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:
From day-to-day benefit
20% discount on frames and lenses at a 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:
-
Pneumonia vaccines:
Covered
Biometric Screening:
Covered , every 3 years
Child Immunisation:
Not covered
Pap Smear:
Covered
Mammogram:
Covered
PAS Test:
Kids' assessment, including height, weight, head circumference and health and milestone tracking
Bowel cancer screening, every 2 years for 45-75yrs
HIV Test:
Covered, subject to authorisation
Other:
Shoulder joint prostheses: no limit, unless you use non-network supplier, in which case R42,950 limit applies
Major joints surgery: no limit, unless you use non-network supplier, in which case 80% scheme rate and R30,900 per prosthesis limit applies
Spinal surgery: no limit, unless you use non-network supplier, in which case R26,250 limit for first level and R52,500 for two or more levels. Limited to one procedure per person per year.
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
