Out-of-hospital benefits include GP & Specialists consultations, acute medication, pathology, radiology and selected non-CDL chronic medicine
- Collectively covered from Member Savings Account (MSA)
- Free choice of service provider
- Consultations once MSA* depleted
- One (1) additional GP visit per beneficiary, limited to four (4) per family per annum and one (1) Specialist visit per family for either a Paediatrician or Gynaecologist
Dental care – (conservatively covered by Scheme Risk) Benefit managed by Dental Risk Company
- Consultations, fillings, extractions
- Preventative scale and polish
- Infection control
- Conscious sedation for beneficiaries below the age of 16 years, subject to dental
- treatment protocols and pre-authorisation
- Advanced dentistry: crowns and bridgework, dentures, and orthodontics covered by MSA
Optical – (Basic optometry covered from Scheme Risk) Benefit managed by Isoleso
- 24-month treatment cycle
- One (1) eye test per beneficiary
- Frame: R621 per beneficiary
- Lenses: Single vision – R238 per lens. Bifocal vision –R504 per lens.
- Multifocal vision – R504 per lens
- Or choose contact lenses – R1 128 per beneficiary
Maternity benefits – Register on the Bambino programme
- Ten (10) antenatal per pregnancy, six (6) either with a GP, Midwife and four (4) with a Specialist Obstetrician
- Specified pregnancy-related blood tests covered
- Vitamins: R270
- Two (2) 2D Scans
- Childhood Immunisation, per the Department of Health, is for children up to 12. One (1) heart, hearing and vision screening for babies under two (2) years of age
Appliances
- Medical Appliances – In and Out of hospital PMB only
- Callipers, Nebulizer, Glucometer, Insulin pump, Morphine pump, C-PAP machine
- Limited to R7 130 per family per annum
- Blood Pressure Monitor: sub-limit of R628
Cover for 26 PMB chronic conditions subject to registration and approval.
- 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 – Paid from MSA.
- Benign Prostatic Hypertrophy (BPH)
- Cushing’s Disease
- Endometriosis
- Hyperthyroidism
- Hypoparathyroidism
- Menopause/Hormone Replacement Therapy (HRT)
- Myasthenia gravis
- Stroke (Cerebrovascular accident)
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
- 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
- One (1) skin cancer screening per beneficiary above 55 years of age, annually
- Blood sugar, cholesterol, blood pressure, Body Mass Index, HIV
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
Member Information and Education
Forms
Principal
Adult
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