Gold Focus

2011
Starting out as a family
Are you a young couple? Maybe about to start a family, or with a baby on the way? It’s important
to make sure you’re able to get and give your family the best healthcare you can afford.

Benefit highlights
In addition to providing unlimited cover in the event of trauma,
the Gold Focus option also provides generous cover for medical
treatments in hospital and for the management of chronic illnesses.
The option offers a range of preventative measures intended to
maintain your good health, thereby saving you the expense of
treating what could be an avoidable illness.
• Major Medical Benefit
Cover up to 100% of LMS rate for in-hospital GP’s, specialist
and other relevant service providers.
• Disease Benefit
Provides cover for all Prescribed Minimum Benefit (PMB)
conditions. In other words, if you have a PMB chronic condition
and need to take medicine on a daily basis, the cost of this
treatment will be paid for. There is no co-payment applicable
provided you obtain the formulary medicine (which is usually
a generic substitute) from a Preferred Provider network
pharmacy. This benefit also includes:
• Treatment for HIV/AIDS through Aid for AIDS (AfA) which
provides a comprehensive management programme which
specialises in a holistic approach to healthcare.
• The Oncology Benefit covers post active treatment for 12
months after the completion of active treatment.
Day-to-Day Extender
As Gold Focus has no Medical Savings Facility (MSF) to provide
cover for day-to-day expenses, we have introduced the Day-to-Day
Extender. These out-of-hospital benefits, which are normally self-
funded, are paid by the Scheme risk and not out of your pocket.
These benefits include:
• Casualty benefit, providing cover for emergency room visits up
to a limit of R1 250 per beneficiary. You will not have to pay for
after-hours visits to a hospital emergency room from your savings.
• Preventative Care Benefit (PCB), providing each person with
one annual screening test for certain common conditions as
well as vaccinations and immunisations.
• MRI/CAT scans benefit, providing two out-of-hospital scans per
beneficiary (with no co-payment).
• Crime Trauma benefit, providing cover for treatment initiated
up to a year following a crime-related event.
Benefits include: Out-of-hospital mental health professionals,
rehabilitation and HIV prophylaxes (to prevent the transmission
of HIV following rape).
• Day procedures benefit, the Scheme pays for certain
investigative procedures done in a doctor’s rooms or in a day
clinic, with no co-payment.
Contact Centre
0860 002 163
The Liberty Medical Scheme has a one-stop Contact Centre for
immediate resolution of queries. Our qualified agents offer friendly
and efficient service in record-breaking response times.
The Contact Centre is open Monday to Friday from 08h00 to 17h00
(closed on public holidays).
Email Communication
webmail@libertyhealth.co.za
Our direct email service empowers you to keep up to date at the
click of a button, even without Internet access. As long as we have
your email address loaded on our database, accessing your personal
data, at any time day or night, is easy.
You send us a blank email and our system immediately generates
a reply that includes membership details, claims history, benefits
used to date, contributions to date, a copy of your latest claims
statement and a copy of your current tax letter.
SMS Facility Walk-in Branches
39372 You can hand in claims at any of our walk-in branches, where
friendly and capable staff will assist in resolving your queries.
Our SMS facility allows you anytime access to important
information. Simply ensure that your cellphone number is loaded on
Walk-in branches are located in Katherine Street, Sandton;
our database before sending through your request for information.
city centre in Durban as well as Century City in Cape Town.
Only SMS the corresponding letter for the information you require:
Walk-in facilities are open Monday to Friday from 08h30 to 16h00. For
BN for benefits, CL for claims, DE for membership details, BR for your
additional regional walk-in branches please call the Contact Centre.
broker’s details, TX to request a copy of your current tax letter, or
send a blank sms for a list of self-help instructions. Within seconds
you will receive a return SMS containing the detailed and real-time Scheme Option Summary
information you requested.
Gold Focus
Interactive Member Website Major Medical Benefits Day-to-Day Benefits

www.libmed.co.za
Hospital Benefit
Our user-friendly and practical website puts you in control, enabling Day-to-Day
you to resolve most simple queries at your own convenience. With Extender
Disease Benefit
access to the same real-time systems used by our Contact Centre,
you can be confident that the information is relevant and up to date.
More expensive and generally
Less expensive and generally more
unforeseeable items including
manageable day-to-day items
Some of the online functions include tracking the status of chronic benefits
submitted claims, checking what benefits are still available,
viewing your contributions history, determining tax information
Monthly Contribution
when completing your income tax returns and even finding a
medical service provider in a specific area. Principal member R 986
Spouse or adult dependant R 831
Although password controlled (to ensure complete confidentiality),
registration is easy and the website is available 24 hours a day. Child dependant R 374

Contribution will be payable in terms of the first three child

Acknowledgement of Claims dependants only.
If your email address is registered on our database, LMS will send Full-time students up to and including the age of 26 pay child rates.
you a mini-claims statement via email as soon as your claim has been
processed. This means you do not have to wait for your emailed or
printed statement to arrive in the mail.
 Gold Focus
Major Medical Benefit Preventative Care Benefits In-hospital Benefits
Overall annual limit (OAL) Unlimited Mammogram Not applicable Blood transfusions, blood products 100% LMS rate
Pap smear 1 per beneficiary & blood substitutes R203 000 per beneficiary
Female 18-60
Cholesterol test 1 per beneficiary
Over age 15
Blood Glucose 1 per beneficiary
Childhood immunisations As per Member Guide, page 34
Flu vaccination 1 per beneficiary
TB Test 1 per beneficiary
Dialysis* 100% LMS rate
HIV Test 1 per beneficiary
Haemodialysis and Peritoneal R112 000 per beneficiary
Prostate Test 1 per beneficiary
Male >45 every 3 years
Bone Density Test 1 per beneficiary
Female >50 every 3 years Hospice services 100% LMS rate
(accommodation, medicine, R8 500 per beneficiary
Emergency Transport Services Unlimited (ER24) consultations)

