Dental Trauma Benefit: Paid for sudden and unanticipated injury to teeth and mouth that requires urgent dental treatment after an accident or trauma injury. R65,150 per person
Otherwise,
<13 yrs: R3,200 co-payment for admission to hospital, or R1,450 co-payment for admission to a day-clinic
13yrs+: R8,250 co-payment for admission to hospital, or R5,300 c0-payment for admission to day-clinic
Assume scheme pays all these costs, unless otherwise stated
Optometry:
Limit:
R6,300 per person. Paid from day-to-day benefit.
Consult:
from above limit
Frames:
from above limit
Single lenses
from above limit
Bifocals:
from above limit
Multifocals
from above limit
Contacts
from above limit
Refractive Surgery:
from above limit
Notes:
20% discount on frames and lenses at network optometrist
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 , for 65yrs+
Pneumonia vaccines:
Every five years, or once per lifetime for persons over the age of 65
Biometric Screening:
Covered
Child Immunisation:
Not covered
Pap Smear:
Covered , every 3 years
Mammogram:
Covered , every 2 years
If you qualify, you can get Breast MRI and once-off BRCA test for breast screening
PAS Test:
Covered
HIV Test:
Covered
Other:
Kids' assessment, including height, weight, head circumference and health and milestone tracking
Bowel cancer screening
Access to the WELLTH Fund. You get up to R10,000 per family for various out of hospital expenses including GP, eye, dental, hearing screenings and medical devices. Find out more .
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
