BENEFITS – FAMILY (Member with dependants)

Doctor Visits

18 per year, only at the Fund’s clinics or at panel doctors

Dentures:

Dentures may only be made at contracted panel dentists and with the prior approval of the Fund. The Fund will only cover one claim per annum

  • The Fund will pay 80% of the costs
  • The member will pay 20% of the costs

A Beneficiary is entitled to a set of dentures once every five years

Hospital Benefit: State hospital:

The member can claim up to R3000 per year for the following medical expenses:

  • Hospital cost
  • Medic Alert bracelet (one per beneficiary)
  • Ambulance cost
Maternity Benefit:

A Beneficiary may claim any costs for antenatal, maternity and post-natal care provided that such care is obtained through state or provincial hospitals to a maximum of R300 per member per year.

Dental Services:

R1000 can be claimed for the following:

  • Teeth extractions
  • Teeth fillings
  • Oral hygiene
  • Repair of dentures
Optical Benefits:

Spectacles may only be made at contracted panel optometrists and with the approval of the Fund. The Fund will only cover one claim per annum. The Fund will pay for:

  • Testing of the beneficiary’s eyes (once every two years)
  • Normal clear lenses
  • Bifocal lenses (reading glasses )
  • R500 to the cost of the spectacle frame

The member will pay for:

  • Balance of spectacle frame charges
  • Tinted / colour (photochromatic) lenses

A Beneficiary who has claimed a set of spectacles may only claim again after two years

Chronic Medication:

Treatment and medication for chronic conditions in terms of the Rules of the Fund.

WHO QUALIFIES AS A DEPENDANT?

1Your spouse or life partner automatically qualify as a dependant on your membership. The Fund may request additional legal documentation, including an affidavit and/or certificate or contracts stating the nature of the relationship.

 

2family Your own and your life partner’s/spouse’s children including foster and legally adopted children up to the age of 21 years.

 

3membersOther persons whom the member deems to be dependent on him (e.g. Mother, father, children over the age of 21 years), will be considered if the application meet the criteria as set out in the Fund’s Rules.