HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS MEDICAL AND SURGICAL PROCEDURES

INCLUDING CONFINEMENTS AUXILIARY HEALTHCARE IN HOSPITAL (EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) BLOOD TRANSFUSIONS (IN AND OUT OF HOSPITAL) RADIOLOGY IN HOSPITAL ADVANCED SCANS SUBJECT TO PRE-AUTHORISATION PATHOLOGY IN HOSPITAL INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION HOME NURSING UP TO 21 DAYS, SUBJECT TO PREAUTHORISATION STEP DOWN APPROVED FACILITIES

100% of Negotiated Rate in general ward and specialised units. Private ward for confinements (subject to availability) Up to 300% CBT 100% of Scheme Rate

100% of Negotiated Rate in general ward and specialised units Up to 300% CBT 100% of Scheme Rate

100% of Negotiated Rate in general ward and specialised units Up to 300% CBT 100% of Scheme Rate

100% of Negotiated Rate in general ward and specialised units Up to 200% CBT 100% of Scheme Rate

100% of Negotiated Rate in general ward and specialised units Up to 100% CBT 100% CBT

100% DSP tariff as per protocols

Up to 100% CBT 100% CBT 100% CBT Physiotherapy limited to R 8 700 per family 100% of cost 100% CBT 100% CBT limited to R 26 000 per family in or out of hospital 100% CBT 100% of cost limited to R 26 000 per family 100% CBT (in lieu of hospitalisation only)

100% CBT 100% of cost 100% CBT 100% CBT 100% Negotiated Rate 100% of cost 100% CBT

100% CBT 100% of cost 100% CBT 100% CBT 100% Negotiated Rate 100% of cost 100% CBT

100% CBT 100% of cost 100% CBT 100% CBT 100% Negotiated Rate 100% of cost 100% CBT

100% CBT 100% of cost 100% CBT 100% CBT 100% Negotiated Rate 100% of cost 100% CBT

100% CBT 100% of cost 100% CBT 100% CBT limited to R 23 600 per beneficiary - in or out of hospital 100% CBT 100% of cost 100% CBT

ONLY, UP TO 90 DAYS
SUBJECT TO PRE-AUTHORISATION MEDICATION IN HOSPITAL TTO MEDICATION UP TO ONE WEEKS SUPPLY INFERTILITY TREATMENT SUBSTANCE ABUSE CHRONIC PMB CDL MEDICATION AND TREATMENT - SUBJECT TO PREAUTHORISATION AND PROTOCOLS REFER TO CHRONIC DISEASE LIST

100% Negotiated Rate 100% SEP plus dispensing fee 100% SEP plus dispensing fee Treatment limited to R 58 400 per family PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

100% Negotiated Rate 100% SEP plus dispensing fee 100% SEP plus dispensing fee Treatment limited to R 40 900 per family PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

100% Negotiated Rate 100% SEP plus dispensing fee 100% SEP plus dispensing fee No benefit PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

100% Negotiated Rate 100% SEP plus dispensing fee 100% SEP plus dispensing fee No benefit PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

100% Negotiated Rate 100% SEP plus dispensing fee 100% SEP plus dispensing fee No benefit PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

100% DSP Tariff 100% SEP plus dispensing fee 100% SEP plus dispensing fee No benefit PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days 100% SEP plus a dispensing fee, subject to MMAP and based on a formulary and DSP (Consultations and procedures - at cost) Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

PMB DTP TREATMENT OUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF CONDITION AND PRE-AUTHORISATION

Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

Medication - SEP plus dispensing fee, subject to RP and DSP. (Consultations and procedures - at cost)

CAMAF LIFESTYLE PROGRAMME

PER ADULT BENEFICIARY ONE GP CONSULTATION ONLY ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY ONE SPECIALIST CONSULTATION *ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS, UROLOGISTS, OR SPECIALIST PHYSICIANS FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIAN FOR BENEFICIARIES UNDER 16 YEARS. PSYCHOTHERAPY SUBJECT TO REGISTRATION ON EMOTIONAL WELLNESS PROGRAMME DIETICIAN CONSULTATION ONE DENTISTRY CONSULTATION GENERAL CHECK UP ONLY ECG (PERFORMED BY GP OR SPECIALIST PHYSICIAN) *ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY
*Refer to website for relevant ICD 10 codes

100% of Negotiated Rate in general ward and specialised units 100% CBT per beneficiary 100% CBT per beneficiary

100% of Negotiated Rate in general ward and specialised units 100% CBT per beneficiary

100% of Negotiated Rate in general ward and specialised units Subject to Medical Savings Account

100% of Negotiated Rate in general ward and specialised units 80% CBT per beneficiary

100% DSP tariff as per protocols Refer to GP, Specialist and Dentist under Other Benefits

100% CBT per beneficiary

100% CBT per beneficiary

100% CBT per beneficiary

Subject to Medical Savings Account

80% CBT per beneficiary

Refer to GP, Specialist and Dentist under Other Benefits

100% CBT limited to R 8 100 per beneficiary One per beneficiary per annum 100% CBT 100% CBT per beneficiary

100% CBT limited to R 8 100 per beneficiary One per beneficiary per annum 100% CBT 100% CBT per beneficiary

100% CBT limited to R 8 100 per beneficiary No Benefit 100% CBT per beneficiary

100% CBT limited to R 8 100 per beneficiary Subject to Medical Savings Account Subject to Medical Savings Account

80% CBT limited to R 7 000 per beneficiary No Benefit 80% CBT per beneficiary

100% CBT for PMB DTP conditions, in or out of hospital No Benefit Refer to GP, Specialist and Dentist under Other Benefits

100% CBT per adult beneficiary

100% CBT per adult beneficiary

100% CBT per adult beneficiary

Subject to Medical Savings Account

80% CBT per adult beneficiary

Refer to GP, Specialist and Dentist under Other Benefits

ONE CONSULTATION AT AN OPTOMETRIST METABOLIC SCREENING FOR NEW BORN BABIES IMMUNISATION (COST OF IMMUNISATION ONLY) CERVICAL CANCER VACCINE (COST OF VACCINE ONLY) SCREENING SCANS SUCH AS BONE DENSITOMETRY AND MAMMOGRAMS AT PROVIDERS WHO ARE NOT RADIOLOGISTS

100% Optical Assistant Rates 100% Negotiated Rate per new born baby SEP plus a dispensing fee, limited to R 3 520 per beneficiary Females between 9 and 16 years of age (SEP plus dispensing fee) 100% of CBT limited to R 1 500 per beneficiary

100% Optical Assistant Rates 100% Negotiated Rate per new born baby SEP plus a dispensing fee, limited to: Adults R 1 750 - Child R 2 920 Females between 9 and 16 years of age (SEP plus dispensing fee) 100% of CBT limited to R 1 200 per beneficiary

100% Optical Assistant Rates 100% Negotiated Rate per new born baby SEP plus a dispensing fee, limited to R 1 170 per beneficiary Females between 9 and 16 years of age (SEP plus dispensing fee) No Benefit

Subject to Medical Savings Account Subject to Medical Savings Account SEP plus a dispensing fee, limited to R 1 170 per beneficiary. Females between 9 and 16 years of age (SEP plus dispensing fee) Subject to Medical Savings Account

Refer to spectacle and lenses benefits 80% Negotiated Rate per new born baby SEP plus a dispensing fee, subject to MMAP, limited to R 1 170 per beneficiary Females between 9 and 16 years of age (SEP plus dispensing fee) No Benefit

Refer to spectacle and lenses benefits No Benefit SEP plus a dispensing fee, subject to MMAP, limited to R 1 170 per beneficiary Females between 9 and 16 years of age (SEP plus dispensing fee) No Benefit

BASIC AND ADVANCED RADIOLOGY OUT OF HOSPITAL

MUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON REFERRAL FROM MEDICAL PRACTITIONER ONLY. ADVANCED SCANS SUBJECT TO PRE-AUTHORISATION

100% CBT

100% CBT

100% CBT

Subject to Medical Savings Account

100% CBT limited to R 3 030 per beneficiary

Basic Radiology - as per protocols (including Mammograms for females of 40+) Referrals by DSP or specialist, 100% CBT limited to R 3 030 per beneficiary

PATHOLOGY OUT OF HOSPITAL

PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER

100% Negotiated Rate

100% Negotiated Rate

100% Negotiated Rate

Subject to Medical Savings Account

100% CBT limited to R 4 440 per beneficiary

Basic Pathology - as per protocols referred by DSP or specialist, 100% CBT, limited to R 4 810 per beneficiary

POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LIST EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL PURCHASE, HIRE AND MAINTENANCE HEARING AIDS - 1 CLAIM PER 3 YEAR CYCLE FOR OVER 16 YEARS OF AGE YOUNGER THAN 16 YEARS OF AGE - 18 MONTH CYCLE WHEELCHAIRS - 3 YEAR CYCLE INSULIN PUMPS, SUBJECT TO PRE-AUTHORISATION - 4 YEAR CYCLE NETCARE 911 EMERGENCY SERVICES

300% CBT for attending practitioners 100% CBT for auxiliary services 100% SEP plus a dispensing fee, subject to RP and DSP Consultations 100% CBT 100% of cost subject to the overall limit of R 58 400 per beneficiary and subject to the following sub-limits: Hearing Aids: Wheelchairs for Quadriplegics: Standard Wheelchairs: Insulin Pumps: Other external appliances: Baby Apnoea monitors: Breast pumps: R 58 400 R R R R R R 58 400 35 000 35 000 11 700 1 800 3 000

300% CBT for attending practitioners 100% CBT for auxiliary services 100% SEP plus a dispensing fee, subject to RP and DSP Consultations 100% CBT 100% of cost subject to the overall limit of R 46 700 per beneficiary and subject to the following sub-limits: Hearing Aids: Wheelchairs for Quadriplegics: Standard Wheelchairs: Insulin Pumps: Other external appliances: Baby Apnoea monitors: Breast pumps: R 46 700 R 46 700 R 29 800 R 30 400 R 9 950 R 1 800 R 3 000

300% CBT for attending practitioners 100% CBT for auxiliary services 100% SEP plus a dispensing fee, subject to RP and DSP Consultations 100% CBT 100% of cost subject to the overall limit of R 26 900 per beneficiary and subject to the following sub-limits: Hearing Aids: Wheelchairs for Quadriplegics: Standard Wheelchairs: Insulin Pumps: Other external appliances: Baby Apnoea monitors: Breast pumps: R 23 300 R 23 300 R 16 400 R 26 900 R 5 850 R 1 800 R 3 000

Subject to Medical Savings Account

No Benefit

No Benefit

Subject to Medical Savings Account

No Benefit except for Depression

No Benefit

Subject to Medical Savings Account

100% of cost in hospital and 80% of cost out of hospital with an overall limit of R 11 800 per beneficiary and subject to the following sub-limits: Baby Apnoea monitors: Breast pumps: R 1 600 R 2 700

100% of cost limited of R 4 500 per beneficiary and subject to DSP referral and subject to the following sub-limits: Baby Apnoea monitors: Breast pumps: R 1 600 R 2 700

Unlimited Subject to Netcare 911 authorisation

Unlimited Subject to Netcare 911 authorisation

Unlimited Subject to Netcare 911 authorisation

Unlimited Subject to Netcare 911 authorisation

Unlimited Subject to Netcare 911 authorisation

Unlimited Subject to Netcare 911

DAY TO DAY BENEFITS BENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT GPS, SPECIALISTS AND DENTISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS; BASIC DENTISTRY ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS NON-DSP VISITS TO DOCTORS ROOMS CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT HOME NURSING AUXILIARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, PODIATRY AND SPEECH THERAPY

Annual Overall Limits Adult R 22 100 Child R 14 200

Annual Overall Limits Adult R 8 650 Child R 6 050

No Benefit

Limited to funds available in the beneficiarys Medical Savings Account

Annual overall limit: Beneficiary specific limits: (a) Medicines R 2 160 (b) Advanced Dentistry R 4 670 (c) Other R 2 160 80% CBT Subject to limit (c) General practitioner consultations: 10 per beneficiary through a DSP Specialist consultations: 100% CBT limited to R 6 870 per family, only on referral from your network GP Basic dentistry: 100% Scheme Tariff at network provider only 100% SEP plus a dispensing fee for basic formulary and 80% SEP plus dispensing fee for extended formulary, both subject to MMAP One non-network visit per beneficiary or two per family, 20% co-payment AND One casualty visit (facility fee, consumed meds and materials). Limited to R 1 120 No Benefit Occupational therapy and physiotherapy only 100% CBT limited to R 1 870 per beneficiary on referral from DSP only

80% CBT

80% CBT

No Benefit

Subject to Medical Savings Account

80% SEP plus a dispensing fee

80% SEP plus a dispensing fee

No Benefit

Subject to Medical Savings Account

80% SEP plus a dispensing fee, subject to MMAP. Subject to limit (a) Not applicable Medication: 80% SEP plus a dispensing fee subject to limit (a) Treatment: 80% CBT subject to limit (c) 80% CBT subject to limit (c)

