2010 Benefits & Contributions

The 2010 POLMED benefits have been approved by the Council for Medical Schemes and communicated to you. It is very important that you study the Benefit and Contributions Card carefully before making your plan selection for 2010. The benefit plans have been restructured to demonstrate a clear distinction between the two plans. 
 
The Lower Plan will provide for the needs of families that have little healthcare requirements or whose chronic conditions are under control. This plan caters mainly for Prescribed Minimum Benefit (PMB) conditions.  Members on this plan will in certain instances only be allowed to access benefits via a Designated Service Provider (DSP).  Certain procedures (operations) will require a co-payment upon hospital admission and will also have procedure limits.
 
The Higher Plan is intended to provide for the needs of families who have significant healthcare requirements. Certain procedures will require a co-payment upon admission at hospital. Co-payments have also been introduced and will be applicable as from 1 January 2010.
 
Co-payments and penalties in respect of services obtained from a non-DSP will not be waived (where the Rules clearly indicate that the service can only be obtained via a DSP). The Rules of the Scheme will be strictly applied during 2010. Any member who chooses to use a provider outside the networks will be liable to pay an additional cost directly to the provider by the member and this will not be refundable by the Scheme. 
 
This year it will be more important than ever for you to submit your plan selection form to the Scheme. Members who are currently on the Lower Plan will have to carefully consider whether they will change to the Higher Plan if their healthcare needs are not covered by the benefits offered in the 2010 Lower Plan benefit structure. Members who fail to submit their forms by 31 December 2009, will remain on the same plan. Please note that members on the Lower Plan face the risk of being without a benefit that they currently have access to.
 
The Plan selection and General Practitioner network nomination forms for 2010 are available on this website in the Administration section on the Forms page.