BENEFITS – SINGLE MEMBER

Doctor Visits

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

Dentures:

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
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:

R700 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 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.

Chronic Medication:

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