Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
Casualty / Emergency Visits:
Paid from medical savings account
Specialists:
Unlimited 100 % of scheme rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Unlimited 100 % of scheme rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
We pay the first 3 150 of the hospital account from your day-to-day benefits and the balance of the hospital account and related accounts from the Hospital Benefit.
MRI and CT scans:
If done as part of an approved admission, we will pay up to 100% of the DHR from the Hospital Benefit.
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
Medical and Surgical Appliances:
Subject to medical savings account
Maternity Confinements:
You have access to antenatal consultations and 2D pregnancy scans, provided you use a gynaecologist/obstetrician who we have a payment arrangement with.
Rehabilitation, Hospice and Step-down facilities:
The Trauma Recovery Extender Benefit covers out-of-hospital claims related to certain traumatic events. Claims are paid from the Trauma Recovery Extender Benefit for the rest of the year in which the trauma occurred, as well as the year after the event oc
Treatment for Mental Health:
21 days for admissions or up to 15 outof- hospital consultations for each person for major affective disorders, anorexia and bulimia and up to 12 out-of-hospital consultations for acute stress disorder accompanied by recent significant trauma. 21 days for
International Travel Benefit:
Up to 500 000 for each person travelling for evidence-based healthcare treatment not available in South Africa. A copayment of 20% and specific rules apply to this benefit.