Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
MRI & CT scans co-payment in and out of hospital
Sigmoidoscopy and cystoscopy; R2 100 co-payment per scope
(in-hospital). Hysteroscopy; R2 950 co-payment per scope (in-hospital).
Arthroscopy and laparoscopy (diagnostic): R3 700 co-payment per scope
(in-hospital).
Casualty / Emergency Visits:
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Dialysis:
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Organ Transplants:
Pre-authorisation compulsory and subject to Case Management. PMB entitlement in DSP hospitals only.
Oncology / Cancer:
Per family per annum. Pre-authorisation compulsory and subject to Case Management and Scheme Protocols.
Neck and Back Operations:
Medical and Surgical Appliances:
Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required.
Maternity Confinements:
Private ward for 3 days for natural birth.
Rehabilitation, Hospice and Step-down facilities:
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Treatment for Mental Health:
R17 700 Per family per annum. Pre-authorisation compulsory and subject to Case Management. In-hospital benefit only. Out-of-hospital: PMB entitlement
HIV / AIDS:
Unlimited. Chronic Disease Programme applicable.
Ambulance Service:
DSP - NETCARE 911. Unlimited, subject to use of DSP and protocols. (40% co-payment at non-DSP service provider.)
