Contributions
Non-Network/Network | Principal Member | Adult Dependant | Child Dependant* | |
---|---|---|---|---|
Risk Amount | NN | R1 363 | R1 058 | R573 |
N | R1 226 | R953 | R516 | |
Savings Amount | NN | – | – | – |
N | – | – | – | |
Total Monthly Contribution | NN | R1 363 | R1 058 | R573 |
N | R1 226 | R953 | R516 |
* You only pay for a maximum of 4 children. All other children can join as beneficiaries of the Scheme free of charge.
Summary:
- No savings option is available
- Scheme rate is 100%
- Most day-to-day expenses are paid from out of pocket, unless PMBs
- You must use a network hospital
- Treatment and medicine for 27 chronic conditions covered by scheme
- Cancer (PMB only) is treated in state hospitals, but you can upgrade to higher plan on cancer diagnosis to receive private hospital treatment
- There are co-payments for in-hospital MRIs and CT Scans (gap cover pays this co-payment)
- There is a benefit for out-of-hospital specialised radiology (paid in full with gap cover)
- Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
In-Hospital Benefits
Specialists: |
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Hospital Choice: |
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Specialised Radiology: |
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Supplementary Services: (Physio, etc) |
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Transplants: |
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Co-payments: |
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Alternatives to hospitals: |
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Casualty: |
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Other: |
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Out-of-Hospital Benefits
Savings available: |
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General info: |
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GP consultations: |
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Childcare: |
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Specialists consultations: |
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Pathology: |
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General radiology: |
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Specialised radiology: |
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Supplementary Services: (Physio, etc) |
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Maternity Benefits
Hospital stay: |
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Consultations: |
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Scans: |
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Oncology (Cancer) Benefits
Overall coverage (in and out of hospital): |
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Dentistry Benefits
Dentistry: |
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Orthodontics: |
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Maxillo Facial Surgery: |
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Medication Benefits
Chronic: |
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Acute (presrcibed) medication: |
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Over-the-counter: |
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Birth Control: |
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On Discharge: |
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Biological: |
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Optometry Benefits
Optometry: |
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Mental Health Benefits
In-hospital: |
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Out-of-hospital: |
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Trauma: |
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Other Benefits
General Appliances: |
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1.1. Hearing Aids: |
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1.2. Wheelchairs: |
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Dialysis: |
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HIV: |
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Emergency Transport: |
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International Insurance: |
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Other: |
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Preventative Benefits
Flu vaccination: |
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Pneumonia vaccines: |
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Back Rehabilitation Programme: |
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Biometric Screening: |
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Child Immunisation: |
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Pap Smear: |
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Mammogram: |
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PAS Test: |
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HIV Test: |
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Other: |
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Prosthetic Benefits
Overal Limit: |
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Sub-limits: |
Exclusions:
PMB joint replacements:
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