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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 for varicose vein surgery and reflux surgery.
The other procedures 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: 
R173 500 benefit Pfpa. Pre-authorisation compulsory and subject to Case Management, Scheme Protocols and use of DSP providers
Joint Replacements: 
PMB entitlement only for varicose vein surgery and reflux surgery. The other procedures will be covered at 100% of Agreed Tariff.
Prosthesis: 

R6 300 benefit Pfpa. Pre-authorisation compusory and subject to Case Management,
reference pricing, DSP and Scheme Protocols

Medical and Surgical Appliances: 
Wheelchairs, orthopaedic appliances and incontinence equipment (incl. contraceptive devices).R7 500 Pfpa. Combined in- and out-of-hospital benefit, subject to quantities and protocols. No pre-authorisation required. Oxygen/nebulizer/glucometer Pre-au...
In Hospital Dentistry: 
R1 640 co-payment per hospital admission. DENIS pre-authorisation compulsory.
Take home Medicine: 
R525 benefit Per admission
Rehabilitation, Hospice and Step-down facilities: 
R29 400 Pre-authorisation compulsory and subject to Case Management and Scheme Protocols. Pfpa. Wound care is included in this benefit, up to an amount of R9 450. Combined in- and out-of-hospital benefit.
Treatment for Mental Health: 
R19 700 Pfpa. Pre-authorisation compulsory and subject to Case Management. In-hospital benefit only. Out-of-hospital: PMB entitlement.
HIV / AIDS: 
Unlimited. Chronic Disease Programme, managed by Lifesense, applicable.
Day-to-day benefits
GP consultations: 

Principal member: R7 615 p.a.
Adult dependant: R5 535 p.a.
Child dependant: R1 535 p.a.
Additional general practitioner consultations (3pfpa) after depletion of
available day-to-day benefit for Child Dependant/s up to the age of 21.

Specialist consultations: 

Principal member: R7 615 p.a.
Adult dependant: R5 535 p.a.
Child dependant: R1 535 p.a.
Additional general practitioner consultations (3pfpa) after depletion of
available day-to-day benefit for Child Dependant/s up to the age of 21.

Over-the-counter (OTC) Medicine: 

R1 640 Pfpa sublimit. Subject to day-to-day benefit.

Optometry benefits: 
R1 545 Pbp2a total optical benefit. Subject to day-to-day benefit and Optical Management. Benefit confirmation compulsory.
Basic dentistry: 
Consultations 2 check-ups pbpa. X-rays: Extra-oral 1 pbp3a. (Additional benefit may be granted where specialised dental treatment planning / follow-up is required.)
MRI and CT Scans (Out of Hospital): 
"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."
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. Category B (other) Additional 3 non-PMB/CDL conditions (Acne/ADHD or ADD/Rhinitis) for children up to the age of 21.
Total Contributions
Silver
Medical Aid Plan Name Term: 
Any