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HEALTH SQUARED ULTIMATE 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited.
Hospitals: 

Unlimited.
Procedure co-payments may also
be applicable.

Upfront Payments to hospitals: 

Arthroscopy R 4 000

Colonoscopy R 3 000

Conservative back / spine treatment R 6 000

Cystoscopy R 2 000

Dental Admissions R 3 000

Endometrial ablation R 4 000

Excision nail bed R 2 000

Gastroscopy R 5 000

Hernia Repair R 5 000

Hysterectomy R 6 000

Hysteroscopy R 6 000

Joint replacements R 12 000

Laparoscopic procedures R 4 000

Medical admission Co-pay (Including Maternity and
Psychitric admissions) R 2 500

Sigmoidoscopy R 1 500

Specialised radiology (MRI, CT,PET Scan ) per scan R 2 000

Spinal surgery R 12 000

Urinary Incontinence Repair R 4 000

Varicose veins R 4 000

Casualty / Emergency Visits: 
Limited to R1 765 for emergency visits per family per annum unless PMB
Specialists: 
Non-Contracted Providers at 100% of Scheme Rate. Contracted Providers at 100% of Contracted Rate (Up to 220% of Scheme Rate)
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to Sub Limit
Radiology and pathology: 
R20 776 per family per annum. Subject to Scheme Protocols and PMB. Pre-auth required. Co-payment of R2 000 per incident. (In-and-out of hospital). 100% of Scheme Rate.
MRI and CT scans: 
R20 776 per family per annum. Subject to Scheme Protocols and PMB. Pre-auth required. Co-payment of R2 000 per incident. (In-and-out of hospital). 100% of Scheme Rate.
Dialysis: 
Unlimited at Network Provider. Subject to Scheme Protocols. Pre- auth required.
Organ Transplants: 
Unlimited, subject to PMB and Scheme Protocols.
Oncology / Cancer: 
Unlimited. Subject to ICON Network and standard protocols. Pre-auth required. 40% NON DSP CO payment
Neck and Back Operations: 
Limited to R59 364 per family per annum.
Joint Replacements: 
Limited to R59 364 per family per annum.
Prosthesis: 

Unlimited per family per annum. Subject to Prosthesis Sub-Limits, Scheme Protocols.

Overall Option Limit R65 966 per Event

Knee R50 082,

Hip R 45 440

Shoulder, Elbow, Ankle R58 068

Medical and Surgical Appliances: 
R16 595 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 Scheme Protocols.
Take home Medicine: 
Maximum of 7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
21 days per family per annum. 100% of Scheme Rate.
HIV / AIDS: 
HIV Management Programme
International Travel Benefit: 
Limited to emergency medical cover up to R2 million per beneficiary per incident
Day-to-day benefits
GP consultations: 

Unlimited.

Non-Contracted Providers at
100% of Scheme Rate. Contracted
Providers at 100% of Contracted
Rate.
CDL PMB consultations covered
separately. Subject to Disease

Management Protocols and pre-
auth.

Specialist consultations: 

M 4 visits per annum.
M+1 5 visits per annum.
M+2+ 6 visits per annum.
Non-Contracted Providers at
100% of Scheme Rate. Contracted
Providers at 100% of Contracted
Rate (Up to 220% of Scheme Rate)
CDL PMB consultations covered
separately. Subject to Disease

Management Protocols and pre-
auth.

Acute medicine: 

M R8 260
M+1 R14 530
M+2+ R16 569
With a sub-limit on Schedule 0-2
drugs of:
M R2 491
M+1 R4 290
M+2+ R4 685

Optometry benefits: 
1 consultation per beneficiary. Limited to Network Provider and 24 month benefit cycle.
Basic dentistry: 
2 Annual check-ups per beneficiary per annum. 2 Emergency consultations per beneficiary per annum. Covered at 100% Scheme Rate.
Specialised Dentistry: 
R14 796 per family per annum.
Orthodontics: 

Benefits on pre-authorisation
will be applied to cases assessed
as treatment mandatory, as per
orthodontic indices. Limited to
individuals younger than 38 years
of age. Orthognathic surgery is not
covered.

MRI and CT Scans (Out of Hospital): 
R20 776 per family per annum. Subject to Scheme Protocols and PMB. Pre-auth required. Co-payment of R2 000 per incident. (In-and-out of hospital). 100% of Scheme Rate.
Radiology and Pathology: 
R20 776 per family per annum. Subject to Scheme Protocols and PMB. Pre-auth required. Co-payment of R2 000 per incident. (In-and-out of hospital). 100% of Scheme Rate.
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 100% of Contracted Rate.chronic
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

Additional Chronic Conditions

ADHD, ALZHEIMER'S DISEASE, ANKYLOSING SPONDYLITIS, CYSTIC FIBROSIS, ENDOMETRIOSIS, GORD/GERD, GOUT, OBSESSIVE COMPULSIVE DISORDER, OSTEOPOROSIS, OSTEOARTHRITIS, PAGET’S DISEASE, PSORIASIS, WILSON’S DISEASE, ALLERGIC RHINITIS, ANGINA PECTORIS, CEREBROVASCULAR ACCIDENT (STROKE), CUSHING’S SYNDROME, DELUSIONAL DISORDER, ECZEMA, HYPERTHYRODISM, IDIOPATHIC THROMBOCYTOPENIC PURPURA, INTERSTITIAL FIBROSIS OF THE LUNG, MAJOR DEPRESSION, MENIERE’S SYNDROME, MOTOR NEURON DISEASE, MYASTENIA GRAVIS, PERIPHERAL VASCULAR DISEASE, PITUITARY ADENOMA, SCLERODERMA, URINARY INCONTINENCE

Preventative Care Benefits
Preventative Benefits: 

R4 155 per family per annum, Scheme Rate applies.

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: 
5921.00
Total Contribution Adult: 
5635.00
Total Contribution Child*: 
1467.00
Ultimate
Risk Contributions
Risk Contribution Main Member: 
5921.00
Risk Contribution Adult: 
5635.00
Risk Contribution Child: 
1467.00
Medical Aid Plan Name Term: 
Any