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Foundation R5,101 – R6,850

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Medical Aid Year: 
2020
Day to day Benefits: 

As specified.

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

PRIVATE HOSPITALS:Unlimited, subject to PMB’s and
only at DSP network hospitals.
Subject to co-payment for use
of non-DSP. Procedure copayments
may also be applicable.
Subject to Scheme Protocols and
option- specific exclusion list.
For procedural an...

Upfront Payments to hospitals: 

Unlimited, subject to PMB’s and
only at DSP network hospitals.
Subject to co-payment for use
of non-DSP. Procedure copayments
may also be applicable.
Subject to Scheme Protocols and
option- specific exclusion list.
For procedural and admission copaym...

Casualty / Emergency Visits: 
No Benefit unless proven PMB
Specialists: 
Non-Contracted Providers at 100% of Scheme Rate. Contracted Providers at 100% of Contracted Rate.
Radiology and pathology: 
Limited to PMB and subject to Network Provider Formulary list
ICU and High Care: 
100% of Contracted Rate.
Dialysis: 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Preauth required.
Oncology / Cancer: 
Limited to R84 949 per beneficiary per annum. Subject to ICON Network and standard protocols. Pre-auth required. 40% NON DSP co-payment
Joint Replacements: 
No Benefit
Prosthesis: 

Limited to R39 569 per family per
annum. Subject to Prosthesis Sub-
Limits, Scheme Protocols and PMB.

Medical and Surgical Appliances: 
R 2 072 per family per annum Subject to PMB, Scheme Protocols and appliance sub-limits.
Take home Medicine: 
Maximum of 7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
Limited to Network Providers and subject to PMB and Scheme Protocols.
HIV / AIDS: 
HIV Management Programme.
International Travel Benefit: 
No Benefit
Day-to-day benefits
GP consultations: 

Limited to a Foundation Network
Provider. Unlimited, however,
authorisation required after 4th
visit per beneficiary.
Non-Contracted Providers at 100%
of Scheme Rate (Limited to 2
out-of-network visits per family).
Contracted Providers at 100% of
Con...

Specialist consultations: 

Subject to PMB and referral by
GP Provider. Subject to Preauthorisation,
and limited to
Specialist Network Providers

Optometry benefits: 
Subject to MSA per beneficiary Sub Limit R 2 520 Frame Sub Limit R 1 155
Basic dentistry: 
Subject to Scheme Protocols, Network Providers and annual limits of: M R2 072 M+ R3 451.Consultations: 2 Annual check-ups per beneficiary per annum. 2 Emergency consultations per beneficiary per annum. Covered at 100% Scheme Rate.X-rays: Intra-Oral: ...
Orthodontics: 

No Benefit.

MRI and CT Scans (Out of Hospital): 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Preauth required.
Radiology and Pathology: 
Limited to PMB and subject to Network Provider Formulary list
Chronic Conditions
Chronic Conditions: 

Included. Subject to registration
by a Network Provider. Subject
to Foundation Chronic Formulary.
Reference and GRP pricing applies.

Total Contributions
Foundation
Medical Aid Plan Name Term: 
Any