Day-to-day benefits payable from MSA include:
- GP and Specialist visits, Acute Medication, Physiotherapy, Radiology, Pathology, Auxiliary and appliances. EDO plan access benefits from network providers. Sub-limits may apply.
- Unused MSA will carry over year-on-year
- Should MSA be fully utilised during the year, a Self-Payment Gap (SPG) is applicable and thereafter an Above Threshold Benefit (ATB) is available annually
Benefits payable from Scheme Risk: Dental care – Benefit managed by Dental Risk Company
- Benefit cover for conservative dentistry per beneficiary
- Two (2) consultations per beneficiary
- Oral hygiene. Root Canal treatment
- Extractions, fillings, intra and extra oral x-rays
- Plastic dentures: one (1) set, full or partial in a four (4) year period
- Specialised dentistry: Crowns and bridges – one (1) crown per family per annum Once (1) per tooth in a five (5) year period
- Orthodontics: Limited to ages nine (9)–21. A 35% co-payment is applicable
Optical – Benefit managed by Isoleso
- 24-month treatment cycle
- One (1) eye test per beneficiary
- Frames: R1 087 per beneficiary
- Lenses: Single vision – R229, bifocal – R497, multifocal – R912
- Or choose contact lenses – up to R1 971
Maternity benefits – Register on the Bambino programme
- Ten (10) antenatal visits 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 as per the Department of Health up to 12 years of age. One (1) heart, hearing and vision screening for babies under 2 years of age
Out of Hospital benefits from Scheme Risk
- Psychiatrists, Clinical and Counselling Psychologists R10 501 per family per annum
Efficiency Discounted Option (EDO)
Choose the EDO plan and enjoy the same rich benefits accessed within a network of service providers both for In and Out of hospital.
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. R 16 008 per family per annum and limited to R7 938 per beneficiary per annum.
- Attention Deficit Hyperactivity Disorder (ADHD)
- Allergic Rhinitis
- Anaemia: Vitamin B12 and Iron deficiency
- Aplastic anaemia
- Anti-phospholipid syndrome
- Benign Prostatic Hypertrophy (BPH)
- Cushing’s Disease
- Cystic Fibrosis
- Depression
- Endometriosis
- Endocarditis & Iron Deficiency Anaemia
- Gastro-oesophageal reflux disease (GORD)
- Gout
- Hyperthyroidism
- Hypoparathyroidism
- Menopause / Hormone Replacement Therapy (HRT)
- Motor Neuron Disease
- Myasthenia gravis
- Obsessive Compulsive Disorder
- Osteoarthritis
- Osteoporosis
- Paget’s Disease
- Pituitary Microadenomas
- Psoriasis
- Pulmonary Interstitial fibrosis
- 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.
Wellness Consultation
- R1 870 per family per annum
Preventative Care and Screening Benefits include
- One (1) pap smear for females over 18 years per beneficiary per annum
- One (1) mammogram for females over 40 years of age per beneficiary per annum
- One (1) skin cancer screening per beneficiary above 55 years of age, annually
- One (1) PSA for males over 40 years per beneficiary per annum
- Blood sugar, cholesterol, blood pressure, Body Mass Index, HIV
Preventative Care and Screening Benefits include
- One (1) pap smear for females over 18 years per beneficiary per annum
- One (1) mammogram for females over 40 years of age per beneficiary per annum
- One (1) skin cancer screening per beneficiary above 55 years of age, annually
- One (1) PSA for males over 40 years per beneficiary per annum
- Blood sugar, cholesterol, blood pressure, Body Mass Index, HIV
Female Contraceptive Benefit
- R3 331 per family per annum, subject to MSA