Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
All treatments and procedures are subject to authorisation and protocols
All benefits are listed as an indication only. Please verify with your broker and scheme
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:
Unlimited. After the first R650,000, a 20% co-payment applies for non-PMB cancers
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:
2 general checkups per person
Root canal: not on wisdom or primary teeth
Plastic Dentures: 1 set, full or partial per person every 4 years
Fillings: coverec
Intra-oral x-ray: from protocols
Extra-oral: 1 per person, every 3 years
Scans:
Crowns: 3 crown per family
Implants: 2 implants, up to R5,000 per implant, per person every 5 years
Metal dentures:2 partial frames per person, every 5 years. One per family per year
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.
