Standard & Standard Select 2024 | Page 4

These benefits are in addition to your overall day-to-day limit . STANDARD STANDARD SELECT
ADDITIONAL GP CONSULTATIONS ( NEW ) ( WHEN THE GP & SPECIALIST CONSULTATIONS DAY-TO-DAY SUBLIMIT IS REACHED )
2 network GP consultations per family 2 network GP consultations per family
ADDITIONAL SPECIALIST CONSULTATIONS ( NEW )
2 network specialist consultations per family
You must get a referral from your GP
2 network specialist consultations per family
You must get a referral from your network GP
EMERGENCY ROOM BENEFIT ( NEW ) ( FOR EMERGENCIES ONLY )
2 emergency consultations per family at a casualty ward or emergency room facility of a hospital
2 emergency consultations at a casualty ward or emergency room facility of a hospital for children under the age of 6
If it is not classified as an emergency , it will be paid from the available GP & specialist day-to-day benefit
2 emergency consultations per family at a casualty ward or emergency room facility of a hospital
2 emergency consultations at a casualty ward or emergency room facility of a hospital for children under the age of 6
If it is not classified as an emergency , it will be paid from the available GP & specialist day-to-day benefit
AUDIOLOGY ( HEARING AIDS , CONSULTATIONS AND TESTS ) ( ALSO SEE CARE PROGRAMMES PAGE 12 )
R8 650 per device ( maximum two devices per family ), once every 3 years ( based on the date of your previous claim )
All tests and consultations limited to the Audiology Benefit Management Programme and use of a network provider
Avoid a 25 % co-payment by using a Designated Service Provider
Claims outside the Audiology Benefit Management Programme paid from the auxiliary services day-to-day benefit
R8 650 per device ( maximum two devices per family ), once every 3 years ( based on the date of your previous claim )
All tests and consultations limited to the Audiology Benefit Management Programme and use of a network provider
Avoid a 25 % co-payment by using a Designated Service Provider
Claims outside the Audiology Benefit Management Programme paid from the auxiliary services day-to-day benefit
MRIs AND CT SCANS ( SPECIALISED RADIOLOGY )
R32 340 per family , in and out-of-hospital
R1 770 co-payment per scan event except for PMB
Pre-authorisation required
R32 340 per family , in and out-of-hospital
R1 770 co-payment per scan event except for PMB
Pre-authorisation required
MENTAL HEALTH CONSULTATIONS ( ALSO SEE CARE PROGRAMMES PAGE 11 )
In and out-of-hospital consultations ( included in the mental health hospitalisation benefit )
Limited to R19 310 per family
In and out-of-hospital consultations ( included in the mental health hospitalisation benefit )
Limited to R19 310 per family
INSULIN PUMP OR CONTINUOUS GLUCOSE MONITOR ( ALSO SEE CARE PROGRAMMES PAGE 11 )
R85 000 per family every 5 years
Consumables limited to R85 000 per family
R85 000 per family every 5 years
Consumables limited to R85 000 per family
Limited to one device per type 1 diabetic for beneficiaries younger than 18 Limited to one device per type 1 diabetic for beneficiaries younger than 18
IN-ROOM PROCEDURES
Cover for a defined list of approved procedures performed in the specialist ’ s rooms
Pre-authorisation required
Cover for a defined list of approved procedures performed in the specialist ’ s rooms
Pre-authorisation required
OPTOMETRY
R7 385 per family , once every 2 years ( based on the date of your previous claim )
Each beneficiary can choose glasses
OR
contact lenses
R7 385 per family , once every 2 years ( based on the date of your previous claim )
Each beneficiary can choose glasses
OR
contact lenses
EYE TESTS
1 composite consultation per beneficiary , at a network provider
OR
R380 per beneficiary for an eye examination , at a non-network provider
1 composite consultation per beneficiary , at a network provider
OR
R380 per beneficiary for an eye examination , at a non-network provider
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 STANDARD & STANDARD SELECT 2024 OUT-OF-HOSPITAL BENEFITS