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Platinum Focus


									Platinum Focus
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
   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                                                            Benefits         Major Medical

                                                                                +                                                                        Self Funding
Our user-friendly and practical website puts you in control, enabling                          (generally
                                                                         Chronic Illness                                                            (No day-to-day benefit)
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
                                                                           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

* Subject to pre-authorisation and/or case management. ** Preferred provider: ICON

                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
                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
                   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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