What are your options for 2018?

Transcription

1 What are your options for 2018? MEDXXI R 1, R 1, R Unlimited hospital cover at any of the Scheme s Designated Hospitals, paid at 100% of Agreed Tariff 25 PMB Chronic Conditions Ante-natal Classes and Foetal Scans R 1, Contraceptive benefit to a maximum of R 1, Benefits for Mammogram and Pap Smear Certain clinical procedures (Gastroscopy and Colonoscopy) covered in Doctor s room Unlimited MRI-, CT scans in and out of hospital Benefits for Non-Elective Maxilla-Facial and Oral Surgery Maternity visits (subject to limit) Out-Patient Treatment at Hospital Facility - Limited to R 1, per family per annum for treatment at a hospital out-patient facility or emergency rooms

2 SELFSURE R 2, R 2, R Unlimited hospital cover for any PMB at DSP (Designated Service Providers) - any private hospital in South Africa, paid at 100% of Agreed Tariff for elective hospitalisation GP visits, specialist visits, acute meds = R 5, (principal member); R 3, (adult dependant); R 1, (minor dependant) Basic Dentistry, Pathology, Radiology and Physiotherapy = R 5, or R 7, for family Optometry : 100% of Scheme Tariff in respect of consultation and spectacles/contact lenses limited to R 5, per family per 24 month cycle All Optical benefits are subject to the Opticlear Network protocol Medical Appliances = R 4, Chronic PMB Conditions Unlimited Maternity visits Ante-natal Classes and Foetal Scans R 1, Contraceptive benefit to a maximum of R 1, Certain clinical procedures (Gastroscopy and Colonoscopy) covered in Doctor s room Unlimited MRI-,CT scans in and out of hospital Benefits for Non-Elective Maxilla-Facial and Oral Surgery Student dependants qualify for minor contributions up to the age of 25

3 MED ELITE R 5, R 4, R 1, Unlimited hospital cover at any of the Scheme s Designated Hospitals, paid at 100% of Agreed Tariff Joint Replacements covered (co-payments may apply/individual sub-limits apply) Generous Oncology Benefits, cover for Biological drugs 65 Chronic Conditions covered up to R 30, Ante-natal Classes and Foetal Scans R 1, Benefits for Mammogram and Pap Smear Certain clinical procedures (Gastroscopy and Colonoscopy) covered in Doctor s room Unlimited MRI-,CT scans in and out of hospital Benefits for Non-Elective Maxilla-Facial and Oral Surgery

4 SELFMED 80% R 6, R 6, R 1, Unlimited hospital cover at any private hospital in South Africa, payable at 100% of Agreed Tariff Specialist covered at 80% of Cost in- and out- of hospital Joint Replacements covered (co-payments may apply/individual sub-limits apply) Generous Oncology benefits, cover for Biological drugs 65 Chronic Conditions covered up to R 47, Optometry: 80% of Scheme Tariff in respect of consultation and spectacles/contact lenses limited to R10, per family per 24 month cycle All Optical benefits are subject to the Opticlear Network protocol Ante-natal Classes paid at Cost R 1, Student dependants qualify for minor contributions up to the age of 25

5 SELFNET R 1, R 1, R Hospital cover - Subject to a DSP network, limited to PMB conditions. 25 PMB Chronic Conditions 3 Non PMB Conditions - Adenoidectomy, Tonsillectomy, Grommets General Practitioners Consultations Unlimited, 100% of Network Rate via the Network GP for all medically necessary consultations per beneficiary. Cover includes basic primary care services. Minor trauma treatment subject to the listed tariffs. Specialist Practitioners Consultations - 100% of Network Rate via the Network Provider, subject to a combined limit of R 1, per Beneficiary per year for cost of consultation, medication, procedures and Radiology and Pathology related to the authorised out of hospital specialised visit, limited to a maximum of R 2, per family per year. Spectacles and Contact Lenses - One pair of clear standard mono-focal, bi-focal or multi-focal lenses plus standard frame from a selection OR one set of approved contact lenses to the value of R per Beneficiary per 24 months at the Network Optometrist. Frames other than the pre -selection of frames limited to R Basic dentistry - 100% of the Network Rate, subject to the Network protocol and the use of the Network Dentist. Basic Radiology - 100% of Network Rate, subject to the Network protocol, formulary and referral by a Network GP. Basic Pathology - 100% of Network Rate, subject to the Network protocol, formulary and referral by a Network GP. Unlimited MRI-, CT scans in and out of hospital - 100% of the Network Rate for MRI-, CT scans, performed in or out of hospital, subject to PMB regulation, obtaining a PAR, motivation and approval. Maternity - Subject to pre-authorisation and Network Provider referral process. Outpatient treatment at hospital facility/out of Network Consultations - Benefits as described in respect of Medical Practitioners, limited to three consultations, subject to R 1, limit. Account payable upfront by member and submitted to Network for refund in accordance with the Network protocol and benefit limit.

6 SELFNET ESSENTIAL R R Specific cover to meet specific individual needs R This option is ideally suited to the healthy individual, who, in the case of a life-threatening in-hospital medical emergency, can enjoy total peace of mind, knowing that they will be well taken care of, in a Network private facility. Hospital cover - Subject to a DSP network, limited to PMB conditions. 25 PMB Chronic Conditions Unlimited MRI and CT scans in and out of hospital - 100% of the Network Rate for MRI and CT scans, performed in or out of hospital, subject to PMB regulation, obtaining a PAR, motivation and approval. Confinement - Subject to pre-authorisation and Network Provider referral process. Ambulance Services - 100% of Network Rate for emergency transport to and from hospital.