Assume scheme pays all these costs, unless otherwise stated
Optometry:
Limit:
R3,860 per person, every 24 months. Paid from day-to-day benefit.
Consult:
from above limit
Frames:
from above limit
Single lenses
R215 per lens
Bifocals:
R460 per lens
Multifocals
R860 per lens
Contacts
from above limit
Refractive Surgery:
R24,240 per family
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+
Whooping cough booster vaccine every 10 years
Dental fissure sealants on permanent teeth for
children under 16
Wellness Extender: Available after completing a wellness screening or online wellness assessment. Get R3,000 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
