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Millenium 2021

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2021
Day to day Benefits: 

Cover from your Medical Savings Account(MSA), Self-Payment Gap(SPG) or Above Threshold Benefit(ATB) for all day-to-day benefits. Sub-limits apply to some services

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

Any. Subject to Scheme Protocols and option-specific exclusion list

Upfront Payments to hospitals: 

Procedure co-payments may apply to admissions; full details in the 2021 brochure

Casualty / Emergency Visits: 
Unlimited for trauma and PMB. Verification of pre-authorisation within 72 hours of the event
Specialists: 
Contracted Providers at 100% of CR. Non-contracted Providers at 100% of Scheme Rate(SR)
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Contracted Providers at 100% of CR. Non-contracted Providers and Physiotherapy at 100% of SR
Radiology and pathology: 
100% of CR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Subject to co-payments of R7 524 for a gastroscopy and R3 762 for a colonoscopy
MRI and CT scans: 
Unlimited for emergency, injury-related and trauma. Non-PMB's limited to R17 697 per annum, with a co-payment of R3 612. Scheme rules and Protocols apply
ICU and High Care: 
100% of CR
Dialysis: 
Unlimited at Network Provider. Subject to Scheme Protocols. Pre-authorisation required
Organ Transplants: 
Unlimited. Subject to PMB's and Scheme Protocols
Oncology / Cancer: 
Unlimited. Subject to ICON Network and Enhanced protocols. Pre-authorisation required. 40% Non-DSP co-payment
Neck and Back Operations: 
Subject to co-payment of R15 048 and prosthesis sub-limit for non-PMB surgery
Joint Replacements: 
Subject to co-payment of R15 048 and prosthesis sub-limit for non-PMB surgery
Prosthesis: 

Internal: Unlimited per family per annum. Subject to prosthesis sub-limits and Scheme Protocols.
Non-PMB's subject to overall annual limit of R70 244 per family per annum.
Cochlear implants once per lifetime per beneficiary R88 488; Coronary stents to a maximum of R68 934 for 2 stents; knee, hip, shoulder, elbow, ankle varying to a maximum of R59 171; spinal fusions per level to a maximum of R68 934; hernia mesh R8 752; intraocular lenses R4 073 per lens

Medical and Surgical Appliances: 
Limited to R13 273 per family per annum. Scheme Protocols and appliance sub-limits apply. Must be prescribed by a registered Healthcare practitioner and obtained from a supplier registered with the Board of Healthcare Funders
Maternity Confinements: 
Normal delivery; 3 days and 2 night: Caesarean section; 4 days and 3 nights
In Hospital Dentistry: 
Limited to impacted wisdom teeth and extensive dental procedures in children under 5 years. Co-payment of R3 762 and Scheme Protocols apply
Take home Medicine: 
Maximum of 7 days supply
Rehabilitation, Hospice and Step-down facilities: 
Unlimited in lieu of hospitalisation. Subject to pre-authorisation. Non-PMB's limited to 18 days per family per annum
Treatment for Mental Health: 
Psychiatric disorders are limited to Network Providers and subject to PMB's and Scheme Protocols. Non-PMB's limited to R22 124
HIV / AIDS: 
Subject to registration on the HIV Management Programme. Hospitalisation at Network Provider hospitals. Subject to Scheme Protocols and PMB's
Ambulance Service: 
Netcare 911 in an emergency
Day-to-day benefits
GP consultations: 

Subject to Medical Savings Account(MSA), Self Pay Gap(SPG) and Above Threshold Benefit(ATB). Contracted Providers at 100% of CR. Non-contracted Providers at 100% of SR

Specialist consultations: 

Subject to MSA, SPG and ATB. Contracted Providers at 100% of CR, up to 220% of Scheme Rate. Non-contracted Providers at 100% of SR

Acute medicine: 

Subject to MSA, SPG and ATB and PMBs, plan formulary and Preferred Provider Pharmacy. Reference and Generic Reference Pricing(GRP) may apply

