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Medical Aid Year: 
2020
Day to day Benefits: 

General practitioner and specialist consultations,
radiology (incl. Nuclear Medicine Study and bone
density scans). Prescribed and over-the-counter
medicine. Optical and auxiliary services, e.g.
physiotherapy, occupational therapy, contraceptive
pill...

In Hospital Benefits
Hospital Rate of Payment: 
Private hospitals Unlimited. 100% of Agreed Tariff, subject to use of DSP hospital (Netcare or Life Healthcare). (30% co-payment at non-DSP hospital.) State hospitals Unlimited. 100% of Agreed Tariff.
Hospitals: 

Unlimited. 100% of Agreed Tariff.

Specialists: 
Unlimited, subject to use of DSP provider.
Radiology and pathology: 
Radiology Pre-authorisation: specialised radiology, including MRI, CT and PET scans. Hospitalisation not covered if radiology is for investigative purposes only. (MSA / day-to-day benefits will then apply.) Pathology Unlimited.
Dialysis: 
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Oncology / Cancer: 
R397 000 benefit Pfpa. Pre-authorisation compulsory and subject to Case Management, Scheme Protocols and use of DSP providers.
Joint Replacements: 
Unlimited. 100% of Agreed Tariff.
Prosthesis: 

R46 300 benefit Pfpa, combined benefit. Pre-authorisation compusory and subject to
Case Management, reference pricing, DSP and Scheme Protocols.

Medical and Surgical Appliances: 
Wheelchairs, orthopaedic appliances and incontinence equipment (incl. contraceptive devices). R8 900 benefit Pfpa. Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required. Oxygen/nebulizer/glucomet...
In Hospital Dentistry: 
R1 640 co-payment per hospital admission. DENIS pre-authorisation compulsory.
Take home Medicine: 
R525 benefit Per admission.
Rehabilitation, Hospice and Step-down facilities: 
R39 900 benefit Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. Pfpa. Wound care is included in this benefit up to an amount of R13 100. Combined in- and out-of-hospital benefit.
Treatment for Mental Health: 
R39 900 Pre-authorisation compulsory and subject to Case Management. Pfpa. Combined benefit; in- and out-of-hospital. Out-of-hospital treatment is limited to R16 300.
HIV / AIDS: 
Unlimited. Chronic Disease Programme, managed by Lifesense, applicable.
Day-to-day benefits
GP consultations: 

Annual Medical Savings Account (MSA):
PM: R6 528 p.a.
AD: R4 416 p.a.
CD: R1 272 p.a.
Additional day-to-day benefits:
PM: R4 920 p.a.
AD: R3 670 p.a.
CD: R1 180 p.a

Specialist consultations: 

Annual Medical Savings Account (MSA):
PM: R6 528 p.a.
AD: R4 416 p.a.
CD: R1 272 p.a.
Additional day-to-day benefits:
PM: R4 920 p.a.
AD: R3 670 p.a.
CD: R1 180 p.a

Over-the-counter (OTC) Medicine: 

R2 010 benefit Pfpa sublimit. Subject to MSA / day-to-day benefit.

Optometry benefits: 
R3 090 benefit Pbp2a total optical benefit. Subject to MSA / day-to-day benefit and Optical Management. Benefit confirmation compulsory. Frames R980 benefit. Per frame, 1 frame pbp2a. Subject to overall optical benefit. Lenses 1 pair pbp2a. Subject t...
Basic dentistry: 
DENIS protocols, Scheme Rules and Managed Care interventions apply. Exclusions apply in accordance with Scheme Rules. 2 check-ups pbpa.
Orthodontics: 

DENIS pre-authorisation compulsory. Cases will be clinically assessed using
orthodontic indices where function is impaired. Not for cosmetic reasons; laboratory
costs also excluded. Only 1 beneficiary per family may commence treatment per
calendar ye...

MRI and CT Scans (Out of Hospital): 
R16 300 benefit Pfpa. R1 000 co-payment per scan (in- or out-of-hospital), excluding confirmed PMBs.
Radiology and Pathology: 
Radiology Pre-authorisation: specialised radiology, including MRI, CT and PET scans. Hospitalisation not covered if radiology is for investigative purposes only. (MSA / day-to-day benefits will then apply.) Pathology Unlimited.
Chronic Conditions
Provider: 
Category A (CDL) Unlimited – subject to reference pricing and protocols. Registration on Chronic Disease Programme compulsory. Category B (other) R8 400 benefit Subject to chronic benefit with a maximum Pfpa.
Chronic Conditions: 

Unlimited – subject to reference pricing and protocols. Registration on
Chronic Disease Programme compulsory

Total Contributions
Gold
Medical Aid Plan Name Term: 
Any