Stratum Benefits update for 2017

Stratum Benefits update for 2017, has been announced.

Stratum Benefits provide medical aid gap cover.  (2018 CHANGES HAVE BEEN ANNOUNCED, LINK TO POST)

They won the Financial Intermediaries Association Award for Health Insurance Category: Product Supplier of the year.

This was a new category in the awards and they are the first to win it.

We have been using Stratum to provide medical aid gap cover for clients for a few years now… we would like to congratulate them on winning the Award.

If you would like to contact us with respect to medical gap cover, please use this form.


Summarised Stratum Benefits update for 2017:

(Broken down into their product range) Corporate products appear after individual products.

MRI & CT SCANS AS WELL AS SPECIALISED RADIOLOGY have been added ,as part of their 10 MONTH CONDITION SPECIFIC WAITING PERIODS.

BASE product:

2016 PREMIUM R150

2017 PREMIUM R180

GAP BENEFIT

CASUALTY BENEFITTRAUMA COUNSELLING BENEFIT CANCER DIAGNOSIS BENEFIT ROAD ACCIDENT BENEFIT
Unchanged Unchanged Unchanged in rand amount limit but opened up to include accidental death Unchanged New benefit

CO-EVOLUTION product:

2016 PREMIUM R 185

2017 PREMIUM R 225

 GAP BENEFIT CO-PAYMENT BENEFIT CASUALTY BENEFIT TRAUMA COUNSELLING BENEFIT CANCER DIAGNOSIS BENEFIT ROAD ACCIDENT BENEFIT
Unchanged Unchanged Unchanged Unchanged in rand amount limit but opened up to include accidental death Unchanged New benefit

ELITE product:

2016 PREMIUM R 275

2017 PREMIUM R 320

GAP BENEFIT CO-PAYMENT BENEFIT ONCOLOGY BENEFITS SUB-LIMIT BENEFIT CASUALTY BENEFIT TRAUMA COUNSELLING BENEFIT ADDITIONAL BENEFITS ROAD ACCIDENT BENEFIT
Unchanged Unchanged Unchanged Internal prosthesis benefit increases from R 20 000 per event to R 30 000 per event but still with a maximum of R 60 000 per person per year Unchanged Unchanged in rand amount limit but opened up to include accidental death ACCIDENTAL DEATH BENEFIT increases from R 5 000 to R 10 000 for a principal member or spouse and from R 3 000 to R 5 000 for a dependant New benefit

G-FORCE product:

2016 PREMIUM R 200

2017 PREMIUM R 240

GAP BENEFIT CO-PAYMENT BENEFIT ONCOLOGY BENEFITS SUB-LIMIT BENEFIT CASUALTY BENEFIT TRAUMA COUNSELLING BENEFIT ADDITIONAL BENEFITS ROAD ACCIDENT BENEFIT
Unchanged Increases from R 8 000 to R 15 000 per policy per year ONCOLOGY OPTIMISER BENEFIT increases from R 50 000 to R 100 000 per person per year Internal Prosthesis benefit increases from R15 000 per event with a maximum of R 50 000 per person per year to R 20 000 per event with a maximum of R 60 000 per person per year Unchanged Unchanged in rand amount limit but opened up to include accidental death ACCIDENTAL DEATH BENEFIT increases from R 5 000 to R 10 000 for a principal member or spouse and from R 3 000 to R 5 000 for a dependant New benefit

HOSPITAL OPTIMISER product:

2016 PREMIUM R 75

2017 PREMIUM R 95

HOSPITAL OPTIMISER BENEFIT ROAD ACCIDENT BENEFIT
Unchanged New benefit

ACCESS OPTIMISER product:

2016 PREMIUM R 160 + ADD OUR GAP BENEFIT @ R 40

2017 PREMIUM R 180 + ADD OUR GAP BENEFIT @ R 40

ACCESS OPTIMISER BENEFIT ROAD ACCIDENT BENEFIT
Policy limit increases from R 80 000 per year to R 100 000 per year New benefit

IMPORTANT TO NOTE REGARDING OUR ACCESS OPTIMISER OPTION

2016 Underwriting states that where a client is reasonably aware of and / or experienced symptoms of a medical condition which may or may not have been diagnosed by a medical practitioner prior to their cover start date, cover is totally excluded for the lifetime of the policy.

Therefore, regardless of when the condition was diagnosed or treated, cover would never apply because the period prior to the cover start date is open ended.

2017 Underwriting states that where a client is reasonably aware of and / or experienced symptoms of a medical condition 12 months prior to their cover start date, which may or may not have been diagnosed by a medical practitioner, cover is totally excluded for the lifetime of the policy.

