2016 benefits and contributions
The AMS plans continue to offer value for money well above similar available products in the industry
Benefit Limits and the Scheme Reimbursement Rate (SRR) will be increased by 6% on all Plans.Improved Benefits
Preventative Care on Standard Care Plan and Managed Care Plan
Members are encouraged to vaccinate against the flu every March/April and, where appropriate, against the pneumococcal virus. Additional consultations have been made available for this purpose. Screening benefits are available to members and you are urged to use them to detect disease early. The 2016 Benefit
Guide includes a new table of preventative care benefits and recommendations for easy reference.
Network on Managed Care Plan
We have introduced a GP Network on the Managed Care Plan aimed at reducing out-of-pocket expenses. When you visit a doctor on the network, the doctor will submit the claim directly to the Scheme for payment from your savings account or from risk if PMB. You will not have to pay cash for the visit and you will not be liable for any co-payment for the visit and for most procedures undertaken in the rooms.
The network fee is slightly higher than the Scheme Reimbursement Rate (SRR), but is in some instances lower than rates charged by non-network doctors. Choosing a network GP is entirely voluntary. More information will be available in the 2016 Benefit Guide or from the Call Centre.
Improved GAP cover in hospital on Managed Care Plan
The maximum reimbursement rate for specialist services provided in hospital (GAP) will be increased from 200% to 230% of the SRR to reduce out-of-pocket expenses.
Example:
In 2015 your anaesthetist charges R2 800 for services in hospital.
The Scheme Reimbursement Rate (SRR) is R1 000. GAP currently pays up to R2 000 and you are liable for the difference of R800 (out of your own pocket).
In 2016, after the new increase of GAP to 230%, the Scheme will pay R2 300 and you will be liable for the additional R500.
Improved Out-of-hospital Specialist Reimbursement Rates on Managed Care Plan
In 2016, consultations and procedures provided by specialists out of hospital will be reimbursed up to 125% of the SRR, paid from your savings account or from risk if PMB.
2016 contribution increases
2015 has been a difficult year for many of our members who have suffered serious illness and complications in hospital. We wish you all well and a speedy recovery. The treatment costs will potentially require us to draw additional amounts from our reserves in 2015. In spite of this, the Trustees have agreed to limit the 2016 contribution increases to a market-related rate.
This will require R140.5 million to be used from the reserves to fund claims in 2016. (R117.9 million in 2015).