Assume scheme pays all these costs, unless otherwise stated
Optometry:
Limit:
R7,385, every 24 months. Paid by scheme.
Consult:
1 per person
Frames:
R1,340 from network provider
Single lenses
100% cost from network provider, or R210 per lens from non-network
Bifocals:
100% cost from network provider, or R460 per lens from non-network
Multifocals
100% cost from network provider, or R860 per lens from non-network
Contacts
R2,060
Refractive Surgery:
No benefit
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+
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
Wellness Extender: Available after completing a wellness screening or online wellness assessment. Get up to R5,000 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
