QUANTUM MEDICAL AID SOCIETY

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QuantumMedical Aid Society(QMAS)QUANTUMMEDICAL AID SOCIETY

Most importantchanges for 2019Contents Contribution increasesMedical Savings AccountsAnnual Threshold LevelsProduct updates for 2019Your benefits for 20192019 Option change form Contribution increases vary from 9.9% to 15%depending on your plan type, with a weightedaverage increase of 10.8% Medical Savings Accounts for the EssentialComprehensive and Essential Saver options havebeen increased in line with their contributionincreases An inflationary increase of 5.4% has been appliedto the benefit limits KeyCare income bands have increased byapproximately 5.4% Funding for endoscopies will be limited toPrescribed Minimum Benefits in 2019 on KeyCarePlus Implementation of a Designated Service Provider(the Discovery Day Surgery Network) for clinicallyappropriate procedures on KeyCare PlusCONTRIBUTION INCREASESWeighted Average Increase10.8%The Society’s overall weighted average increase for 2019 is10.8%. By comparison the average increases announced bythe major open medical schemes to date have ranged from 6.1%to 14.3%. Discovery Health’s average weighted increase was 9.2%.Quantum’s total average contribution for each option is listed in thetable below:PlanEssential ComprehensiveEssential SaverKeyCare Plus%15%9.9%15%New for 20191. Introducing the Discovery DaySurgery networkThe Discovery Day Surgery network willbe the Designated Service Provider fora defined list of clinically appropriateprocedures on KeyCare Plus. For thedefined list of clinically appropriateprocedures, members will be covered infull if the procedure is performed in theDiscovery Day Surgery network. Memberswill have no cover if the procedure isperformed outside the network. In thecase of an emergency, the memberwill be covered in full for the procedureoutside the network.2. Changes to the 2019 chronicillness benefitThere will be formulary changes andChronic Drug Amount updates appliedfrom 1 January 2019. Discovery hascommunicated these changes with theimpacted members since August 2018.These members will have until the end of2018 to make changes to their treatmentto avoid or reduce co-payments.2. Funding for endoscopies onKeyCare PlusFunding for endoscopies on KeyCare Pluswill be limited to Prescribed MinimumBenefits in 2019.

Medical Savings AccountSavings contributions as a percentageof total contributions have remainedunchanged and are as follows:PlanMSA%Essential Comprehensive15%Essential Saver15%KeyCare PlusN/AMedicalSavings Account(MSA)The MSA is an amount allocated to a member at thebeginning of the year to pay for day-to-day medicalexpenses like GP visits, acute medication, optometry,radiology etc. The amount allocated is based on thesize of a member’s family. Any money remaining inthe MSA at the end of the year will carry over to thenext year. The MSA allocation for 2019 has increasedin line with the average contribution increases onthe Essential Comprehensive and Essential Saveroptions. For both of these plans the MedicalSavings Account portion will constitute 15%of total contributions. The KeyCare Plusplan does not have a MedicalSavings account.Self-PaymentGapOn the Comprehensive plan, if a memberruns out of money in the MedicalSavings Account and before claimsadd up to the Annual Threshold level,the member will have to pay forday-to-day medical expenseshi mself. This is cal led theSelf-payment Gap.AnnualThresholdThe Above Threshold Benefit is a ‘safety net’included on the Essential Comprehensiveoption. Day-to-day claims submitted to thescheme are added up at the Scheme Rate.Once these claims add up to a certainamount, known as the Annual Threshold,the claims start paying from the AboveThreshold Benefit. This benefit protectsmembers against high cost day-today medical expenses.

QuantumMedical Aid SocietyChronic Condition BenefitsChronic Disease List (CDL) covered on QuantumEssential Comprehensive, Essential Saver plans andKeyCare Plus plans Addison’s diseaseEpilepsyAsthmaBipolar mood disorderBronchiectasisCardiac failureCardiomyopathyChronic obstructive pulmonary diseaseChronic renal diseaseCrohn’s diseaseDiabetes insipidusDiabetes mellitus type 1Diabetes mellitus type 2Dysrhythmia thyroidismIschaemic heart diseaseMultiple sclerosis (MS)Parkinson’s diseaseRheumatoid arthritisSchizophreniaSystemic lupus erythematosusUlcerative colitisAdditional Disease List (ADL)covered on QuantumEssential Comprehensive and EssentialSaver plans Ankylosing spondylitisDelusional disorderGeneralised anxiety disorderMajor depressionMotor neurone diseaseMuscular dystrophy and other inherited myopathiesObsessive compulsive disorderOsteoporosisPanic disorderPost traumatic stress disorderPulmonary interstitial fibrosisAdditional Disease List (ADL) coveredon Quantum Essential Comprehensive Attention deficit hyperactivity disorderGastro-oesophageal reflux diseaseOsteopeniaPsoriatic arthritis

