Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Casualty / Emergency Visits:
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
MRI and CT scans:
R30 580 per family available, in- or out-of hospital. Subject to pre-authorisation. R1500.00 co-payment per scan
Dialysis:
Unlimited at 100% of BR. You must use a Designated Service Provider(DSP), or a 20% co-payment will apply
Organ Transplants:
Unlimited at 100% of BR. Sub-limit of R33 220 for corneal grafts
Oncology / Cancer:
R410 400 available per family. Subject to the use of a preferred provider. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations:
For spinal surgery: you will have a co-payment of R15 000 if you do not go for an assessment through the back and neck program
Joint Replacements:
You will have a co-payment of R30 000 if you do not use the preferred provider
Medical and Surgical Appliances:
Subject to available savings. Hearing aids; R17 810 per family available once in 5 years, with a 10% co-payment. Subject to the use of a preferred supplier
In Hospital Dentistry:
A co-payment of R3 500 per hospital admission applies for children under the age of 5 and R5 000 for any other admission including removal of impacted teeth or any other medical condition
Take home Medicine:
R490 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities:
Physical rehabilitation R52 320 per family. Hospice and step-down facilities; R16 880 per family. Terminal Care; unlimited
Treatment for Mental Health:
Hospitalisation; R42 610 per family with R17 810 per family available for In- or out-of-hospital consultations. No cover for physiotherapy for mental health admissions. Subject to the use of a DSP
HIV / AIDS:
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from Pharmacy Direct
International Travel Benefit:
Cover for medical emergencies when you travel outside South Africa. Subject to registration