Casualty benefit* 100% LMS Rate HIV/Aids prevention Yes Hospitalisation* 100% of negotiated tariff
R1 250 per beneficiary (including childbirth) Unlimited
Unlimited for physical injury

Day Procedures 100% LMS rate Rehabilitation and private nursing 100% LMS rate Take-out medication 100% Maximum Medicine
• Diagnostic cystoscopy Unlimited R13 800 per family Reference Price.
• Laser tonsillectomy Maximum of 7 days supply
• Lumbar puncture Crime Trauma Benefit 100% LMS rate Limited to R1 500 per admission
• Needle aspiration of joint, bursa HIV - Prophylaxis (Rape) R10 350 per beneficiary
or ganglion Rehabilitation R19 500 per family General practitioners & specialists 100% LMS rate
• Proctoscopy Psychologists, Psychiatrists and R2 500 per beneficiary (in-hospital) Unlimited
• Sigmoidoscopy Social Workers
Physiotherapy, Pathology, Clinical 100% LMS rate
• Upper GI endoscopy
Technologist, Occupational Therapy* Unlimited
• Vasectomy
• Colonoscopy Disease Management Programme Yes Radiology* 100% LMS rate
Asthma, Cancer, Diabetes, General Unlimited
HIV/AIDS Specialised R19 700 per family
Co-payments Member Care Yes Dentistry* 100% LMS rate
• Colonoscopy R1 310 per event Elective R7 350 per beneficiary
• Sigmoidoscopy R1 310 per event Lifestyle risk assessment Yes R11 250 per family
• Proctoscopy R1 310 per event Trauma Unlimited***
• Conservative back treatment R1 310 per event
• Extraction of wisdom teeth R1 310 per event Biokineticist assessment* 1 per beneficiary Psychiatric admissions* 100% LMS rate
(in hospital) R13 800 per family
• Gastroscopy R1 310 per event Smoking cessation support Yes Oncology* 100% LMS rate**
• Arthroscopy R3 200 per event programme R170 400 per beneficiary
• Functional nasal procedures R3 200 per event Associated diagnostics R14 700 per beneficiary
• Hysterectomy (non-cancer R3 200 per event PET Scans (staging of malignant No benefit
related) tumours)
• Laparoscopy, hysteroscopy, R3 200 per event Oncology specialised drugs No benefit
endometrial ablation
• Joint replacements R6 400 per event Internal Prosthesis 100% LMS rate
• Nissen fundoplication (reflux R6 400 per event (internal surgical appliances) R110 100 per beneficiary.
surgery) Annual sub-limits apply per
• Spinal/back surgery R6 400 per event prosthetic type
Organ transplants* 100% LMS rate
Unlimited

* Subject to pre-authorisation and/or case management. ** Preferred provider: ICON *** All costs relating to hospitalisation, anaethetists and procedural
05064Gf_1110

Gold Focus
Chronic Illness Benefits Day-to-day Benefits
Chronic medication* 100% of Maximum Medicine Reference Price subject to Threshold Level (THL) No benefit
(including non-Oncology Biological drugs) Standard Formulary** Accumulation to THL
Unlimited for PMB conditions Reimbursement from Threshold Benefit
Excludes cover for specialised drugs
Maximum negotiated dispensing fees apply (Preferred
Providers)**
HIV 100% Reference Price
Subject to PMB protocols

Chronic Conditions Medical Savings Facility

Reimbursement from MSF
Addison’s Disease Dysrhythmias
General practitioners
Asthma Cardiac Arrhythmias
Bipolar Mood Disorder Epilepsy Specialists
Bronchiectasis Glaucoma
Dentistry
Cardiac Failure Haemophilia Basic dentistry
Cardiomyopathy HIV/AIDS Specialised dentistry
Chronic Obstructive Pulmonary Disease Hyperlipidaemia Social workers
Emphysema Hypercholesterolaemia
Mental health
Chronic Renal Failure Hypertension
Coronary Artery Disease Hypothyroidism Acute medication
Angina Multiple Sclerosis
Optical
Ischaemic Heart Disease Parkinson’s Disease
Crohn’s Disease Rheumatoid Arthritis Pathology
Diabetes Insipidus Schizophrenia
Auxiliary services
Diabetes Mellitus Type 1 Systemic Lupus Erythematosus (Physiotherapy, Occupational Therapy,
Diabetes Mellitus Type 2 Discoid Lupus Erythematosus Speech Therapy, Audiology, Dietician,
Clinical Technologist, Private Nursing, Biokineticist,
Ulcerative Colitis Podiatry)
Alternate therapies
(Homeopath, Chiropractor, Naturopath, Herbalist)
Sick Bay at Frail Care Centre
Accommodation

Dressings and ointments

External appliances

Basic radiology

MRI & CAT Scans* 100% LMS rate paid from MMB
(Out-of-hospital) Total of 2 scans (MRI and CAT) per beneficiary
Ultrasounds for pregnancies No benefit

Note: All conditions in itallics are sub-conditions. * Subject to pre-authorisation and/or case management. ** Preferred providers apply: Please refer to page 42 of the Member Guide for the list.