Private Hospitalisation | Unlimited at any private hospital Planned PMB’s: Network hospitals |
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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 |
Medical Savings Account (MSA) Values per Annum |
Member: R10 968 Adult dependent: R9 396 Child dependent: R2 556 |
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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 |
PMB CDL Conditions | 29 conditions covered |
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Additional Chronic Benefit Specified conditions |
Subject to MSA |
Preventative Care Benefit | Sub-limit: R2 941 per family per annum |
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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 |