Out-of-hospital, scheme pays for some: specialised radiology, maternity, alternative to hospitalisation, optometry, some non-surgical procedures including scopes,preventative benefits. Limits apply. All else paid from extended fund or out of pocket, unless PMB. .
IN HOSPITAL PROCEDURES: | |||
---|---|---|---|
Payout Rate for Specialists: | |||
Hospital Choice: | |||
Specialised Radiology: | |||
Supplementary Services: (Physio, etc) | |||
Transplants: | |||
Co-payments: | |||
Alternatives to hospitals: |
.
.
OUT OF HOSPITAL BENEFITS: | |||
---|---|---|---|
GP consultations: |
|
||
Specialists consultations: | |||
Pathology: | |||
General radiology: | |||
Specialised radiology: | |||
Supplementary Services: (Physio, etc) |
.
.
MATERNITY BENEFITS: | |||
---|---|---|---|
Hospital stay: |
|
||
Consultations: | |||
Scans: |
.
.
CANCER (ONCOLOGY): | |||
---|---|---|---|
Overall coverage (in and out of hospital): | Note: All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy. |
|
.
.
DENTISTRY: | |||
---|---|---|---|
Dentistry: |
|
||
Orthodontics: | |||
Maxillo Facial Surgery: |
.
.
MEDICATION: | |||
---|---|---|---|
Chronic: | |||
Acute (presrcibed) medication: | |||
Over-the-counter: | |||
Birth Control: | |||
On Discharge: | |||
Notes: |
.
.
OPTOMETRY: | |||
---|---|---|---|
Optometry: |
|
.
.
MENTAL HEALTH: | |||
---|---|---|---|
In-hospital: |
|
||
Out-of-hospital: |
.
.
OTHER BENEFITS: | |||
---|---|---|---|
General Appliances: |
|
||
1.1. Hearing Aids: | |||
1.2. Wheelchairs: | |||
Dialysis: | |||
HIV: | |||
Emergency Transport: | |||
International Coverage: | |||
Other: |
.
.
WELLNESS/PREVENTATIVE BENEFITS: | |||
---|---|---|---|
Flu vaccination: |
|
||
Pneumonia vaccines: | |||
Back Rehabilitation Programme: | |||
Biometric Screening: | |||
Child Immunisation: | |||
Pap Smear: | |||
Mammogram: | |||
PAS Test: | |||
HIV Test: |
.
.
PROSTHESIS: | |||
---|---|---|---|
Overal Limit: | |||
Sub-limits: |
- Important!
- Unless specified, assume that all benefits are paid are paid at 100% scheme rate
- No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
- "Unlimited" benefits are still subject to authorisation, protocols and sublimits
- Assume that all benefits need to be pre-authorised