The Axis Option

Overview

The Axis option is a premium comprehensive private hospital benefit plan with post-operative rehabilitation benefits for complete peace of mind.

YOU CAN LOOK FORWARD TO THE BENEFITS THAT YOU NEED WITH AXIS IN 2012

• You receive unlimited cover in private hospitals
• We’ve introduced a new post-operative rehabilitation benefit
• Unlimited oncology benefits for complete peace of mind
• We’ve provided cover for professional sportsmen and women, for injuries relating to participating in professional sport
• You are covered for 27 chronic conditions
• You pay only for the first three child dependants – the rest are free!

Day-to-Day Benefits

The Axis option is a hospital plan that only covers Prescribed Minimum Benefits (PMB) conditions. The member is liable for all day-to-day expenses incurred.

Benefits	Limits
PMB related	Unlimited
Post operative rehabilitation benefit for physiotherapy, occupational therapy and biokinetics	R2 300 for 14 days. PMB's only.

Cover for Chronic Conditions

The Axis option offers extensive cover for 27 chronic conditions as per Chronic Disease List (CDL).

If you suffer from one of the chronic conditions on the list, you need to register with Mediscor in order to qualify for the chronic benefit. Registered CDL chronic medication is unlimited.

Chronic medication is subject to the core formulary and Mediscor Reference Pricing (MRP). A 25% co-payment is payable for the voluntary use of non-formulary or non-generic medicines.

In-Hospital Cover

Benefits	Limits
Overall Annual Limit	Unlimited, subject to pre-authorisation Co-payments are payable for certain elective procedures – refer to website for details
Private hospitals and nursing homes	100% of Agreed Tariff (AT), unlimited, subject to pre-authorisation
Ward fees: General; High Care; Intensive Care	100% of AT, unlimited
Theatre fees	100% of AT, unlimited
TTO Medication (take home medication)	Limited to 7 days supply
GPs and specialists	100% of AT, unlimited
Surgical prosthesis and electronic/nuclear devices	100% of AT, limits per category, sub-limits apply, subject to pre-authorisation, PMBs and protocols
Surgical procedures including maxillo-facial surgery	100% of AT Maxillo-facial surgery subject to PMB’s
Clinical technologist	100% of AT, unlimited
Radiology	100% of AT, unlimited
Pathology	100% of AT, limited to R21 200 p/f
MRI, CT scans and PET scans (Combined in-and-out hospital limit)	100% of AT, limited to R12 720 p/f, pre-authorisation required
Confinements • Normal birth • Caesarean section	100% of AT, unlimited, subject to pre-authorisation and registration on the maternity programme Three days Four days
Blood transfusions	100% of AT, unlimited (Preferred Provider)
Physiotherapy in hospital	100% of AT, limited to R5 300 p/f
Mental health: Psychiatric hospitalisation	100% of AT, limited to 21 days per family, subject to pre-authorisation, protocols, PMB’s and Designated Service Provider (DSP)
Alcoholism, drug dependence and narcotism	100% of AT, PMB’s only, subject to pre-authorisation, protocols and DSP
Organ transplants, renal dialysis (includes transportation of the organ, surgically related procedures, professional fees and services, as well as immunosuppressant drugs)	100% of AT, PMBs only, subject to pre-authorisation, protocols, and DSP
Sport injuries	100% of AT, including professional sport
Emergency room/casualty	100% of AT for emergency medical conditions and injuries resulting from accidents or trauma
Wellness, lifestyle and preventative care	Flu vaccinations limited to R70 for 1 dose p/b per annum

Alternatives to Hospitalisation

The Axis option offers cover for step-down nursing facilities, Hospice and rehabilitation. Cover is subject to pre-authorisation, protocols and case management.

Benefits	Limits
Step-down nursing facilities, Hospice and rehabilitation	100% of General Ward Rate (GWR), unlimited, subject to pre-authorisation and protocols
Terminal care	100% of AT, subject to pre-authorisation, PMB and protocols Comfort care, pain relief and hydration
Surgical procedures out of hospital	100% of AT, unlimited, subject to pre-authorisation and protocols
Oncology, including chemotherapy and radiology	100% of AT, unlimited, subject to pre-authorisation, protocols and DSP
Biological agents	100% of AT, subject to pre-authorisations and protocols, limited to R100 000 per family with a 25% co-payment

Prescribed Minimum Benefits (PMB)

• Subject to Scheme protocols
• Hospitalisation – 100% AT at DSP, unlimited
• Medication – CDL conditions are unlimited subject to a formulary and dispensed by a DSP
• Medical management in and out of hospital – 100% AT, subject to protocols and treatment by DSP
• HIV/AIDS – subject to registration on HIV/AIDS programme, subject to protocols, failing which a R3 000 limit will apply

Co-Payments

Co-payments are payable on specified elective procedures (excluding PMBs) done in a hospital or a day facility. The following treatments require a R1 500 co-payment:
Gastroscopy, colonoscopy, cystoscopy, nasal/sinus endoscopy, functional nasal surgery (septoplasty), hysteroscopy, flexible sigmoidoscopy, arthroscopy, diagnostic laparoscopy, dental, conservative back and neck treatment (spinal cord injections)

The following treatment requires a R1 000 co-payment:
Excision lesion (benign & malignant)

The following treatments require a R8 000 co-payment:
Joint replacements (arthroplasty), laminectomy, spinal fusion and Nissen fundoplication (reflux surgery)

The following treatment requires a R4 000 co-payment:
Hysterectomy (except for cancer)

Contributions Table

Principal	Adult	Child
R1 146	R1 146	R354

Glossary

• PMB - Prescribed Minimum Benefit
• P/F - Per Family
• CDL - Chronic Disease List
• CDL - Chronic Disease List
• AT - Agreed Tariff
• P/B - Per Beneficiary
• DSP - Designated Service Provider
• GWR - General Ward Rate
• To Take Out i.e. Medicines taken out of hospital when discharged