New Benefit Rules Changes Effective 01 January 2016

Effective 01 January 2016, new benefit rules has been implemented on the following benefits and procedures:

1.1 Maternity Benefits: Caesarean Sections
1.2 In-Hospital Circumcisions
1.3 Chronic Formulary list

1.1 Caesarean Sections

Effective 01 January, as part of the new benefit rules changes a 10% member co-payment will be applicable on all elective caesarean-sections. All caesareans done due to an emergency or the medical condition of the member will be paid as per the current Fund Rules which is 225% of the Fund tariff.

1.2 Circumcisions
Effective 01 January 2016, circumcisions will be covered as follows on the Fund:

1.2.1 In-Hospital Circumcisions

• As part of the new benefit rule changes, a 10% member co-payment will be applied to the GP & Specialist cost of all circumcisions done in Hospital.
• The 10% member co-payment will only be applicable on the GP & Specialist cost and not the Hospital Fees

1.2.2 O ut of Hospital (In-Rooms Circumcisions)

• GP & Specialist In Rooms procedures cost for circumcisions will be covered at 225% of the Fund Tariff.
• The Fund Tariff for GP & Specialist for circumcisions has been increased from 100% to 225% for 2016, when done out of Hospital.

NB: Please take note that the 10% member co-payment will only apply on circumcisions done in Hospital.