Quantum Medical AidContributionsQuantum Essential Comprehensive 2019 scontributionTotal MonthlycontributionAnnual MSAallocationThresholdSelf-paymentGapPrincipal Member4 2827555 0379 06015 3706 310Adult Dependant4 0487144 7628 56815 3706 802Child8631521 0151 82428801 056RiskcontributionMedicalSavingscontributionTotal MonthlycontributionAnnual tionPrincipal4 2827555 0379 06015 3706 310Principal Adult8 3301 4699 79917 62830 74013 112Principal Adult Child9 1931 62110 81419 45233 62014 168Principal Adult 2Children10 0561 77311 82921 27636 50015 224Principal Adult 3Children10 9191 92512 84423 10039 38016 280Principal Child5 1459076 05210 88418 2507 366Principal 2 Children6 0081 0597 06712 70821 1308 422Principal 3 Children6 8711 2118 08214 53224 0109 478Principal 2 Adult12 3782 18314 56126 19646 11019 914Principal 2 Adult Child13 2412 33515 57628 02048 99020 970Principal 2 Adult 2Children14 1042 48716 59129 84451 87022 026* Contributions are charged up to maximum of 3 children

Quantum Medical AidContributionsQuantum Essential Saver Plan 2019 ContributionsCategoryRiskcontributionMedical SavingscontributionTotal MonthlycontributionAnnual MSAallocationPrincipal Member1 8093192 1283 828Adult Dependant1 3572391 5962 868Child7251278521 524FamilyCompositionRiskcontributionMedical SavingscontributionTotal MonthlycontributionAnnual MSAallocationPrincipal1 8093192 1283 828Principal Adult3 1665583 7246 696Principal Adult Child3 8916854 5768 220Principal Adult 2Children4 6168125 4289 744Principal Adult 3Children5 3419396 28011 268Principal Child2 5344462 9805 352Principal 2 Children3 2595733 8326 876Principal 3 Children3 9847004 6848 400Principal 2 Adult4 5237975 3209 564Principal 2 Adult Child5 2489246 17211 088Principal 2 Adult 2Children5 9731 0517 02412 612* Contributions are charged up to a maximum of three children

Quantum Medical AidContributionsQuantum KeyCare Plus 2019 ContributionsR0 – R7 850R7 851 – R11 100R11 101 CategoryTotal MonthlycontributionTotal MonthlycontributionTotal MonthlycontributionPrincipal Member1 1141 5602 322Adult Dependant1 1141 5602 322Child403437624FamilyCompositionPrincipalR0 – R7 850R7 851 – R11 100R11 101 1 1141 5602 322Principal Adult2 2283 1204 644Principal Adult Child2 6313 5575 268Principal Adult 2 Children3 0343 9945 892Principal Adult 3 Children3 4374 4316 516Principal Child1 5171 9972 946Principal 2 Children1 9202 4343 570Principal 3 Children2 3232 8714 194Principal 2 Adult3 3424 6806 966Principal 2 Adult Child3 7455 1177 590Principal 2 Adult 2 Children4 1485 5548 214* Contributions are charged for all children

Quantum Medical AidBenefits for 2019Essential ComprehensiveEssential SaverKeyCare PlusSPECIAL FEATURESAll benefits paid at 100% of Quantum Scheme Rate unless otherwise statedScreening Benefit A:Pays up to a maximum of 100% of the Scheme Ratefor a group of tests performed at a Scheme WellnessNetwork PharmacyPays up to a maximum of 100% of the Scheme Ratefor a group of tests performed at a Scheme WellnessNetwork PharmacyPays up to a maximum of 100% of the Scheme Ratefor a group of tests performed at a Scheme WellnessNetwork PharmacyTests include: Blood glucose, Blood pressure,Cholesterol and Body Mass Index(BMI)Tests include: Blood glucose, Blood pressure,Cholesterol and Body Mass Index (BMI)Tests include: Blood glucose, Blood pressure,Cholesterol and Body Mass Index (BMI)Includes cover for HbA1c and Lipograms formembers at riskIncludes cover for HbA1c and Lipograms for membersat riskIncludes cover for HbA1c and Lipograms for membersat riskBody Mass Index (BMI) and counselling, hearingscreening, dental screening, milestone tracking forchildren under age of 8Body Mass Index (BMI) and counselling, hearingscreening, dental screening, milestone tracking forchildren under age of 8Body Mass Index (BMI) and counselling, hearingscreening, dental screening, milestone tracking forchildren under age of 8Pays up to a maximum of 100% of the Scheme RatePays up to a maximum of 100% of the Scheme RatePays up to a maximum of 100% of the Scheme RateTests include: HIV Rapid and Elisa; Mammogram; Papsmear and Prostate-specific Antigen (PSA)Tests include: HIV Rapid and Elisa; Mammogram; Papsmear and Prostate-specific Antigen (PSA)Tests include: HIV Rapid and Elisa; Mammogram; Papsmear and Prostate-specific Antigen (PSA)Screening Benefit B:Non-invasive prenatal screening and ExomesequencingNo BenefitNo BenefitMammograms are covered once every 2 years andPap Smears are covered once every 3 years perpersonMammograms are covered once every 2 years andPap Smears are covered once every 3 years perpersonMammograms are covered once every 2 years andPap Smears are covered once every 3 years perpersonSeasonal flu vaccines for members over the age 65and for the following registered chronic conditions:Seasonal flu vaccines for members over the age 65and for the following registered chronic conditions:Seasonal flu vaccines for members over the age 65and for the following registered chronic conditions:Asthma; Bronchiectasis; Cardiac Failure;Cardiomyopathy; Chronic Obstructive PulmonaryDisease (COPD); Chronic Renal Disease; CoronaryArtery Disease; Diabetes Mellitus Types 1 and 2and HIVAsthma; Bronchiectasis; Cardiac Failure;Cardiomyopathy; Chronic Obstructive PulmonaryDisease (COPD); Chronic Renal Disease; CoronaryArtery Disease; Diabetes Mellitus Types 1 and 2and HIVAsthma; Bronchiectasis; Cardiac Failure;Cardiomyopathy; Chronic Obstructive PulmonaryDisease (COPD); Chronic Renal Disease; CoronaryArtery Disease; Diabetes Mellitus Types 1 and 2 andHIVPreventative Benefit :