Not applicable

Not applicable

Not applicable

Not applicable

80% CBT

80% CBT

No Benefit

Subject to Medical Savings Account

80% CBT up to 21 days

80% CBT up to 21 days

No Benefit

Subject to Medical Savings Account

80% CBT

80% CBT

No Benefit

Subject to Medical Savings Account

80% CBT subject to sub-limit R 1 180 Subject to limit (c)

BENEFIT SPECIFIC LIMITS

ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES 80% CBT limited to: Mo R 11 700 M1 R 17 500 M2+ R 21 000 Subject to Annual Benefits 80% SEP plus a dispensing fee, limited to R 2 920 per beneficiary 80% CBT limited to R 8 750 per eye 80% CBT limited to: Mo R 8 650 M1 R 12 500 M2+ R 16 900 Subject to Annual Benefits 80% SEP plus a dispensing fee, limited to R 1 290 per beneficiary 80% CBT limited to R 3 250 per eye No Benefit Subject to Medical Savings Account 50% CBT Subject to limit (b) excluding dental implants 80% SEP plus a dispensing fee, subject to MMAP, limited to R 1 240 per beneficiary. Subject to limit (a) No Benefit 100% of CBT at network provider only, limited to R 2 690 per beneficiary 80% SEP plus a dispensing fee, subject to MMAP, limited to R760 per beneficiary No Benefit

OVER THE COUNTER MEDICATION LASER K NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS ANTE-NATAL FOETAL SCANS PER PREGNANCY ANTE-NATAL CLASSES SUBJECT TO ENROLMENT ON THE MOTHER-TO-BE PROGRAMME

No Benefit

Subject to Medical Savings Account

No Benefit

Subject to Medical Savings Account

6 Scans at 80% CBT 80% CBT limited to R 1 750 per pregnancy Consultation: See Preventative Wellness Add ons R 930 Single vision R 1 170 OR Bifocal R 2 340 OR Varifocal R 3 520 AND Frames R 4 650 OR Contact lenses R 5 850 Lenses, frames etc 80% Optical Assistant Rates

4 Scans at 80% CBT 80% CBT limited to R 1 290 per pregnancy Consultation: See Preventative Wellness Add ons R 760 Single vision R 760 OR Bifocal R 2 060 OR Varifocal R 3 160 AND Frames R 2 110 OR Contact lenses R 2 920 Lenses, frames etc 80% Optical Assistant Rates

No Benefit No Benefit

Subject to Medical Savings Account Subject to Medical Savings Account

3 scans at 80% CBT. Subject to limit(c) 80% CBT subject to sub-limit R 770 Subject to limit (c)

3 scans at 80% CBT No Benefit

SPECTACLES AND LENSES FROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE STATED

Consultation: Part of Preventative Wellness

Subject to Medical Savings Account

Monthly Risk Contribution Adult Child R 3 349 R 1 894

Monthly Risk Contribution Adult Child R 2 218 R 1 321

Total Monthly Contribution Adult Child R 1 433 R 777

Monthly Risk Contribution Principal R 1 108 Adult R 881 R 535 Child NEW Monthly MSA Contribution Principal R R Adult Child R 369 294 178

Income Category R 0 - R 3 470 Adult Child R 3 471 - R 6 770 Adult Child

Income Category R 0 - R 16 890 Principal Adult 1st Child (rest are free) R 16 891 - 27 800 Principal Adult Child R 27 801 + Principal Adult Child

Monthly MSA Contribution Adult Child R R 434 207

Monthly MSA Contribution Adult Child R R 283 184

R R R R

321 179 632 376

R 1 008 R 851 R 454

Total Monthly Contribution Adult Child R 3 783 R 2 101

Total Monthly Contribution Adult Child R 2 501 R 1 505

Total Monthly Contribution Principal R 1 477 Adult R 1 175 Child R 713

R 6 771 - R 13 080 R 1 002 Adult Child R 583 R 13 081 - R 18 530 Adult R 1 498 R 860 Child R 18 531+ Adult Child R 1 866 R 1 201

