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HEALTH SQUARED FOUNDATION (R5,101 – R6,850) 2019

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Medical Aid Year: 
2018
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited. Subject to Scheme Protocols.
Specialists: 
Non-Contracted Providers at 100% of Scheme Rate. Contracted Providers at 100% of Contracted Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Limited to Network Providers and subject to PMB and Scheme Protocols.
Radiology and pathology: 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Pre- auth required.
MRI and CT scans: 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Pre- auth required.
Dialysis: 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Pre- auth required.
Organ Transplants: 
Limited to PMB ‘s Only
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
Neck and Back Operations: 
Limited to R39 569 per family per annum. Subject to Prosthesis Sub- Limits, Scheme Protocols and PMB's
Joint Replacements: 
Limited to R39 569 per family per annum. Subject to Prosthesis Sub- Limits, Scheme Protocols and PMB's
Prosthesis: 

Foundation PMB ONLY Overall Option

Limit R 39 569

Medical and Surgical Appliances: 
R 2 072 per family per annum Subject to PMB, Scheme Protocols and appliance sub-limits.
Maternity Confinements: 
Length of stay: 3 days & 2 nights.
In Hospital Dentistry: 
Subject to PMB’s only. Pre- authorisation is required and Scheme Protocols apply. Multiple hospital admissions are not covered.
Take home Medicine: 
Maximum of 7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
No Benefit except in lieu of hospitalisation. Subject to pre-auth.
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
Contracted Rate.
CDL PMB consultations covered
separately. Subject to Disease

Management Protocols and pre-
auth.

Specialist consultations: 

Subject to PMB and referral by

GP Provider. Subject to Pre-
authorisation, and limited to

Specialist Network Providers

Acute medicine: 

Limited to Network Providers.
Scheme protocols and formularies
apply. For Non-Dispensing
Providers, script limit of R104
per event limited to 4 events per
beneficiary.

Optometry benefits: 
1 consultation per beneficiary. Limited to Network Provider and 24 month benefit cycle.
Basic dentistry: 
Subject to Scheme Protocols, Network Providers and annual limits of: M R2 072 M+ R3 451
Orthodontics: 

No Benefit.

Pregnancy benefits: 
Surgical operations & procedures Theatre fees Labour and recovery wards Ward accommodation Intensive care and high care units X-rays and pathology Ultrasound scans (other than for pregnancy) Blood transfusions
Chronic Conditions
Chronic Conditions: 

CDL CONDITIONS

ADDISON'S DISEASE, ASTHMA, BIPOLAR MOOD DISORDER, BRONCHIECTASIS, CARDIAC DYSRHYTHMIAS, CARDIAC FAILURE, CARDIOMYOPATHY, COPD, CROHN'S DISEASE, CHRONIC RENAL FAILURE, CORONARY ARTERY DISEASE, DIABETES INSIPIDUS, DIABETES MELLITUS TYPE 1, DIABETES MELLITUS TYPE 2, EPILEPSY, GLAUCOMA, HAEMOPHILIA, HIV, HYPERLIPIDAEMIA, HYPERTENSION, HYPOTHYROIDISM, MULTIPLE SCLEROSIS, PARKINSON'S DISEASE, RHEUMATOID ARTHRITIS, SCHIZOPHRENIA, SLE, ULCERATIVE COLITIS

Preventative Care Benefits
Preventative Benefits: 

Screening Benefit:

Blood Pressure, Blood Sugar, Cholesterol, Body Mass Index R130 per beneficiary over the age of 18 years. Only at pharmacy.

HIV Test 1 Test per beneficiary per annum.

Mammogram (screening) 1 Examination per female beneficiary per annum over the age of 35 years

Pap smears 1 Test per beneficiary per annum.

PSA Testing 1 Test per beneficiary per annum over the age of 45 years.

Vaccinations:

Flu 1 dose Flu vaccination per beneficiary per annum.

Childhood immunisations Childhood immunisations as recommended by the Department of Health up to 18 months.

HPV Vaccine (Cervical cancer prevention) 1 course (3 doses per registeredschedule) per female beneficiaryper life between 9 and 46 years of age.

Oral Contraception R1 668 per female beneficiary per annum - R139 per month.

Clinic Nurse Consultation Subject to Preferred Provider Only :

Additional 15 min Consult + Flu vacine , Mother Ante-Natal visit, Mother and Well Baby Consult (incl admin of Immunisation)  Subject to PDC referral

Total Contributions
Total Contribution Main Member: 
1261.00
Total Contribution Adult: 
1261.00
Total Contribution Child*: 
435.00
Foundation (R5,101 – R6,850)
Risk Contributions
Risk Contribution Main Member: 
1261.00
Risk Contribution Adult: 
1261.00
Risk Contribution Child: 
435.00
Medical Aid Plan Name Term: 
Any