E.g. If a client is diagnosed with or treated for one of the listed conditions as stipulated in our Access Optimiser option 6 or 10 months prior to their cover start date, the condition will be totally excluded for the lifetime of the policy but if the condition was diagnosed or treated 13 or 14 months or even 3 years before their cover start date, benefits will apply after the 3 MONTH GENERAL WAITING PERIOD has been waited out.

E.g. If a client needs to undergo back surgery due to an accidental event, benefits will apply within the first 3 months of cover because we cover accidental events even if a policy is still within the 3 MONTH GENERAL WAITING PERIOD.

DENTAL ASSURE: (NEW ADDITION TO OUR 2017 PRODUCT RANGE)

(Update Aug 2017: Please note that there have been changes to the Dental Assure plan- discontinuation of the Orthondontic benefit from 1 Sept 2017). If you wish to see the email regarding this, let me know at :[email protected] and I will forward it to you).

Dental Assure new stratum benefit

  • This product is available as a stand-alone option which means a client can join regardless of whether they belong to a medical scheme or not.
  • A maximum entry age of 65 applies which means a client must join before their 66th birthday. If a client turns 66 on 2 October 2016 but applies for cover with a cover start date of 1 October 2016, we will allow cover as the first day of cover will be in accordance with the maximum entry age
  • Children under the age of 21 will pay a Child Dependant premium
  • A month prior to a child dependant turning 21, a 30-day notification will be sent to the Principal Insured informing them that their child will be taken off cover
  • If the child dependant is a full time student between the ages of 21 and 28, a Child Dependant premium will apply provided they submit proof of studies every year
  • Children between the ages of 21 and 28 who are registered as students who cannot submit yearly proof of studies, will be taken off cover

 Our DENTAL ASSURE product consists of 3 different options:

  • SOLUTION A provides cover for BASIC DENTISTRY, limited SPECIALISED DENTISTRY, a DENTAL TRAUMA & EMERGENCY BENEFIT as well as a POLICY PREMIUM WAIVER benefit
  • SOLUTION B provides cover for BASIC DENTISTRY, comprehensive SPECIALISED DENTISTRY, a DENTAL TRAUMA & EMERGENCY BENEFIT as well as a POLICY PREMIUM WAIVER benefit
  • SOLUTION C provides cover for BASIC DENTISTRY, comprehensive SPECIALISED DENTISTRY, EYE CARE BENEFITS, a DENTAL TRAUMA & EMERGENCY BENEFIT as well as a POLICY PREMIUM WAIVER benefit

 Waiting periods on our DENTAL ASSURE option applies to each insured person and not to the policy

2017 WAITING PERIODS on Dental Assure
BASIC DENTISTRY 3 MONTHS
SPECIALISED DENTISTRY 6 MONTHS
EYE CARE BENEFITS 6 MONTHS
DENTAL TRAUMA & EMERGENCY BENEFIT 1 MONTH
POLICY PREMIUM WAIVER 6
  • Insured persons older than 18 covered on either Solution B & C, must undergo a compulsory Panoramic Scan before any Specialised Dentistry benefits will be authorised.
  • This product is registered as a gap cover product and not as a healthcare product.
  • This product is underwritten by Dental Risk Underwriting Managers (Pty) Ltd and not by Constantia Insurance Company Limited

ESSENTIAL PRIMARY PLUS product (PRIMARY HEALTHCARE PRODUCT):

Essential Primary Plus - Stratum Benefits

 

  • This product is available as a stand-alone option which means a client can join regardless of whether they belong to a medical scheme or not
  • Maximum entry ages apply depending on the chosen option. For instance, a client applying for cover on our DAY-TO-DAY BENEFITS ONLY must join before their 56th birthday. If a client turns 56 on 2 October 2016 but applies for cover with a cover start  from 1 October 2016, we will allow cover as the first day of cover, as the first day of cover will be in accordance with the maximum entry age
  • Children under the age of 21 will pay a Child Dependant premium
  • A month prior to a child dependant turning 21, a 30-day notification will be sent to the Principal Insured informing them that their child will be taken off cover
  • If the child dependant is a full time student between the ages of 21 and 28, a Child Dependant premium will apply provided they submit proof of studies every year
  • Children between the ages of 21 and 28 who are registered as students who cannot submit yearly proof of studies, will be taken off cover
  • This product consists of 3 different options:

