Assume scheme pays all these costs, unless otherwise stated
Hospital stay:
Delivery fee: 200% scheme rate
Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.
Consultations:
Paid by scheme, unless otherwise stated
Consults: 13 consults
Lactation consult: 1 per pregnancy
Nutrition consultation: 1 per pregnancy
Nuchal Translucency Non-Invasive Pre-Natal Test:: 1 per pregnancy
Scans:
2 x 2D scans
Note:
If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don’t have medical aid.
Assume scheme pays all these costs, unless otherwise stated
In-hospital:
In-hospital:R28,245 per family
PMBs: Covered in full at DSP, up to 21 days admission, paid from above limit but not limited to it
Alcoholism/Drug Addiction: 21 days admission, paid from above limit but not limited to it
Out-of-hospital:
GPs: R580
Specialists: R850
Paid by scheme from psychiatric in-hospital limit
Trauma:
Covers certain day-to-day claims that form part of the recovery following specific traumatic events, such as near drowning, poisoning, severe allergic reaction and external and internal head injuries.
Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts