Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% of Bonitas Rate (BR)
Upfront Payments to hospitals:
Day surgery procedures must be done in a day-hospital or a R2 200 co-payment will apply. Co-payments apply to certain procedures performed in hospital: R1 570 for minor procedures;
R3 980 for Arthroscopy, Diagnostic Laparoscopy, Laparoscopic Hysterectomy and Percutaneous Rhizotomies;
R7 840 for Back Surgery including Spinal Fusions, Laparoscopic Pyeloplasty, Laparoscopic Radical Prostatectomy and Reflux surgery
Other healthcare professionals eg. Physio, Occupational, Dietician:
Subject to referral by treating practitioner and available savings, except for PMB
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Co-payment of R1 570 applies if performed in-hospital
MRI and CT scans:
R24 610 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:
R344 500 available per family. Subject to the use of a preferred provider. Sub-limit of R44 220 per beneficiary for Brachytherapy
Neck and Back Operations:
Co-payment of R7 840. Managed Care Protocols apply and the use of a preferred supplier
Medical and Surgical Appliances:
Subject to available savings
In Hospital Dentistry:
PMB only. Pre-authorisation required
Take home Medicine:
R405 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities:
Physical rehabilitation R52 320 per family. Hospice and step-down facilities; R17 450 per family. Terminal Care; unlimited
Treatment for Mental Health:
Hospitalisation; R33 410 per family with R16 430 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