IN HOSPITAL BENEFITAll In Hospital Benefits are subject to Pre-authorisationHospitalisationUnlimited and paid at 100% of the Scheme RateUnlimited and paid at 100% of the SchemeRateCover unlimited at 100% of the Scheme Rate atKeyCare Primary Network Hospitals only, cover limitedto 70% of the Scheme Rate at KeyCare SecondaryNetwork. A Designated Service Provider (DSP) network(Discovery Day Surgery Network) applies for clinicallyappropriate proceduresProfessional healthcare providers(including Anaesthetists,specialists)Premier Rate Specialists: Unlimited and paid at the PremierRate. No balance billing to the memberOther providers: Unlimited and paid at 100% of the SchemeRatePremier Rate Specialists: Unlimited and paidSpecialists: Unlimited for Specialists participating in theat the Premier Rate. No balance billing toKeyCare payment arrangementthe memberOther providers: Unlimited and paid at100% of the Scheme RateOther providers: Unlimited and paid at 100% of theScheme RateUnlimited and paid at 100% of the Scheme RateUnlimited and paid at 100% of the SchemeRateUnlimited and paid at 100% of the Scheme RateNo overall limit for dentistry. Hospital account: Paid at 100% ofthe Scheme Rate with a deductible.No overall limit for dentistry. Hospitalaccount: Paid at 100% of the SchemeRate with a deductible.Deductible: Age up to 12 years - R1 000 (day case)Deductible: Age up to 12 years - R1 000(day case)& R2 100 (in-hospital);& R2100 (in-hospital);Age over 12 years - R3 600 (day case)Age over 12 years - R3 600 (day case)& R5 550 (in-hospital).& R5 550 (in-hospital).Deductible will be waived for severe in-hospital admissions.Related accounts (dentist, dental surgeon and anaesthetist): Paidfrom risk at 100% of the Scheme RateDeductible will be waived for severe inhospital admissions. Related accounts(dentist, dental surgeon and anaesthetist):Paid from risk at 100% of the Scheme RateDental devices, appliances, prosthesis & orthodontics: Paid at100% of the Scheme Rate, subject to available funds in the MSA orATB, limited to R28 800 per person per yearDental devices, appliances, prosthesis &orthodontics: Paid at 100% of the SchemeRate, subject to available funds in the MSA,limited to R26 000 per person per yearImplants as a result of oncology or specific trauma events:Unlimited and paid at 100% of Scheme RateImplants as a result of oncology or specifictrauma events: Unlimited and paid at100% of Scheme RateGeneral Practitioners and Allied Healthcare ProvidersDentistrySubject to PMBs

Maternity BenefitsPaid at 100% of the Scheme Rate, limited to 3 days fornormal delivery and 4 days for Caesarean Section.Private ward for 2 nights for normal delivery and 3nights for Caesarean SectionPaid at 100% of the Scheme Rate, limited to 3 days fornormal delivery and 4 days for Caesarean SectionPaid at 100% of the Scheme Rate, limited to 3 days fornormal delivery and 4 days for Caesarean SectionUnlimited and paid at 100% of the Scheme RateUnlimited and paid at 100% of the Scheme RatePaid at 100% of the Scheme Rate or agreed networkrate, unlimited at KeyCare Network HospitalsUnlimited as part of an approved hospital event.Paid from the Hospital Benefit up to 100% of theScheme