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
Maternity Benefit Normal Delivery: 3 days and 2 nights
Caesarean Section: 4 days and 3 nights
Antenatal Care Maternity Programme Included: Consultations and 2x 2D scans
Welcome gift: R357
Internal Prostheses PMB: Unlimited
Non-PMB: R25 475
Oncology PMB: Unlimited
Non-PMB: R308 529 per family
Subject to ICON protocols
Specialised Radiology: CT, MRI, PET Scans Unlimited PMB and trauma cover
Non-PMB: R21 297
Emergency evacuation and Ambulance services Netcare 911
100% of Scheme Rate – Unlimited

Day-to-Day Benefit

General Practitioner Consultations (Non-network providers) Member: 4 consultations
Member +1: 7 consultations
Member +2+: 9 consultations
Primary Care Network Providers (GP, Physio and Psychology) Member: 6 consultations
Member +1: 10 consultations
Member +2+: 13 consultations
Conservative Dentistry Member: R3 517
Member +: R5 653
Optometry 1 consultation per beneficiary in 24 months
Limited to R2 557 per beneficiary
Acute and Over the Counter Medication Subject to MSA
Medical Savings Account (MSA)
Values per Annum
Member: R4 128
Adult dependent: R3 840
Child dependent: R1 440
Specialist Consultations Subject to MSA
Alternative Healthcare Services Subject to MSA
Radiology and Pathology Subject to MSA
Physiotherapy and Psychology – Non-network providers Subject to MSA
Primary Care Network providers – (GP, Physio and Psychology) Included in Primary Care Network (PCN) Benefit
Advanced Dentistry
Includes cover for crowns, bridges,implants, dentures and orthodontics
Subject to MSA

Chronic Condition Benefit

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

Preventative Care Benefit

Preventative Care Benefit – Per Annum R2 999 per family
Blood Pressure, Blood Sugar and Cholesterol test, Body Mass Index R139 per beneficiary
Mammogram (screening) Female beneficiary > 40 years
Pap smears 1 test per female beneficiary
PSA Testing Male beneficiary > 45 years
HIV Test 1 Test per beneficiary
Vaccinations: Flu Subject to MSA
Childhood immunisations Subject to MSA