Our flagship offering, the Titanium Executive Plan, is designed for those seeking the highest level of medical cover and peace of mind. This premium plan includes a comprehensive Savings component and provides extensive In-Hospital and Out-of-Hospital benefits.
Members enjoy access to advanced diagnostic services, specialist consultations, surgical procedures, mental health support, alternative therapies, and a wide range of wellness benefits. The plan also covers 62 chronic conditions, ensuring continuity of care and long-term health management.
Experience exceptional healthcare tailored to your lifestyle.
R11737
R10385
R2399
R29296 pm
R25921 pm
R5988 pm
In Hospital Benefits
In-hospital PMBs
- Subject to DSPS, pre-authorisation and case management, clinical guidelines and scheme rules
- Emergency admissions must be notified to the Scheme within 48 hours of admission
Hospital Admission
- (Intensive Care, High Care, General Ward, Theatre and Recovery Room)
- All admissions (including PMBs) are subject to preauthorisation, case management, clinical protocols and scheme rules
- A 30% penalty will be imposed for non-emergency late pre-authorisations
In-hospital General Practitioner
- Subject to PMB, clinical protocols and scheme rules. All procedures must be
preauthorised
Back and Neck Surgery
- Subject to PMB, preauthorisation, clinical protocols and scheme rules
- Subject to adherence to conservative treatment
Organ Transplant
- Department of Health Protocols apply
- Unlimited benefits for PMBs
- Subject to pre-authorisation, clinical guidelines, medicine formulary* and registration on the Disease Management Programme
Stereotactic Radio-Surgery
- Subject to PMBs, preauthorisation, managed care protocols and scheme rules
Male Sterilisation/ Vasectomy
- Subject to pre-authorisation and PMBs at Day Clinic or as Day Case.
Female Sterilisation/ Tubal Ligation
- Subject to PMBs and preauthorisation at Day Clinic or as Day Case.
Dental Hospitalisation
- Subject to PMBs pre-authorisation, treatment protocols and the use of DSP
- General in-hospital benefit rules apply Advanced dentistry benefits In-Hospital are limited to extensive conservative treatment for children under the age of 7 years involving three (3) teeth.
- General anaesthetic benefits are only available for children under the age of seven (7)
years for extensive dental treatment, limited to once per beneficiary per annum - Removal of symptomatic impacted wisdom teeth covered only as Day Case at a day hospital
Maxillo-facial and Oral Surgery
- Subject to PMBs, pre-authorisation, treatment protocols and scheme rules
- Benefit for Temporo-Mandibular Joint (TMJ) therapy is limited to non-surgical intervention/treatments
- Oral pathology procedures (cysts and biopsies, the surgical treatment of tumours of the jaw and soft tissue tumours) will only be covered if supported by a laboratory report that confirms diagnosis
Out-of-hospital Benefits
- Out-of-Hospital Benefits for Day-to-Day are subject to MSA, excluding Scheme risk benefits as stipulated, which include PMBs, Chronic non-PMB medicine, Advanced Dentistry (See detailing), Air or Road emergency services, Hearing aids, non-motorised wheelchairs, Maternity and Wellness.
- Benefit limits apply.
- Subject to PMBs, evidence-based clinical protocols and medicine formulary*.
Overall Annual Limit for Out-of-Hospital benefits: Subject to the use of DSP Subject to Medical Savings Account, Self-Payment Gap and Above Threshold Benefits.
Medical Savings Account (20.8%)
(GP, Specialists, Acute medicine, Radiology, Pathology and other out-of-hospital expenses)
- Main Member: R29 296.00
- Adult dependent: R25 921.00
- Child dependent: R5 988.00
Self-Payment Gap (SPG)
- Main member: R5 602.00
- Adult dependent: R4 643.00
- Child dependent: R2 124.00
Above Threshold Benefits (ATB)(Excludes Pharmacy Advised Treatment)
Applicable Limits:
- Physiotherapy: R17 535.00 per family per year
- Pathology & Radiology combined: R17 535.00 per family per year
Acute medicine:
- Main member R8 190.00 per year
- Adult dependant R8 190.00 per year
- Child dependant R2 564.10 per year
Chronic Benefits
Cover for 26 PMB chronic conditions, subject to registration and approval. Covered medication, bloods and GP within PMB protocols and authorisations.
- Addison’s disease
- Asthma
- Bipolar Mood Disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Chronic obstructive pulmonary disease
- Chronic renal disease
- Coronary artery disease
- Crohn’s disease
- Diabetes insipidus
- Diabetes mellitus types 1 & 2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- HIV/AIDS
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative colitis
Other Chronic (Non-CDL) Medicine, Subject to pre-authorisation clinical protocol and medicine formulary. R17 648.82 per family per annum and limited to R8 751.65 per beneficiary per annum.
- Attention Deficit Hyperactivity Disorder (ADHD)
- Allergic Rhinitis
- Benign Prostatic Hypertrophy (BPH)
- Cushing’s Disease
- Cystic Fibrosis • Depression
- Endometriosis
- Gout
- Hyperthyroidism
- Hypoparathyroidism
- Menopause/Hormone Replacement Therapy (HRT)
- Myasthenia gravis
- Osteoarthritis
- Osteoporosis
- Paget’s Disease
- Pituitary Microadenomas
- Psoriasis
- Stroke (Cerebrovascular accident)
Preventative Care Benefits
Health screening is an essential part of preventative healthcare and is vital to maintaining overall well-being and improving outcomes by providing care at the earliest possible stage.
Preventative Care and Screening Benefits include
- Wellness Consultation limit, R2 061.68 per family per annum
- One (1) Pap Smear for females over 18 years per beneficiary annually
- One (1) Mammogram for females over 40 years per beneficiary annually
- One (1) PSA for males over 40 years per beneficiary annually
- Blood sugar, cholesterol, blood pressure, Body Mass Index (BMI), HIV
- One (1) skin cancer screening per beneficiary above 55 years of age, annually
Vaccinations Benefit
- Covid-19 vaccination per beneficiary
- One (1) flu vaccination per beneficiary
- One (1) HPV vaccination for beneficiaries between nine (9) and 12 years of age
- One (1) Pneumococcal vaccine per beneficiary above 65 years of age
