Risk Benefit
| Hospitalisation | Unlimited hospital benefit with access at extensive DSP hospital network (subject to Scheme Protocols and pre-authorisation) Netcare, Life and Medi-Clinic in certain regions |
|---|---|
| Oncology ICON Network |
PMB unlimited Non-PMB limited to R90 459 |
| Casualty | Emergency Room Benefit | Trauma and PMB: Unlimited |
| Maternity Benefit | Normal Delivery: 3 days and 2 nights Caesarean Section: 4 days and 3 nights |
| Antenatal Care | Unlimited GP consultations 2x 2D scans |
| Specialised Radiology: CT, MRI, PET Scans | Unlimited cover for PMB, emergency and trauma scans |
Day-to-Day Benefit
| General Practitioners (GP) | Unlimited at Network Providers No nomination required – any network doctor may be accessed Non-Contracted Providers up to 100% of Scheme Rate Limited to 2 out-of-network visits per family |
|---|---|
| Acute Medication | Unlimited, as dispensed by network GP. Subject to formulary |
| Radiology and Pathology | Unlimited at network providers on referral by GP, subject to formulary |
| Chronic conditions | 29 conditions covered, subject to formulary |
| Dentistry | 2x annual consultations per beneficiary per annum Single Member: R2 206 Family: R3 672 |
| Optometry | Benefit available every 24-months Consultation, test, frame and single vision lenses: R1 234 per beneficiary Consultation, test, frame and bifocal lenses: R1 878 per beneficiary |
| HIV and AIDS Management | Unlimited cover for HIV treatment, including consultations and medication |
| Emergency Evacuation | Unlimited Emergency Evacuation and Ambulance services via Netcare 911 |
| Preventative Care | Blood pressure Blood sugar Cholesterol Body Mass Index Pap smear Prostate exams As directed by network doctor |