Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
Casualty / Emergency Visits:
Specialists:
Unlimited 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Unlimited 100 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
You pay first R3 900 of hospital account. Scheme pays balance of account and related accounts from Hospital Benefit.
MRI and CT scans:
Unlimited 100 % of scheme rate if related to admission. If not related to admission, not covered.
ICU and High Care:
Unlimited 100 % of scheme rate
Dialysis:
Unlimited 100 % of scheme rate
Neck and Back Operations:
Medical and Surgical Appliances:
Maternity Confinements:
Unlimited 100 % of scheme rate
In Hospital Dentistry:
Dentistry: day clinic; R930 <13 years. R3 400 >13 years. In hospital: R2050 <13 years. R5 250 > 13 years
Rehabilitation, Hospice and Step-down facilities:
Subect to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health:
21 days for admissions or up to 15 out of hospital consultations for each beneficiary, up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma.
International Travel Benefit: