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HEALTH SQUARED ADVANCE 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited. Subject to Scheme Protocols.
Casualty / Emergency Visits: 
Subject to MSA, unless PMB
Specialists: 
Non-Contracted Providers at 100% of Scheme Rate. Contracted Providers at 100% of Contracted Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Limited to Network Providers and subject to PMB and Scheme Protocols.
Radiology and pathology: 
R20 000 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 000 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: 
Covered at Network Provider. Subject to Scheme Protocols and PMB. Pre- auth required.
Organ Transplants: 
Limited to PMB ‘s Only
Oncology / Cancer: 
Limited to R200 000 per family per annum. Subject to ICON Network and standard protocols. Pre-auth required. 40% NON DSP co-payment
Neck and Back Operations: 
Limited to R18 000 per family per annum. 25% co payment for NON PMB’s. Subject to Prosthesis Sub- Limits, Scheme Protocols.
Joint Replacements: 
Limited to R18 000 per family per annum. 25% co payment for NON PMB’s. Subject to Prosthesis Sub- Limits, Scheme Protocols.
Prosthesis: 

25 % Co-payment on Non-PMB Overall Option Limit R 18 000

 

Medical and Surgical Appliances: 
Subject to My Saver and PMB’s
Maternity Confinements: 
Length of stay: 3 days & 2 nights.
In Hospital Dentistry: 
Only for impacted wisdom teeth and extensive dental / multiple procedures in children under 5 years of age. Multiple hospital admissions are not covered. Co- payment of R3 000 will apply to all in-hospital dental admissions. Scheme Protocols apply.
Take home Medicine: 
Maximum of 7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
No Benefit except in lieu of hospitalisation. Subject to pre-auth.
HIV / AIDS: 
HIV Management Programme
International Travel Benefit: 
Limited to emergency medical cover up to R750 000 per beneficiary per incident
Day-to-day benefits
GP consultations: 

Subject to MSA
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: 

Subject to MSA
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.

Acute medicine: 

Subject to MSA.

Optometry benefits: 
Subject TO MSA
Basic dentistry: 
Subject to MSA
Orthodontics: 

Subject to MSA

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
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

Preventative Care Benefits
Preventative Benefits: 

Subject to MSA. Sub limit of R2 762
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: 
3178.00
Total Contribution Adult: 
3099.00
Total Contribution Child*: 
1114.00
Advance
Annual Medical Savings Account
Annual Medical Savings Main Member: 
4956.00
Annual Medical Savings Adult: 
4824.00
Annual Medical Savings Child*: 
1728.00
Risk Contributions
Risk Contribution Main Member: 
3178.00
Risk Contribution Adult: 
3099.00
Risk Contribution Child: 
1114.00
Medical Aid Plan Name Term: 
Any