R 1 339 R 1 046 R 697 R 1 783 R 1 452 R 914

Addisons Disease Asthma* Bipolar Mood Disorder* Bronchiectasis* Cardiac Failure Cardiomyopathy Chronic Obstructive Pulmonary Disorder (COPD)* Chronic Renal Disease Coronary Artery Disease Crohns Disease Diabetes Insipidus Diabetes Mellitus Type 1* Diabetes Mellitus Type 2* Dysrhythmia Epilepsy Glaucoma Haemophilia A & B HIV/AIDS* Hyperlipidaemia Hypertension Hypothyroidism Multiple Sclerosis Parkinsons Disease Rheumatoid Arthritis Schizophrenia* Systemic Lupus Erythematosus Ulcerative Colitis

ADHD (Alliance only) Agranulocytosis Allergic Rhinitis Alzheimers Disease Anaemias: Aplastic, Haemolytic, Sickle Cell Ankylosing Spondylitis Benign Prostatic Hypertrophy Chronic Granulomatous Disease Coagulation Disorders Congenital Heart Malformations Cystic Fibrosis Deep Vein Thrombosis Depression* (includes First Choice and Essential Plus) Eczema Endometriosis Gastro-Oesophageal Reflux Disease (GORD) Gauchers Disease Gout Prophylaxis Hormone Replacement Therapy Hyperparathyroidism Hyperthyroidism Menires Disease Migraine Prophylaxis Muscular Dystrophy Myasthenia Gravis Narcolepsy Organ Transplant Osteoarthritis Osteoporosis Plegia: Hemi, Para & Quad Polycystic Ovarian Syndrome Psoriasis

ADULT CBT

Refers to the member and dependants who are 22 or older at any time in the year of cover. CAMAF Base Tariff - the maximum rate paid by the Scheme to providers of healthcare services, based on 2009 RPL (Medical Aid) rates, increased annually by CPI. Tariff differs per type of service provider and % paid on different options. Chronic Disease List - the list of PMBs includes 27 common chronic conditions called CDLs. Schemes must provide cover for the diagnosis, treatment and care of these conditions. Members must register their conditions to qualify for benefits. Schemes can provide protocols in terms of the range (RP and Formularies) and delivery of medication (DSPs). Condition Medicine List - once a patients chronic condition has been registered, a patient will have access to the CML. This is a list of drugs, appropriate for the condition, that do not require authorisation. This is maintained by the Scheme and differs per Option. Reference pricing may still apply. Refers to a dependant who is younger than an adult, as defined above. Fee negotiated by the Scheme with Network pharmacies and added to SEP. The network of service providers contracted to provide healthcare services to members, eg. Diabetes programme (CDE), HIV programme (LifeSense) PPN for optical benefits on First Choice and Network Choice, Pharmacy networks for all chronic medications and Netcare hospital group for Network Choice hospital admissions. The Regulations to the Medical Schemes Act in Annexure A provide a list of conditions identified as Prescribed Minimum Benefits. The List is in the form of Diagnosis Treatment Pairs (DTPs). A DTP links a specific diagnosis to a treatment/procedure and therefore broadly indicates how each of the 270 PMB conditions should be treated. These treatment pairs cover serious and acute medical problems that include the cost of diagnosis, treatment and care of these conditions. Stands for International Classification of Diseases and Related Health Problems (10th revision). It is a coding system developed by the World Health Organisation (WHO) that translates the written description of medical and health information into standard codes, e.g. Jo3.9 is an ICD-10 code for acute tonsillitis (unspecified) and G40.9 denotes epilepsy (unspecified). These codes are used to inform medical schemes about what conditions their members were treated for so that claims can be paid from the correct benefit. A savings account that accrues monthly but the annualised amount of savings is available immediately and can be used for: top up on cost of service charged by a doctor extension when an overall benefit has been exceeded exclusion from benefits payment of day to day claims on Essential Plus option Newborn screening whereby rare disorders are detected by a blood test done 48 - 72 hours after birth. Maximum Medical Aid Price - is a reference price model and determines the maximum medical scheme price that medical schemes will reimburse for an interchangeable multi-source pharmaceutical product (generic) on the relevant option. MMAP applies to all options for chronic medication. This is the rate, negotiated by the scheme with the service provider/group of service providers, eg. hospitals and pathologists. Prescribed Minimum Benefits - as set out in the Medical Schemes Act, 1998. Medical schemes have to cover the costs related to the diagnosis, treatment and care of: Any emergency medical condition A limited set of 270 medical conditions (Defined in DTPs) 27 chronic conditions defined in the CDL These costs may not be paid from the members savings benefit and cost saving measures can be used by way of utilising DSPs, Reference Pricing and Formularies. A member must obtain prior approval for an intended admission to hospital. Failure to pre-authorise could result in wholly or partly disallowing the claim or imposing a penalty of 20% of related accounts up to a maximum of R 2 500. Emergency treatment is not subject to Pre-authorisation but members should notify the Scheme as soon as possible after the event. Means a set of guidelines in relation to diagnostic testing and management of specific conditions and includes, but is not limited to, clinical practice guidelines, standard treatment guidelines and disease management guidelines. Those funds allocated to the overall pool of funds for the payment of all claims other than those paid from the Medical Savings Account. Reference Pricing is the maximum price for which the Scheme will be liable for specific medicine or classes of medicine, listed on the Schemes Condition Medicine List (CML). The reference price varies per option and where a drug is above the reference price it is indicated that a co-payment will apply. This includes MMAP. Total cost to company prior to deductions. The maximum rate paid by the scheme to providers of healthcare services, based on SAMA (Private) rates, increased annually by CPI. Tariff differs per type of service provider and % paid on different options. Single Exit Price - nationally applied pricing for medication as determined by the Department of Health and the pharmaceutical manufacturers. To Take Out - medication supplied by the hospital for use after the date of discharge from hospital - limited to a 7 day supply.