DAY-TO-DAY BENEFITS ONLY

 DAY-TO-DAY AND EMERGENCY & ACCIDENTAL BENEFITS

 EMERGENCY & ACCIDENTAL BENEFITS ONLY

Unique enhancements have been added to this product. Please refer to the table below:

Essential Primary Plus day to day Startum Benefits

Essential Primary Plus Emergency and Accidental benefits- Stratum benefits

  • Waiting periods on the Essential Primary Plus option is applied to each insured person and not to the whole policy.
  • Different waiting periods apply to different benefits and underwriting has changed for 2017

Essential Primary Plus waiting periods 2017 Stratum Benefits

 

  • This product is registered as a primary healthcare product and not as a gap cover product
  • This product is underwritten by Constantia Insurance Company Limited

2017 CORPORATE PRODUCT RANGE

 Please take note of the corporate options available to employer groups.

  • The minimum criteria to qualify for corporate benefits and premiums is 10 employees
  • Options available in our Corporate Range are CORPORATE ELITE, CORPORATE ACCESS, CORPORATE ASSURE and our primary healthcare option, CORPORATE ESSENTIAL

CORPORATE ELITE is an exact replica of ELITE, CORPORATE ACCESS of ACCESS OPTIMISER and CORPORATE ASSURE of DENTAL ASSURE in terms of benefits. CORPORATE ESSENTIAL is slightly different to our ESSENTIAL PRIMARY PLUS as it offers 27 chronic conditions and higher rand amount limits on certain benefits.

2016 PRODUCT RANGE

Products displayed in our 2016 Product Brochure can be taken with an inception date of no later than 1 October 2016

A 2016 Client Application Form with an inception date of 1 October 2016 and a debit date of the 15th, 20th, 25th or 28th must be received 5 days prior to the debit order date. Should we receive an application with a debit date of the 15th on the 17th of October 2016, this will be pushed back with a request to submit a 2017 Client Application Form

FINAL 2016 CLIENT APPLICATION FORM SUBMISSIONS
1 OCTOBER 2016 INCEPTION ON A 2016 PRODUCT DEBIT DATE APPLICATION MUST BE RECEIVED BY
1st of a month25 September 2016
15th of a month 10 October 2016
20th of a month 15 October 2016
25th of a month 20 October 2016
28th of a month 23 October 2016

Should an inception date of 1 November 2016 be received on a 2016 Client Application Form, this will be pushed back

 Clients on a 2016 product will be subject to the addition of MRI & CT SCANS AS WELL AS SPECIALISED RADIOLOGY as from 1 January 2017.

Should a client still be within their 10 MONTH CONDITION SPECIFIC WAITING PERIOD as at 1 January 2017, the new condition will be subject to the number of months still remaining under the waiting period. Should the policy no longer be within this waiting period come 1 January 2017, the new addition will not apply

Our COMPREHENSIVE option that was available to clients at an individual premium will be discontinued and will automatically be upgraded to our ELITE INDIVIDUAL option effective 1 January 2017 with a premium of R 265

Clients on our COMPREHENSIVE option that was available to clients at a monthly premium will automatically be upgraded to our ELITE option effective 1 January 2017 with a premium of R 320

Our G-FORCE option that was available to clients at an individual premium will be discontinued and will automatically be upgraded to our G-FORCE option effective 1 January 2017 with a premium of R 240

A 30-day’s notice regarding this change will be communicated to our clients in their 2017 Annual Premium Increase Notification during the month of November 2016.

UPGRADING AN EXISTING STRATUM BENEFITS POLICY

Existing clients will be able to upgrade during a 3 month window period with upgrade dates of either 1 November 2016, 1 December 2016 or 1 January 2017

Last day to receive an upgrade request will be 20 December 2016 for a debit date of 1 January 2017

Clients on our BASE, CO-EVOLUTION, SENIOR and G-FORCE options can upgrade to our ELITE option and will only receive a 3 MONTH WAITING PERIOD on enhanced benefits for pre-existing conditions instead of the standard 6 MONTH WAITING PERIOD.

Should a client still be within their various waiting periods at the time of the upgrade, the remainder of the term will be carried over to the upgraded option and a 3 MONTH WAITING PERIOD will be applied to the enhanced benefit.

E.g. Client joined our BASE option 1 July 2016 and received the following waiting periods:

3 MONTH GENERAL WAITING PERIOD

6 MONTH PRE-EXISTING CONDITION WAITING PERIOD

10 MONTH CONDITION SPECIFIC WAITING PERIOD

PRE-DIAGNOSED CANCER WAITING PERIOD

Client sends an upgrade request effective 1 November 2016 to our ELITE option.

