PHYSICAL REHABILITATION
ALTERNATIVES TO HOSPITAL ( HOSPICE , STEP-DOWN FACILITIES )
PALLIATIVE CARE ( CANCER ONLY )
CANCER TREATMENT ( ALSO SEE CARE PROGRAMMES PAGE 8 )
R57 890 per family
R19 310 per family
Unlimited , subject to using the Designated Service Provider
Unlimited for PMBs
Avoid a 30 % co-payment by using a Designated Service Provider
Managed Care protocols apply
Including hospice / private nursing , home oxygen , pain management , psychologist and social worker support
R159 800 per family for non-PMBs . Paid at 80 % at a Designated Service Provider and no cover at a non-Designated Service Provider , once limit is reached
Sublimit of R57 680 per beneficiary for Brachytherapy
CANCER MEDICINE Subject to Medicine Price List and preferred product list Avoid a 20 % co-payment by using a Designated Service Provider
ORGAN TRANSPLANTS Unlimited Sublimit of R36 760 per beneficiary for corneal grafts
KIDNEY DIALYSIS Unlimited Avoid a 20 % co-payment by using a Designated Service Provider
HIV / AIDS ( ALSO SEE CARE PROGRAMMES PAGE 9 )
DAY SURGERY PROCEDURES ( APPLIES TO SELECTED PROCEDURES )
Unlimited , if you register on the HIV / AIDS programme
Avoid a R2 590 co-payment by using a network day hospital
Chronic medicine must be obtained from the Designated Service Provider
R1 840 co-payment R4 690 co-payment R8 680 co-payment
PROCEDURE CO-PAYMENTS ( PER EVENT , SUBJECT TO PRE-AUTHORISATION ) |
1 . |
Colonoscopy |
2 . |
Conservative Back Treatment |
3 . |
Cystoscopy |
4 . |
Facet Joint Injections |
5 . |
Flexible Sigmoidoscopy |
6 . |
Functional Nasal Surgery |
7 . |
Gastroscopy |
8 . |
Hysteroscopy ( not Endometrial Ablation ) |
9 . |
Myringotomy |
10 . Tonsillectomy and Adenoidectomy |
11 . Umbilical Hernia Repair |
12 . Varicose Vein Surgery |
|
1 . |
Arthroscopy |
2 . |
Diagnostic Laparoscopy |
3 . |
Laparoscopic Hysterectomy |
4 . |
Percutaneous Radiofrequency Ablations |
( Percutaneous Rhizotomies ) |
|
1 . |
Laparoscopic Pyeloplasty |
2 . |
Laparoscopic Radical Prostatectomy |
3 . |
Nissen Fundoplication ( Reflux Surgery ) |
|
OUT-OF-HOSPITAL BENEFITS
These benefits provide cover for emergency room consultations and other out-of-hospital medical expenses .
EMERGENCY ROOM BENEFIT ( NEW ) ( FOR EMERGENCIES ONLY )
2 emergency consultations per family at a casualty ward or emergency room facility of a hospital
Benefit limited to emergencies only
IN-ROOM PROCEDURES ( NEW ) Cover for a defined list of approved procedures performed in the specialist ’ s rooms Pre-authorisation required
All benefits and limits are per calendar year , unless otherwise stated . Managed Care protocols apply . All benefits are approved by the Council for Medical Schemes . PMB = Prescribed Minimum Benefits
4 HOSPITAL STANDARD 2024 IN-HOSPITAL BENEFITS