Designed for families who need dependable, comprehensive, all-around healthcare, the Value Platinum and Value Platinum Core Plans offer top-tier medical cover you can trust in every season of life.
The Value Platinum Plan provides access to any hospital, while the Value Platinum Core Plan offers the same benefits but limits access to hospitals within the Scheme network only.
- Full private hospital and specialist cover
- Advanced scans & 24/7 emergency services
- Support for 43 chronic conditions
- Dental, optical, and day-to-day benefits
- Wellness screenings & vaccinations
- Medical appliances and mobility aids
R6696
R6287
R1834
R6363
R6094
R1624
R15267 pm
R14334 pm
R4182 pm
R14508 pm
R13894 pm
R3703 pm
In-hospital Benefits
Hospital and related
- No overall annual limit (100% scheme rate)
- Private hospitals (CORE plan network hospitals)
- Specialists cover a 100% medical aid rate
- To-Take-Out medication (TTO): seven (7) days PMB medication (Non PMBs, subject to MSA)
- Maternity cover within medical protocols (100% Scheme rate)
- Internal and external prosthesis, R59 865.75 per family, sub-limits apply
- Oncology: unlimited for PMB and 80% scheme rate cover above R632 063.25
Specialised Radiology: MRI/PET/CT, combined in and out of hospital benefit, one scan per beneficiary subject to family limit of R39 861.99 per annum. A R1 736.44 co-payment per scan event applies (excluding PMBs)
- Ambulance & emergency services – Netcare 911 24-hour access. Authorisation is required within 72 hours of an emergency PMB event
Out-of-hospital Benefits
Out of Hospital Benefits for Day to Day are subject to MSA, excluding Scheme risk benefits as stipulated, sub-limits may apply.
Scheme risk benefits include PMB’s, Chronic non- PMB medicine, Advanced Dentistry, Emergency services, Hearing aids, non-motorised wheelchair, Maternity and Wellness. Benefit limits and Sub-Limits apply.
VALUE PLATINUM CORE
Overall Annual Limit for Out of Hospital benefits: Subject to Medical Savings Account, Self-Payment Gap and Above Threshold Benefits.
Medical Savings Account (MSA) (GP, Specialists, Acute medicine, Radiology, Pathology and other out of hospital expenses):
- Main Member: R14 508
- Adult dependent: R13 894
- Child dependent: R3 703
Self-Payment Gap (Excludes Acute Medication):
- Main Member: R2 462
- Adult dependent: R2 085
- Child dependent: R539
Above Threshold Benefits (Excludes Acute Medication):
- Main Member: R6 507
- Adult dependent: R3 827
- Child dependent: R1 664
VALUE PLATINUM
Overall Annual Limit for Out of Hospital benefits: Subject to Medical Savings Account, Self-Payment Gap and Above Threshold Benefits.
Medical Savings Account (MSA) (GP, Specialists, Acute medicine, Radiology, Pathology and other out of hospital expenses):
- Main Member: R15 267
- Adult dependent: R14 334
- Child dependent: R4 182
Self-Payment Gap (Excludes Acute Medication):
- Main Member: R2 462
- Adult dependent: R2 085
- Child dependent: R539
Above Threshold Benefits (Excludes Acute Medication):
- Main Member: R6 507
- Adult dependent: R3 827
- Child dependent: R1 664
Dental care- Benefit managed by Dental Risk Company
- Conservative dentistry Paid from MSA.
- Subject to pre-authorisation and managed care protocols, Scheme tariff rate applies
- Consultations, fillings and extractions
- Preventative scale and polish
- Infection control
- Conscious sedation: (limited to beneficiaries below the age of 16 years)
- Dental X-rays Subject to dental treatment protocols and pre-authorisation
- Advanced dentistry paid from Risk
- Subject to pre-authorisation and managed care protocols, Scheme tariff rate applies
Optical – Benefit managed by Isoleso
- 24-month treatment cycle
- One (1) eye test per beneficiary
- Frame: R1 233.75 per beneficiary
- Lenses:
Single vision – R259.69 per lens
Bifocal vision – R536.76 per lens
Multifocal vision – R1 034.21 per lens - Or choose contact lenses –R2 234.40 per beneficiary
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
- Two (2) x 2D scans
- Childhood Immunisation, as per the Department of Health, is for children up to 12 years of age. One (1) heart, hearing and vision screening for babies under two (2) years of age
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