CDL

CML/ FORMULARY CHILD DISPENSING FEES DSP

DTP

ICD 10 CODE

MEDICAL SAVINGS ACCOUNT

METABOLIC SCREENING MMAP NEGOTIATED RATE

PMB

Oncology* (PMB DTP) consult website for further details

Restrictive Lung Disease Thalassaemia Transient Ischaemic Attack / Stroke Tuberculosis

PRE-AUTHORISATION

*Subject to registration on relevant Wellness Programme

Valvular Heart Disease

*Subject to registration on relevant Wellness Programme

PROTOCOL RISK CONTRIBUTIONS

CAMAF Client Relations* E-mail Fax Reception Hospital Pre-authorisations Hospital Pre-authorisations Fax Hospital Pre-authorisations E-mail Hospital Pre-authorisations Online Website Membership Fax Post Claims to: CAMAF LIFESTYLE PROGRAMME Telephone E-mail CANCER WELLNESS PROGRAMME Telephone CARDIAC SUPPORT LINE Telephone Emergency Contact Number General Enquires Website CHRONIC CONDITION AUTHORISATION Telephone for: Doctors and Pharamacists only / SwiftAuth Members Fax E-mail EMOTIONAL WELLNESS PROGRAMME Telephone Fax E-mail Telephone 24 Hour Call Centre E-mail MOTHER-TO-BE PROGRAMME Telephone NETCARE 911 Emergency Number Telephone Fax Namibia PMB DTP AUTHORISATION Fax E-mail 011 707 8866 pmbdtp@camaf.co.za 082 911 011 254 1911 011 254 1950 09264 61 230 612 0860 100 544 0860 100 544 011 707 8747 emotionalwellness@camaf.co.za 0861 700 600 0860 506 080 camaf@lifesense.co.za 0800 200 300 0861 700 600 Option3 011 707 8622 clinicalrisk@camaf.co.za 0860 100 544 082 456 7844 011 712 6000 www.cdecentr.co.za CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) DISEASE MANAGEMENT PROGRAMME 0860 100 544 0860 200 911 lifestyle@camaf.co.za 0860 100 545 custserv@camaf.co.za 0861 113 676 0861 700 600 0860 100 544 011 706 9946 preauth@camaf.co.za www.camaf.co.za www.camaf.co.za 011 707 8735 PO Box 2964, Randburg, 2125 SEP TTO RP SALARY SCHEME RATE

RESPIRATORY PROGRAMME Telephone Fax E-mail STRESSLINE Telephone Fax E-mail General Enquires Fax E-mail Website PPN CALL CENTRE Telephone Post Claims To Website 0860 103 529 PO Box 12450, Centrahil, 6006 www.ppn.co.za 0861 700 600 011 707 8747 emotionalwellness@camaf.co.za 0860 REALITY (732 5489) 021 700 8750 info@reality.co.za www.reality.co.za 0861 700 600 011 707 8622 clinicalrisk@camaf.co.za

REALITY (LOYALTY PROGRAMME)

FOR FIRST CHOICE AND NETWORK CHOICE MEMBERS ONLY

HYPERTENSION AND CHOLESTEROL PROGRAMME LIFESENSE (HIV DISEASE MANAGEMENT PROGRAMME)