The following waiting periods will apply from 1 November 2016 applicable to our GAP BENEFIT (because this is the benefit the client already had on our BASE option)

0 MONTH GENERAL WAITING PERIOD

1 MONTH PRE-EXISTING CONDITION WAITING PERIOD

6 MONTH CONDITION SPECIFIC WAITING PERIOD

PRE-DIAGNOSED CANCER WAITING PERIOD (the remainder of the remission period will still apply)

AS WELL AS

3 MONTH PRE-EXISTING CONDITION WAITING PERIOD effective 1 November 2016 applicable to our CO-PAYMENT BENEFIT, SUB-LIMIT BENEFIT and ONCOLOGY BENEFITS (because these are the new benefits the client did not have prior to the upgrade)

PLEASE NOTE

A client on our BASE option who received our PRE-DIAGNOSED CANCER WAITING PERIOD (applicable to all benefits), will not be subject to the full PRE-DIAGNOSED CANCER WAITING PERIOD on ONCOLOGY BENEFITS. In this particular example, the client joined our BASE option on 1 July 2016 and will therefore be into their PRE-DIAGNOSED CANCER WAITING PERIOD by 4 months. The remainder of this period will be carried over to the upgraded ELITE option and will be applied to the benefits that the client had on their BASE option. In terms of the enhanced benefits, a

3 MONTH PRE-EXISTING CONDITION WAITING PERIOD will apply during the upgrade window period.

 Clients on our BASE option cannot upgrade to our CO-EVOLUTION option as this upgrade opportunity will not be included in the upgrade concession. Should a client however wish to upgrade in this manner, a 6 MONTH WAITING PERIOD on enhanced benefits for pre-existing conditions will apply

STRATUM BENEFITS OPTION UPGRADE TO OUR ELITE OPTION WITH 3 MONTHS WAITING PERIOD ON ENHANCED BENEFITS APPLICABLE TO

PRE-EXISTING CONDITIONSDURING THE WINDOW PERIOD

ENHANCED BENEFITS APPLICABLE TO OUR ELITE OPTION
BASE CO-PAYMENT BENEFIT

ONCOLOGY BENEFITS

SUB-LIMIT BENEFIT

CO-EVOLUTION ONCOLOGY BENEFITS

SUB-LIMIT BENEFIT

SENIOR LIKE FOR LIKE – NO NEW WAITING PERIODS WILL APPLY
G-FORCE LIKE FOR LIKE – NO NEW WAITING PERIODS WILL APPLY

A concession exists for our HOSPITAL OPTIMISER clients which does not form part of the concession upgrade period for our gap cover clients.

 Applicable to existing clients who have been on cover for longer than 10 months and wish to upgrade to a gap cover option

 No waiting periods will apply to our GAP BENEFIT on the chosen option but all other benefits on the chosen option will be underwritten as per the below:

 0 MONTH GENERAL WAITING PERIOD

6 MONTH PRE-EXISTING CONDITION WAITING PERIOD applies to all enhanced benefits on the upgraded option

TRANSFERRING COVER FROM ANOTHER PROVIDER

Individual clients belonging to another gap cover provider can transfer their cover to Stratum Benefits. The process for 2017 will remain the same as for 2016

 The qualifying criteria is as follows:

Clients must have

uninterrupted cover with another provider

on a gap product with a gap benefit

for a period of 3 months or longer

 If any of the applicants are aware of a medical condition that will require a medical procedure within the first 6 months from the first day their cover starts with Stratum Benefits, the following waiting periods will apply:

 0 MONTHS GENERAL WAITING PERIOD

0 MONTHS CONDITION SPECIFIC WAITING PERIOD however a 10 MONTH WAITING PERIOD will apply to PREGNANCY & CHILDBIRTH as well as a 10 MONTH PRE-EXISTING CONDITION WAITING PERIOD

3 YEAR PRE-DIAGNOSED CANCER WAITING PERIOD

 If any of the applicants are not aware of a medical condition that will require a medical procedure within the first 6 months from the first day their cover starts with Stratum Benefits, the following waiting periods will apply:

 0 MONTHS GENERAL WAITING PERIOD

0 MONTHS CONDITION SPECIFIC WAITING PERIOD however a 10 MONTH WAITING PERIOD will apply to PREGNANCY & CHILDBIRTH

0 MONTH PRE-EXISTING CONDITION WAITING PERIOD

3 YEAR PRE-DIAGNOSED CANCER WAITING PERIOD

 


(Taken from material freely available on Stratum website)

form for Gap cover

 

Stratum Benefits update for 2017 was last modified: October 17th, 2017 by Kenny Williamson

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