Day-to-Day Benefit

The following services are covered from the additional out-of-hospital benefit limits

Total Annual Benefit Member: R16 764
Adult Dependent: R12 572
Child Dependent: R1 753
General Practitioner Consultations Unlimited
Subject to annual Benefit Limits
Specialist Consultations Member: 4 consultations
Member +1: 5 consultations
Member +2+: 6 consultations
Conservative Dentistry 2x Annual check-ups per beneficiary
2x Emergency consultations per beneficiary
Advanced Dentistry R15 756 per family
Includes cover for crowns, bridges, implants, dentures and orthodontics
Optometry 1 consultation per beneficiary in 24 months
Includes frame and lenses (single vision, bifocal or multifocal lenses) or contact lenses limited to R4 068 per beneficiary
Additional Day-to-day BenefitAnnual limits Member: R8 757 per annum
Member +1: R15 413 per annum
Member +2+: R16 740 per annum
Alternative HealthcareSub-limits Member: R3 755 per annum
Member +1: R5 567 per annum
Member +2+: R7 354 per annum
Radiology and PathologySub-limits Member: R3 755
Member+1: R4 608
Member+2+: R5 567
PhysiotherapySub-limit R1 730 per family
Psychology and PsychiatrySub-limit R1 878 per family
Speech Therapy and AudiologySub-limit R1 878 per family
Additional Medication (Acute)Sub-limit Member: R 8 796
Member+1: R15 472
Member+2+: R17 644
With a sub-limit on Schedule 0-2 medication Member: R2 652
Member+1: R4 568
Member+2+: R4 989

Risk Benefit

Private hospitalisation Unlimited at any private hospital
Professional Fees Up to 220% of Scheme Rate
Casualty | Emergency Room Benefit Trauma and PMB: Unlimited
Non-PMB limited to R1 879
Maternity Benefit Normal Delivery (including Home birth): 3 days and 2 nights
Caesarean Section: 4 days and 3 nights
Antenatal Care Maternity Programme Included: Welcome gift: R1 082
Antenatal visits at GP, Specialist, Midwives and 2x 2D scans
Internal Prostheses PMB: Unlimited
Non-PMB: R76 425
Oncology Unlimited. Subject to ICON protocols
Specialised Radiology
MRI and CT Scans
Unlimited PMB and trauma cover
Non-PMB: R22 124
Emergency evacuation and Ambulance services Netcare 911
100% of Scheme Rate Unlimited

Preventative Care Benefit

Blood Pressure, Blood Sugar and Cholesterol test, Body Mass Index R139 per beneficiary
Mammogram (screening) Covered > 35 years
Pap smears Covered
PSA Testing Covered > 45 years
HIV Test Covered
Vaccinations: Flu Covered
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

Chronic Condition Benefit

PMB CDL Conditions Unlimited
Additional Chronic Benefit Specified conditions Single Member: R6 475
Family: R12 933