Risk Benefit

Private Hospitalisation Unlimited at any private hospital
Planned PMB’s: Network hospitals
Professional Fees 100% of Scheme Rate
Casualty | Emergency Room Benefit Trauma and PMB: Unlimited
Non-PMB: Subject to MSA and ATB
Maternity Benefit Normal Delivery: 3 days and 2 nights
Caesarean Section: 4 days and 3 nights
Antenatal Care Maternity Programme
Consultations and 4x 2D scans
Internal Prostheses PMB: Unlimited
Non-PMB: R70 244
Oncology Unlimited. Subject to ICON protocols
Specialised Radiology: CT, MRI, PET Scans Unlimited PMB and trauma cover
Non-PMB: R17 697
Emergency evacuation and Ambulance services Netcare 911
100% of Scheme Rate Unlimited

Day-to-Day Benefit

Medical Savings Account (MSA)
Values per Annum
Member: R10 968
Adult dependent: R9 396
Child dependent: R2 556
General Practitioner Consultations Subject to MSA and ATB
Specialist Consultations Subject to MSA and ATB
Conservative and Advanced Dentistry Subject to MSA and ATB
Psychology and Psychiatry Subject to MSA and ATB
Optometry 1 consultation per beneficiary in 24 months
R3 374 per beneficiary
Alternative Healthcare Services Subject to MSA and ATB
Radiology and Pathology Subject to MSA and ATB
Physiotherapy Subject to MSA and ATB
Speech Therapy and Audiology Subject to MSA and ATB
Additional Medication (Acute) Subject to MSA and ATB
Over-the-Counter Medication (OTC Subject to MSA and ATB

Chronic Condition Benefit

PMB CDL Conditions 29 conditions covered
Additional Chronic Benefit
Specified conditions
Subject to MSA

Preventative Care Benefit

Preventative Care Benefit Sub-limit: R2 941 per family per annum
Screening Benefit
Blood Pressure test
Blood Sugar
Cholesterol
Body Mass Index
Mammogram (screening): >40 years
Pap smear: 1 test per annum
PSA testing: >45 years
HIV: 1 test per annum
R139 per beneficiary
Childhood immunisations Up to 18 months
HPV Vaccine (Cervical cancer prevention) 1 course per female beneficiary between 9 and 46 years of age
Oral Contraception R1 776 per female beneficiary per annum – R148 per month