| SERVICE |
BENEFIT |
LIMIT |
HOSPITAL |
| Overall Hospital Annual Limit of R750
000 of which members may utilise R100 000 per beneficiary
in Private Hospitals and the balance in Private Wards in Public
Hospitals |
| Medical Practitioners and Specialist Hospital Charges |
100%
of AT |
Authorization required for hospital admission.
Subject to overall annual limit. |
ICU & High Care (Max 30 Days)
Organ transplant
Oncology
|
100% |
Pre-Authorization Required |
Radiology & Pathology
Maxillo Facial Surgery
PET, MRI & CT Scans
|
100% |
Injury cases only |
| Medical Prosthesis (Medical & Surgical Appliances) |
100% |
R 10 000 per annum |
| Dental Surgery |
100% |
No Benefit |
Maternity
• Normal Birth
• Caesarian
Section
|
100% |
Confirmation every 24 hours
1 day maximum
2 days maximum |
| Psychiatric Hospitalization |
100% |
Authorization Required Limit to 7 Days per annum |
| Ambulance Services |
100% |
Emergency Transportation Only Preferred Provider –
Tel : 011 541 1118 |
DAY-TO-DAY BENEFITS |
| General Practitioner Visits |
100%
of Cost |
Unlimited from Selected Doctor
(Dr list available above: see search) |
Acute Medication
(Please refer to B1 in the information brochure)
|
100% |
Unlimited (Subject to Formulary) |
Chronic Medication
(Please refer to B1 in the information brochure)
|
100% |
Authorization is Required, call 0860 EMC EMC |
Pathology
(Please refer to B2 in the information brochure)
Radiology
(Please refer to B2 in the information brochure)
|
100% |
Unlimited
Authorization is Required, call 0860 EMC EMC |
OVERALL LIMIT OF
R3000 |
Special Visits
• Including Maternity Scan
(Please refer to B3 in the information brochure)
|
100% |
R 1500 p.a per beneficiary
Subject to overall limit
Authorization is Required, call 0860 EMC EMC |
Dentistry
• Conservative Dentistry
Specialized Dentistry
|
100% |
R 2000 p.a per family
Subject to overall limit |
Optometry
• Eye Test
• Spectacles
• Contact Lenses
|
100% |
R 750 p.a per beneficiary
Subject to overall limit |
Auxiliary Practitioners
• Speech Therapy
•
Occupational Therapy
|
100% |
R 1500 p.a per family
Subject to overall limit
Authorization is Required, call 0860 EMC EMC |
