Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
Casualty / Emergency Visits:
Paid from medical savings account
Specialists:
Unlimited 200 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Unlimited 200 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
We pay the first 3 150 of the hospital account from your day-to-day benefits and the balance of the hospital account and related accounts from the Hospital Benefit.
MRI and CT scans:
If done as part of an approved admission, we will pay up to 100% of the DHR from the Hospital Benefit.
ICU and High Care:
Unlimited 100 % of scheme rate
Dialysis:
Unlimited 100 % of scheme rate
Organ Transplants:
Subject to pre-authorisation and clinical protocols Unlimited 100 % of scheme rate
Medical and Surgical Appliances:
Subject to medical savings account
Maternity Confinements:
You have access to antenatal consultations and 2D pregnancy scans, provided you use a gynaecologist/obstetrician who we have a payment arrangement with
Rehabilitation, Hospice and Step-down facilities:
Out-of-hospital claims for recovery after certain traumatic events are covered on this benefit for the rest of the year in which the trauma took place, and a year after the trauma.
Treatment for Mental Health:
21 days for admissions or up to 15 outof- hospital consultations for each person for major affective disorders, anorexia and bulimia and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma. 21 days for
International Travel Benefit:
Up to 500 000 for each person travelling for evidence-based healthcare treatment not available in South Africa. A copayment of 20% and specific rules apply to this benefit.