BENEFITS – FAMILY (Member with dependants)

Doctor Visits 1

(at Scheme clinic or approved Scheme panel doctor)
18 per year, only at the Fund’s clinics or at contracted panel doctors

Medication:

Obtained from clinic / panel doctor.

Dental Services: 2

(to be obtained from dental practitioner approved by Scheme) 
Member + dependents R1800 per year

The above includes:

  • Extractions
  • Fillings
  • Oral hygiene
  • Repair of dentures (dentures are not included in above limits)
Dentures: 3

(to be obtained from service provider approved by the scheme.  A beneficiary is entitled to 1 set of  dentures once every 5 years) to be covered as follows: 

  • The Fund will pay 80% of the costs
  • The member will pay 20% of the costs
Optical Benefits: 2

(to be obtained only from service provider approved by Scheme) One pair of glasses per beneficiary every 2 years and covered as follows:

  • Eye test (once every 2 years)
  • Normal clear lenses only
  • Bifocal lenses (reading glasses)
  • R600 to the cost of the frame. Member responsible for the balance of the cost of the frame and any tinting of lenses.
Maternity Benefit: 3

6 additional GP visits per pregnancy per year.

Hospital Benefit: 2

Covers costs for:

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

Member + Dependents R4000 per year.

X-RAYS

Black and white x-rays are covered under the hospital benefit limits.

Physiotherapist 3

6 visits per family per year

Pathology 3

Basic out-of-hospital blood test limited to R1 000 per year. Subject to GP referral.

Preventative Care 3

Mammograms: Limit of R800 per beneficiary per annum. Subject to GP referral and limited to one mammogram every three years.

Pap Smears: One pap smear for females 16 years and older every two years.

 

  1. These benefits are available to a member after seasonal lay-off or retrenchment for the remainder of the year provided that the member has continuously contributed to the Fund for least 4 weeks.
  2. These benefits are available to a member after seasonal lay-off or retrenchment for a 2-months period provided that the member has continuously contributed to the Fund for least 4 weeks.
  3. These benefits are available to a member after seasonal lay-off or retrenchment.

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.

 

3members Other 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..

CHRONIC MEDICATION BENEFITS: 1
  1. Hypertension
  2. Asthma
  3. Rheumatoid arthritis (medical proof required)
  4. Non-insulin dependent diabetes (type 2 diabetes)
  5. Chronic obstructive pulmonary disorders
  6. Epilepsy
  7. Hypothyroidism
  8. Bipolar mood disorder
  9. Gout
  10. Psoriasis
  11. Stroke
  12. Bronchieactasis
  13. Chronic renal disease
  14. Coronary artery disease (ischaemic heart disease)
  15. Hyperlipidaemia
  16. Systemic lupus erythematosus
  17. Glaucoma
  18. Parkinson’s disease
  19. Adddison’s disease
  20. Ulcerative colitis
  21. Diabetes mellitus (type 1)
  22. Diabetes insipidus
  23. Cardiomyopathy
  24. Dysrhythmias
  25. Schizophrenia
  26. Crohn’s Disease
  27. Multiple Sclerosis
  28. Haemophilia
  29. Cardiac Failure