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Health Squared – Optimum

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
Consultations and 4x 2D scans
Internal Prostheses PMB: Unlimited
Non-PMB: R134 172
Oncology Unlimited. Subject to ICON protocols
Specialised Radiology: CT, MRI, PET Scans Unlimited PMB and trauma cover
Non-PMB: R17 554
Emergency evacuation and Ambulance services Netcare 911
100% of Scheme Rate Unlimited

Day-to-Day Benefit

Medical Savings Account (MSA)
Values per Annum
Member: R9 240
Adult dependent: R7 704
Child dependent: R3 156
General Practitioner Consultations Subject to MSA
Specialist Consultations Subject to MSA
Conservative Dentistry Subject to MSA
Optometry 1 consultation per beneficiary in 24 months
R2 838 per beneficiary
Alternative Healthcare Services Subject to MSA
Radiology and Pathology Subject to MSA
Physiotherapy Subject to MSA
Speech Therapy and Audiology Subject to MSA
Additional Medication (Acute) Subject to MSA
Over-the-Counter Medication (OTC) Subject to MSA
Annual limits
M: R7 938
M+1: R9 615
M+2: R11 069
M+3: R12 573
M+4+: R14 200
Psychology and Psychiatry
Subject to BenefitBooster
Sub-limit : R6 150
Advanced Dentistry
Subject to BenefitBooster
Includes cover for crowns, bridges, implants, dentures and orthodontics

Chronic Condition Benefit

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

Preventative Care Benefit

Preventative Care Benefit
Subject to BenefitBooster
Blood Pressure test
Blood Sugar test
Cholesterol test
Body Mass Index
Pap Smear
Mammogram Screening
Sub-limit: R2 952