Assume scheme pays all these costs, unless otherwise stated
Optometry:
Limit:
R6,440 per family, every 24 months. Paid by scheme.
Consult:
1 per person
Frames:
R1,180 per person
Single lenses
100% rate
Bifocals:
100% rate
Multifocals
100% rate
Contacts
R2,065
Refractive Surgery:
no benefit
Notes:
Above benefits from network provider
Note:
This section does not apply to opthamology benefits, which fall under "in-hospital" benefits. Some of those are PMBs, and are paid for in full by your scheme. You can read more about PMBs here.
Assume scheme pays all these costs, unless otherwise stated
Flu vaccination:
Covered
Pneumonia vaccines:
Covered , 65yrs+ every 5 yrs
Biometric Screening:
Covered
Child Immunisation:
Covered
Pap Smear:
Covered , every 3 years for women 21yrs-65yrs
Mammogram:
1 mammogram every 2 years, women 40-74yrs
PAS Test:
1 test for men 45-69yrs, who are high risk for prostate cancer
HIV Test:
Covered
Other:
One stool test for colon cancer, 50yrs-75yrs
One lipogram every 5yr, 20yrs+
One bone density screening every 5 years for women 65yrs+ and men 70yrs+
Wellness Extender: Available after completing a wellness screening or online wellness assessment. Get R2,070 per family and use for out of hospital claims like : GP consult(s), OTC medicine, etc
A quick guide to how you can change your medical aid plan, including the resignation procedure, and things to look out for, such as imposed waiting periods from your new scheme
