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HEALTH SQUARED RISE 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: 
Subject to ICON Network and standard protocols. Pre-auth required. 40% NON DSP co-payment
Neck and Back Operations: 
Subject to Scheme Protocols and PMB
Joint Replacements: 
Subject to Scheme Protocols and PMB
Prosthesis: 

PMB Only

Medical and Surgical Appliances: 
PMB only
Maternity Confinements: 
Length of stay: 3 days & 2 nights.
In Hospital Dentistry: 
No Benefit
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: 
Limited to emergency medical cover up to R750 000 per beneficiary per incident
Day-to-day benefits
GP consultations: 

No Benefits Subject to PMB’s

Specialist consultations: 

Limited to PMB at Network

Providers. Subject to pre-
authorisation.

CDL PMB consultations covered
separately. Subject to Disease

Management Protocols and pre-
auth.

Acute medicine: 

Subject to PMB's

Optometry benefits: 
No Benefit
Basic dentistry: 
No Benefit
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: 
1513.00
Total Contribution Adult: 
1509.00
Total Contribution Child*: 
548.00
Rise
Risk Contributions
Risk Contribution Main Member: 
1513.00
Risk Contribution Adult: 
1509.00
Risk Contribution Child: 
548.00
Medical Aid Plan Name Term: 
Any