LMS Medical Scheme Options
December 15, 2016
The LMS Medical Scheme differentiates its options by the scale of cover for each benefit, the measure of freedom to choose doctors or specialists and the premium. The highest premium and most comprehensive cover option are the Traditional Ultimate. Policyholders on this option, have the most freedom to choose service providers and this option covers more comprehensively, receiving the most compensation for medical bills incurred.
The next option plan down the scale is the Complete Plus Plan. This plan has a threshold and savings portion of benefits from which the program pays for hospital visits and procedures according to the schemes schedule. Next up is the Saver Plus plan, the Complete Standard program, Hospital Plus, Complete Select, Saver Standard, Saver Select, Hospital Standard, Traditional Standard and the Hospital Select.
Traditional Plus LMS medical scheme
The Traditional Ultimate which is LMS’s gold star of options has unlimited overall annual limits. Benefits apply to any private hospital of the member’s choice. Specialist bills are safe up to 300% of the LMS scheme rate with no co-payments for in-hospital procedures that need to be paid by the member. General practitioner bills are paid at 200% of plan price. Cancer treatment has no cover cap. It is at 100% of the scheme rate, and one must get authorization from the plan before receiving treatment.
Any treatment of chronic conditions is also covered at 300% and 200% for specialist and general practitioner care respectively. MRI and CT scans fall under radiology procedure which is covered at 100% of the LMS rate. So both benefits are at 200% of the LMS rate. This cover has no medical savings benefit but day to day benefits apply. Premiums are currently R6416 for a principal member.
More on Traditional Plus LMS medical scheme
MRI and CT scans fall under radiology procedure which is at 100% of the LMS rate. Both benefits are at 200% of the LMS medical plan rate. The chronic benefit recognises 69 conditions, 27 of which are set out in the Prescribed Minimum Benefits which are government regulation. This cover has no medical savings benefit but day to day benefits apply. Premiums are currently R6416 for a principal member.
Complete Plus LMS medical scheme
The Complete Plus option has threshold and savings benefits. Key differences to the Traditional Ultimate are that specialists are at 200% of LMS’s rate. Oncology treatment attracts a co-payment of 10%. And where the Traditional Ultimate plan limits the dental treatment to R41000 per beneficiary. Here cover is at R13700 per beneficiary, while the cap per family if R19100. Medicine cover depends on savings and the above threshold benefit. It still does, however, cover 69 chronic illnesses.So premiums start at R4889 for the principal member. All the other products only cover 27 chronic conditions which are the minimum requirement laid out in Prescribed Minimum Benefits.
While the Saver plans pay for medicines according to the scheme rate for drugs, depending on how much savings the policyholder has, with the hospital plans, the policyholder pays out of his pocket. The Oncology benefit is quite substantial for all plan options with this scheme.
Premiums start at R4889 for the principal member. While the Saver plans pay for medicines according to the plan rate for drugs. The policyholder pays out of his pocket. So the Oncology benefit is quite substantial for all plan options with this scheme.
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All info was correct at time of publishing