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Medical Aid Year: 
2020
Day to day Benefits: 

General practitioner and specialist consultations,
radiology (incl. Nuclear Medicine Study and
bone density scans). Prescribed and over-thecounter
medicine. Optical and auxiliary services,
e.g. physiotherapy, occupational therapy,
contraceptive pills...

In Hospital Benefits
Hospital Rate of Payment: 
Private hospitals Unlimited, up to 100% of Agreed Tariff, subject to use of DSP hospital (Netcare or Life Healthcare). (30% co-payment at non-DSP hospital.) State hospitals Unlimited, up to 100% of Agreed Tariff.
Hospitals: 

PMB entitlement only. Hysterectomies will be covered at 100%
of Agreed Tariff.

Specialists: 
Unlimited, subject to use of DSP provider.
Radiology and pathology: 
Radiology: Pre-authorisation compulsory for specialised radiology, including MRI and CT scans. Hospitalisation not covered if radiology is for investigative purposes only. (Day-to-day benefits will then apply.) Pathology: Unlimited.
Dialysis: 
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
Oncology / Cancer: 
R154 500 benefit Pfpa. Pre-authorisation compulsory and subject to Case Management, Scheme Protocols and use of DSP providers.
Joint Replacements: 
PMB entitlement only. Hysterectomies will be covered at 100% of Agreed Tariff.
Prosthesis: 

Subject to pre-authorisation and Scheme Protocols. PMB entitlement only.

Medical and Surgical Appliances: 
Wheelchairs, orthopaedic appliances and incontinence equipment (incl.contraceptive devices). R7 250 benefit Pfpa. Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required.Oxygen/nebulizer/glucometer...
In Hospital Dentistry: 
Hospitalisation (general anesthesia) R1 640 co-payment per hospital admission. DENIS pre-authorisation compulsory.
Take home Medicine: 
R525 benefit. Per admission.
Rehabilitation, Hospice and Step-down facilities: 
Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. PMB entitlement only.
HIV / AIDS: 
Day-to-day benefits
Specialist consultations: 

Unlimited, subject to use of DSP provider.

Over-the-counter (OTC) Medicine: 

Subject to day-to-day benefit.

Optometry benefits: 
Frames Subject to day-to-day benefit. Lenses Subject to day-to-day benefit. Eye test Subject to day-to-day benefit. Contact lenses Subject to day-to-day benefit.
Basic dentistry: 
Consultation 1 check-up pbpa. 3 specific (emergency) consultations pbpa. X-rays: Intra-oral 4 intra-oral radiographs pbpa. X-rays: Extra-oral 1 pbp3a. Oral hygiene 1 scale and polish treatment pbpa. Fillings 1 per tooth per 365 days. A treatment plan...
MRI and CT Scans (Out of Hospital): 
Pfpa. R1 000 co-payment per scan (in- or out-of-hospital), excluding confirmed PMBs.
Radiology and Pathology: 
Radiology: Pre-authorisation compulsory for specialised radiology, including MRI and CT scans. Hospitalisation not covered if radiology is for investigative purposes only. (Day-to-day benefits will then apply.) Pathology: Unlimited.
Chronic Conditions
Provider: 
Category A (CDL) Unlimited – subject to reference pricing and protocols. Registration on Chronic Disease Programme compulsory.
Total Contributions
Origin
Medical Aid Plan Name Term: 
Any