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Our Plans

Ebony

Ebony Plan
Private hospitals, government, municipal and mission facilities

Contributions Schedule

Age Band

Principal Member/Member

Spouse

18 - 25

34

34

26 – 39

43

43

40 – 50

49

49

51 – 60

59

59

61 an over

72

72

+60 first time joiner

86

86

Child

26

Routine Benefit Account

*Entitlement determined by MSA contribution level

MSA Low

MSA Medium

MSA High

MSA Super High

 

 

Allocation per principal member

$208

$250

$300

$360

MEDICAL SAVINGS ACCOUNT CONTIBUTIONS

Level

Member with no dependant

Member with 1 dependant

Member with 2 dependants

Member with 3 dependant

Member with 4 or more dependants

Low

8

17

25

34

42

Medium

13

25

38

50

64

High

17

34

50

67

84

Super High

22

42

64

84

106

Benefits Schedule

Plan Name

EBONY

Insured Benefit

Annual limit

$20 800

Facility Admission

Private, government, mission, municipal

Ward Admission

General wards

GP Consultations

Limited to MSA/RBA

Chronic Medication

Members must register

on the Chronic Care Network

US$300

Generic policy applies.

 

Acute Medicine

Excluding over the counter medication

Limited to MSA & RBA

Dental (annual limit)

Member liable for

dental co-payment

Paid per AHFoZ tariff.

US$1,500

Orthodontic

No benefit

Optical (2 yearly limit)

US$300

Pathology

Paid per AHFoZ tariffs Overall limit apply

Radiology

(Pre-notification

required for MRI

scans, CT scans &

Bone densitometry

Scans)

 

Paid per AHFoZ tariffs Overall limit apply

Prosthesis

i. Internal

ii. External

 

US$1,200

US$300

Rehabilitation

Notification required.

US$980 per annum

Special Appliances

i) Hearing Aid (lifetime award)

 

ii) Glucometer, Nebuliser, etc.

 

iii) Ostomy bags (Motivation letter from doctor required)

 

US$360

 

US$150 per 4 years.

 

US$300 per annum

Funeral Grant

US$400

Biller Code: 35376                           

one money logoBiller Code: 22411                           Biller Code: 100126 

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