BENEFITS – SINGLE MEMBER
10 per year, only at the Fund’s clinics or at contracted panel doctors
Dentures may only be made at contracted panel dentists and with the prior approval of the Fund.
- 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 R1800 per year for the following medical expenses:
- Hospital cost
- Medic Alert bracelet (one per beneficiary)
- Ambulance cost
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.
R700 can be claimed for the following:
- Teeth extractions
- Teeth fillings
- Oral hygiene
- Repair of dentures
Spectacles may only be made at contracted panel optometrists and with the prior approval of the Fund.
The Fund will pay for:
- Testing of the member’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, unless as otherwise agreed between the Fund and the contracted service provider.
A Beneficiary who has claimed a pair of spectacles may only claim again after two years.
Treatment and medication for chronic conditions in terms of the Rules of the Fund.