Comprehensive Health Plans

Schemes A, B and C are tiered to offer three levels of medical aid cover. Scheme A is the entry-level option while Scheme C is the executive health plan option.

If you are looking for a basic outpatient, affordable health option, then Scheme A Standard is for you.

Comprehensive Health Plan Benefit Guides

• Benefits
• Comparison

DESCRIPTION	SCHEME A		SCHEME B		SCHEME C
	Single	Family	Single	Family	Single	Family
RECOMMENDED FOR	Low income, relatively healthy employees.		Middle income earning corporate clients.		Executives and those who travel frequently.
CONTRIBUTIONS AND BENEFITS	Affordable, competitive and comprehensive to cover both outpatient and inpatient services.		Affordable, competitive and comprehensive to cover both outpatient and inpatient services.		Affordable, competitive and comprehensive to cover both outpatient and inpatient services.
Annual Overall Cover	274,145	290,772	866,532	1,009,686	1,351,121	1,785,000
Annual Dread Disease Cover	Up to 236,250	252,000	Up to 813,225	931,350	Up to 1,249,500	1,485,750
Annual Hospital Cover	89,250	105,000	393,225	511,350	1,249,500	960,750
Annual Normal Delivery Cover	7,043	7,043	12,818	12,818	12,818	12,818
Annual Caesarean Section Cover	12,404	12,404	19,229	19,229	21,122	21,122
Annual Chemo/Radio Therapy Cover	31,500	42,000	136,500	157,500	157,500	168,000
Annual Renal Dialysis Cover	31,500	42,000	136,500	157,500	157,500	168,000
Annual Chronic Medication Cover	10,500	12,600	37,800	44,100	50,400	67,200
Annual HIV/AIDS Assistance Cover	Per Beneficiary: 12,600		Per Beneficiary: 12,600		Per Beneficiary: 12,600
Annual Outpatient Cover	16,790	23,568	30,255	43,545	43,798	60,638
Annual Dental Cover	14,343	20,512	50,661	74,213	67,326	92,925
Optical Cover(2 year cycle)	Full cover through designated providers		Full cover through designated providers		Full cover through designated providers
Allied Health Cover	2,909	4,541	7,881	11,294	10,924	17,174
Medical Travel Insurance	None	None	None	None	International EMERGENCY Medical Travel cover P5 Million cover per life covered for Executive Members
Executive Annual Medical Examination	None	None	None	None	Covers member plus one adult dependant at designated service providers

	SCHEME A STANDARD	SCHEME A	SCHEME B	SCHEME C
10% co-payment
VAT
Outpatient
Hospital Cover
Managed Care
Chronic medication
Safe Male circumcision
Screening & Prevention
Waiver of Premiums
MRI Cover
Funeral Cover
BOMbaby Programme
Alternative treatment
P1 million travel insurance
Annual Executive Med Exam
Delivery of chronic conditions

	SCHEME A		SCHEME B		SCHEME C
BENEFIT CATEGORY	SINGLE	FAMILY	SINGLE	FAMILY	SINGLE	FAMILY
Overall Scheme Benefit	P274,145	P290,772	P866,532	P1,009,686	P1,351,121	P1,785,000
In-Patient Dread Disease Cover	In-Patient Dread Disease Cover	240,000	P813,225	P931,350	P1,249,500	P1,,485,750
Hospitalization	P85,000	P100,000	P374,500	P487,000	P724,500	P960,750
Maternity Cover	P85,000	P100,000	P374,500	P487,000	P724,500	P960,750
Out-patient Cover (Unlimited Consult; Invest; Drugs)	P16,790	P16,790	P30,255	P43,545	P43,798	P60,638
Chronic Medication (excl. HIV Benefit)	P10,500	P12,600	P37,800	P44,100	P50,400	P67,200
ARV DRUGS & Monitoring per person @ P1,000 per month	12,600	P12,600	P12,600	P12,600	P12,600	P12,600
Dental Cover	P3,842	P4,672	P4,672	P10,163	P8,256	P14,175
Optical/Ophthalmic(Inclusive of appliance limit)	AS PER BENEFIT SCHEDULE	AS PER BENEFIT SCHEDULE	AS PER BENEFIT SCHEDULE	AS PER BENEFIT SCHEDULE	AS PER BENEFIT SCHEDULE	AS PER BENEFIT SCHEDULE
Appliances	P5,250	P6,195	P9,450	P11,340	P11,340	P13,650
Allied health services(rehab & alternative	P2,909	P4,541	P7,881	P11,294	P10.924	P17,174
Severe Illness Benefit (PM & Spouse	P20,000		P20,000		P20,000
Child Dependant	P4,000		P4,000		P4,000
Funeral (PM ,Spouse & child dep.(14-21)	P10,000		P10,000		P10,000
Child(6-13years)	P5,000		P5,000		P5,000
Child (1-5 years)	P2,500		P2,500		P2,500
Under 1 year	P1,500		P1,500		P1,500

2019 A & B Health Plans Benefit Guide (3.86 MB)
2019 C Health Plan Benefit Guide (2.80 MB)