping to prevent future illnesses. The early detection and treatment of medical conditions also helps to Our direct email service empowers you to keep up to date at the prevent the progression of chronic illnesses. click of a button, even without Internet access. Unique benefits As long as we have your email address loaded on our database, accessing your personal data, at any time day or night, is easy. The Platinum Focus plan aims to take care of your physical and You send us a blank email and our system immediately generates emotional well-being in the following ways: a reply that includes membership details, claims history, benefits • Cover for trauma. used to date and chronic medication details. • Rehabilitation and counselling following a crime trauma. • Accidental trauma cover from day one, irrespective of waiting periods or exclusions. 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 Bedfordview, Johannesburg, 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 or DE for information on registered dependants. Within seconds you will receive a return SMS containing the detailed and real-time information you requested. Scheme Option Summary Platinum Focus Interactive Member Website Preventative Care In-hospital www.libmed.co.za Benefits Major Medical Chronic + Self Funding Our user-friendly and practical website puts you in control, enabling (generally Chronic Illness (No day-to-day benefit) in-hospital) you to resolve most simple queries at your own convenience. With benefits + access to the same real-time systems used by our Contact Centre, Preventative you can be confident that the information is relevant and up to date. Care More expensive and generally Less expensive and generally = A Complete unforeseeable items with more manageable day-to-day Some of the online functions include tracking the status of Solution chronic and preventative care items submitted claims, checking what benefits are still available, viewing your contributions history, determining tax information when completing your income tax returns and even finding a medical Monthly Contribution service provider in a specific area. Principal member R1 159 Although password controlled (to ensure complete confidentiality), Spouse or adult dependant R1 043 registration is easy and the website is available 24 hours a day. Child dependant R 374 Acknowledgement of Claims Notes: Contributions will be payable in respect of the first three child dependants only. If your email address is registered on our database, the Liberty Child dependants over the age of 21 pay adult dependant contributions. 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. Platinum Focus Platinum Focus Platinum Focus Major Medical Benefit Preventative Care Benefits In-hospital Benefits Overall annual limit (OAL) Unlimited Mammogram Not applicable Blood transfusions, blood products 100% Scheme rate Pap smear 1 per beneficiary & blood substitutes Unlimited Female 18-60 Cholesterol test 1 per beneficiary Over age 15 Blood Glucose 1 per beneficiary Childhood immunisations As per Member Guide Flu vaccination 1 per beneficiary TB Test 1 per beneficiary Dialysis* 300% Scheme rate HIV Test 1 per beneficiary Haemodialysis and Peritoneal R225 000 per beneficiary Prostate Test 1 per beneficiary Male >45 every 3 years Bone Density Test 1 per beneficiary Hospice services 100% Scheme rate Female >50 every 3 years (accommodation, medicine, R11 900 per beneficiary Eye Test Not applicable consultations) Dental Check up Not applicable Local medical rescue Unlimited (Netcare 911) HIV/Aids prevention 100% Scheme rate Hospitalisation* 100% of negotiated tariff Needle-stick and mother-to-child R9 620 per beneficiary then (including childbirth) Unlimited Casualty benefit* 100% Scheme rate transmission unlimited through State R1 175 per beneficiary Unlimited for physical injury Day Procedures 300% Scheme rate Rehabilitation and private nursing 100% Scheme rate Take out medication 100% Reference Price. Maximum of • Diagnostic cystoscopy Unlimited R17 000 per family 7 days supply • Laser tonsillectomy Limited to R1 405 per admission • Lumbar puncture Crime Trauma Benefit 300% Scheme rate • Needle aspiration of joint, bursa HIV - Prophylaxis (Rape) R11 240 per beneficiary General practitioners & specialists 300% Scheme rate or ganglion Rehabilitation R22 600 per family (in-hospital) Unlimited • Proctoscopy Psychologists, Psychiatrists and Social R3 240 per beneficiary • Sigmoidoscopy Workers • Upper GI endoscopy Liberty Baby programme Not applicable Physiotherapy, Pathology, Clinical 100% Scheme rate • Vasectomy Technologist, Occupational Unlimited Therapy* Disease Management Programme Yes Radiology* 100% Scheme rate Asthma, Cancer, Diabetes, General Unlimited HIV/AIDS Specialised R27 600 per family Deductibles Member Care Yes Dentistry* 300% Scheme rate • Colonoscopy R1 230 per event Elective R8 750 per beneficiary • Sigmoidoscopy R1 230 per event Lifestyle risk assessment Yes R12 500 per family • Proctoscopy R1 230 per event Trauma Unlimited • Conservative back treatment R1 230 per event • Extraction of wisdom teeth R1 230 per event Biokineticist assessment* 1 per beneficiary Psychiatric admissions* 300% Scheme rate (in hospital) R17 000 per family • Gastroscopy R1 230 per event Smoking cessation support Yes Oncology* 100% Scheme rate** • Arthroscopy R3 000 per event programme Unlimited • Functional nasal procedures R3 000 per event Associated diagnostics R34 400 per beneficiary • Hysterectomy (non-cancer R3 000 per event PET Scans (staging of malignant 1 per beneficiary related) tumours) • Laparoscopy, hysteroscopy, R3 000 per event Oncology biologicals R160 000 per beneficiary endometrial ablation 10% co-payment • Joint replacements R6 000 per event • Nissen fundoplication (reflux R6 000 per event Prosthesis 100% Scheme rate surgery) (internal surgical appliances) Unlimited • Spinal/back surgery R6 000 per event Sub-limits apply per prosthetic type Organ transplants* 300% Scheme rate Unlimited * Subject to pre-authorisation and/or case management. ** Preferred provider: ICON 03018PF_0110 Platinum Focus Platinum Focus Chronic Illness Benefits Day-to-day Benefits Chronic medication* 100% of Reference Price subject to Comprehensive Threshold Level No benefit (including non-Oncology Biological drugs) Formulary** Accumulation to threshold level Reimbursement from Threshold Benefit M : R7 460 M+1 : R9 720 M+2 : R12 400 M+3 : R14 400 Sub-limit of R7 460 per beneficiary PMB conditions are payable above the limits 64 chronic conditions HIV 100% Reference Price Subject to PMB protocols Chronic Conditions Medical Savings Facility Reimbursement from MSF Addison’s Disease Depression Obstructive/reflux Nephropathy General practitioners Alzheimer’s Disease Dermatomyositis Paget’s Disease Specialists Ankylosing Spondylitis Diabetes Insipidus Pancreatic Disease Anorexia Nervosa Diabetes Mellitus Type 1 Panic Disorder Dentistry Basic dentistry Asthma Diabetes Mellitus Type 2 Paraplegia/Quadriplegia Specialised dentistry Barrett’s Oesophagitis Dysrhythmias Parkinson’s Disease Social workers Bipolar Mood Disorder Cardiac Arrhythmias Pemphigus Mental health Bronchiectasis Epilepsy Peripheral Vascular Disease Acute medication Bulimia Nervosa Generalised Anxiety Disorder Pituitary Adenomas Cardiac Failure Glaucoma Polyarteritis Nodosa Optical Cardiomyopathy Haemophilia Post-Traumatic Stress Disorder Pathology Cerebrovascular Accident – Stroke HIV/AIDS Pulmonary Interstitial Fibrosis Auxiliary services Chronic Obstructive Pulmonary Huntington’s Disease Rheumatoid Arthritis (Physiotherapy, Occupational Therapy, Speech Therapy, Audiology, Dietician, Disease Hyperlipidaemia Schizophrenia Clinical Technologist, Private Nursing, Biokineticist, Emphysema Hypercholesterolaemia Systemic Lupus Erythematosus Podiatry) Chronic Renal Failure Hypertension Discoid Lupus Erythematosus Alternate therapies Coronary Artery Disease Hypoparathyroidism Systemic Sclerosis (Homeopath, Chiropractor, Naturopath, Herbalist) Angina Hypothyroidism Thromboangiitis Obliterans Sick Bay at Frail Care Centre Accommodation Ischaemic Heart Disease Motor Neuron Disease Thrombocytopenic Purpura Conn’s Disease Multiple Sclerosis Tourette’s Syndrome Dressings and ointments Crohn’s Disease Muscular Dystrophy Ulcerative Colitis External appliances Cushing’s Disease Myasthenia Gravis Valvular Heart Disease Basic radiology Deep Vein Thrombosis Narcolepsy Zollinger-Ellison Syndrome Delusional Disorders Obsessive Compulsive Disorder MRI & CAT Scans* 100% Scheme rate paid from MMB (Out-of-hospital) Total of 2 scans (MRI and CAT) per beneficiary Ultrasounds for pregnancies No benefit Note: All conditions depicted in dark blue itallics are sub-conditions. * Subject to pre-authorisation and/or case management. ** Preferred provider: Pharmacy Direct and Clicks Pharmacies.
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