Over-the-counter (OTC) Medicine: 

Subject to MSA, SPG and ATB and PMBs, plan formulary and Preferred Provider Pharmacy. Reference and Generic Reference Pricing(GRP) may apply

Optometry benefits: 
Subject to a 24 month cycle and Network Provider. Subject to MSA, SPG, ATB and sub-limit of R3 374 per beneficiary for eye test and spectacles or contact lenses
Basic dentistry: 
Subject to Scheme Protocols MSA, SPG, ATB and sub-limits: M = R7 374; M+1 = R10 174; M+2+= R12 093. 2 check-ups, 2 emergency consults and 2 scale and polish per beneficiary pa. Cover for x-rays, fillings, extractions and root canal therapy at 100% of SR
Specialised Dentistry: 
Subject to Scheme Protocols, MSA, SPG, ATB and sub-limits: M = R6 958; M+1 = R9 599; M+2+= R11 410. 1 set of partial or full plastic dentures pbp4a, crowns and bridges. Pre-authorisation required
Orthodontics: 

Subject to MSA. 1 per lifetime for beneficiaries younger than 18 years. Benefits on pre-authorisation will be applied to cases assessed as treatment mandatory, as per orthodontic indices. No benefit for corrective jaw surgery

MRI and CT Scans (Out of Hospital): 
Unlimited for emergency, injury-related and trauma. Non-PMB's limited to R17 697 per annum, with a co-payment of R3 612. Scheme rules and Protocols apply
Radiology and Pathology: 
Subject to MSA, SPG and ATB
Pregnancy benefits: 
Subject to registration on the Maternity Programme. Consultations at any provider, subject to MSA, SPG and ATB, 2x 2D scans
Physiotherapy and Occupational Therapy day to day: 
Subject to MSA, SPG and ATB
Chronic Conditions
Provider: 
Medipost, Dischem and Clicks pharmacies. Subject to chronic formulary. Reference and Generic Reference Pricing(GRP) may apply
Chronic Conditions: 

Diagnosis, treatment and care costs of 27 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes. Benign Prostatic Hypertrophy and Hormone Replacement Therapy also covered as PMB's. Subject to Disease Management Protocols and pre-authorisation

Additional Chronic Conditions: 
2 as above + 30. Limited to M = R3 067; M+= R6 147
Preventative Care Benefits
Preventative Benefits: 

Limited to R2 941 per family per annum. Scheme Rate applies. Screening benefit with a sub-limit of R139 per beneficiary over the age of 18 only at pharmacy, pap smear, mammogram for female beneficiaries older than 40 years, HPV vaccine for females between 9 and 46 years, prostate test for males older than 45 years, flu vaccine and HIV test, childhood immunisations as recommended by the Department of Health up to 18 months, limited to R2 211 and preventative dental fissure sealants programme for children younger than 16. Oral contraceptives limited to R1 776 per beneficiary per annum with a sub-limit of R148 per month

Total Contributions
Total Contribution Main Member: 
6535.00
Total Contribution Adult: 
5595.00
Total Contribution Child*: 
1522.00
Millenium
Annual Medical Savings Account
Annual Medical Savings Main Member: 
10968.00
Annual Medical Savings Adult: 
9396.00
Annual Medical Savings Child*: 
2556.00
Monthly Medical Savings
Savings Child*: 
213.00
Savings Adult: 
783.00
Savings Main Member: 
914.00
Annual Threshold Amounts
Annual Threshold Main Member: 
17491.00
Annual Threshold Adult: 
14557.00
Annual Threshold Child*: 
3849.00
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
6539.00
Above Threshold Benefit Adult: 
5577.00
Above Threshold Benefit Child*: 
914.00
Risk Contributions
Risk Contribution Main Member: 
5621.00
Risk Contribution Adult: 
4812.00
Risk Contribution Child: 
1309.00
Medical Aid Plan Name Term: 
Millennium