Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
R9 500 for back and neck fusions. R3 550 for endoscopic procedures in hospital. R2 900 for dentistry. R1 550 for MRI scans.
Casualty / Emergency Visits:
Specialists:
Unlimited 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Unlimited 100 % of scheme rate
Radiology and pathology:
Unlimited 100 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
100 % of scheme rate subject to R3 550 co-payment per admission. In doctor's rooms no co-payment
MRI and CT scans:
Unlimited 100 % of scheme rate subject to R1 550 co-payment
ICU and High Care:
Unlimited 100 % of scheme rate
Dialysis:
Unlimited 100 % of scheme rate
Organ Transplants:
Subject to pre-authorisation and clinical protocols Unlimited 100 % of scheme rate
Oncology / Cancer:
100 % of scheme rate DSP ICON
Neck and Back Operations:
100 % of scheme rate subject to R9 500 co-payment per admission
Medical and Surgical Appliances:
Sub-limits apply subject to scheme protocols
Maternity Confinements:
Unlimited 100 % of scheme rate
In Hospital Dentistry:
100 % of scheme rate co-payment of R2900 per admission for impacted wisdom teeth, extensive dental treatment for children younger than 5 years. Dentist's account from savings.
Rehabilitation, Hospice and Step-down facilities:
Subect to pre-authorisation and prescribed by a medical doctor
Treatment for Mental Health:
Subect to pre-authorisation and prescribed by a medical doctor
International Travel Benefit: