Affordable, income-based medical aid with unlimited hospitalisation at network providers; limited cover for GP and specialist visits; cover for 29 chronic conditions; 24/7 emergency medical assistance; and free flu and child vaccinations.
In Hospital Benefits
Overall Annual Limit |
Unlimited subject to sub-limits 100% (Resolution Rate) |
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Provider |
Network Hospitals, R7000 co-payment for use of non Network hospitals |
GP's & Specialists |
Professional fees paid at 100% Scheme Tariff Covered at DSP GP's & Specialists: Unlimited Radiology & Pathology: Unlimited Oncology: Unlimited (PMB conditions) & R88 772 per family for non-PMB per annum at ICON Network. Organ Transplants: Limited to PMBs Dialysis: PMBs and subject to Network Internal Prosthesis: Unlimited per family per annum. Subject to prosthesis sub-limits and Scheme Protocols. R41 350 overall annual limit for non-PMB conditions (per family per annum). |
Chronic |
26 PMBs |
Out of Hospital Benefits
Saving / Day to Day / OHEB |
GPs: Unlimited to Network authorisation required after 4th visit |
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Pooled Day to Day Benefit |
No benefit |
Threshhold / Safety Net |
Not applicable |
Self-Payment Gap Before Threshold |
Not applicable |
Above Threshold Limits |
Not applicable |
Maternity Care |
Subject to scheme protocols and PMBs |
Contributions
Contributions |
INCOME BASED: R0 - R8 000 Member: R1 234 Adult: R1 234 Per Child: R534
INCOME BASED: R8 001 - R12 000 Member: R1 537 Adult: R1 537 Per Child: R691
INCOME BASED: R12 01 - R15 000 Member: R1 646 Adult: R1646 Per Child: R746 INCOME BASED: R15 001 - R18 700 Member: R2 986 Adult: R2 986 Per Child: R1 029
INCOME BASED: R18 701+ Member: R3 812 Adult: R3 812 Per Child: R1 307
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