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Hospital Standard

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Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2020
Day to day Benefits: 

No benefit

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited at 100% of Bonitas Rate (BR)
Hospitals: 

Any

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
PMB only. Your therapist must have a referral from the doctor treating you in hospital
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Co-payment of R1 520 applies if performed in-hospital
MRI and CT scans: 
R26 620 per family available, in- or out-of hospital. Subject to pre-authorisation
ICU and High Care: 
Unlimited at 100% of BR
Dialysis: 
Unlimited at 100% of BR. You must use a Designated Service Provider(DSP), or a 20% co-payment will apply
Organ Transplants: 
Unlimited. Sub-limit of R32 120 per beneficiary for corneal grafts
Oncology / Cancer: 
R344 500 available per family. Subject to the use of a preferred provider. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations: 
Co-payment of R7 580. Managed Care Protocols apply and the use of a preferred supplier
Joint Replacements: 
No benefit
Prosthesis: 

Internal: R45 090 per family.
Managed Care protocols apply and the use of a preferred supplier.
External: PMB only. Managed Care protocols apply

Medical and Surgical Appliances: 
No benefit
Maternity Confinements: 
Unlimited at 100% of BR
In Hospital Dentistry: 
Co-payment of R3 500 per admission. General anaesthetic only available to children under 5 for extensive treatment once per lifetime and for impacted wisdom teeth. Pre-authorisation required. Managed Care Protocols apply
Take home Medicine: 
R475 per beneficiary per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation; R50 600 per family. Hospice and step-down facilities; R16 880 per family. Terminal care; unlimited
Treatment for Mental Health: 
Hospitalisation; R15 830 per family. No cover for physiotherapy for mental health admissions. Subject to the use of a DSP
HIV / AIDS: 
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from Pharmacy Direct
Ambulance Service: 
ER24 in an emergency
International Travel Benefit: 
Cover for medical emergencies when you travel outside South Africa. Subject to registration
Day-to-day benefits
GP consultations: 

No benefit

Specialist consultations: 

No benefit

Acute medicine: 

No benefit

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
No benefit
Basic dentistry: 
No benefit
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
R26 620 per family available, in- or out-of hospital. Subject to pre-authorisation
Radiology and Pathology: 
No benefit
Pregnancy benefits: 
6 antenatal consultations with a gynaecologist, GP or midwife, 2 2D scans,1 amniocentesis, 4 consultations with a midwife after delivery. 1 of these may be used for a consultation with a lactation specialist. Maternity support for pregnant moms
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
Pharmacy Direct and formulary medication. A 40% co-payment applies for non-use of the network pharmacy or formulary
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes

Additional Chronic Conditions: 
None
Preventative Care Benefits
Preventative Benefits: 

Contraceptives for women up to 50, limited to R1 610 per family. Subject to the DSP for pharmacy-dispensed contraceptives. Childcare: Hearing screening for newborns, in- or out-of hospital; Congenital hypothyroidism screening for infants under 1 month; Babyline 24/7 helpline for children under 3 years; Paediatrician or GP consultations: 1 per child, per annum, up to 2 years; 1 GP consultation per child, from 2 - 12 years. Other: 1 wellness screening test per beneficiary at a wellness network provider; 1 HIV test and 1 Flu vaccine per beneficiary; Age specific tests for: pap smear; mammogram; prostate screening; pneumococcal vaccine and stool test for colon cancer. Wellness Extender benefit of R1 270 per family available after completing a wellness screening test

Total Contributions
Total Contribution Main Member: 
2284.00
Total Contribution Adult: 
1925.00
Total Contribution Child*: 
869.00
Hospital Standard
Medical Aid Plan Name Term: 
Any