BENEFITS – SINGLE MEMBER
Doctor Visits 1
(at Scheme clinic or approved Scheme panel doctor)
10 per year, only at the Fund’s clinics or at contracted panel doctors
Obtained from clinic / panel doctor.
Dental Services: 2
(to be obtained from dental practitioner approved by Scheme)
Member only R900 per year
The above includes:
- Oral hygiene
- Repair of dentures (dentures are not included in above limits)
(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 only R2000 per year.
Black and white x-rays are covered under the hospital benefit limits.
3 visits per single member per year
Basic out-of-hospital blood test limited to R500 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.
- 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.
- 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.
- These benefits are available to a member after seasonal lay-off or retrenchment.
CHRONIC MEDICATION BENEFITS: 1
- Rheumatoid arthritis (medical proof required)
- Non-insulin dependent diabetes (type 2 diabetes)
- Chronic obstructive pulmonary disorders
- Bipolar mood disorder
- Chronic renal disease
- Coronary artery disease (ischaemic heart disease)
- Systemic lupus erythematosus
- Parkinson’s disease
- Adddison’s disease
- Ulcerative colitis
- Diabetes mellitus (type 1)
- Diabetes insipidus
- Crohn’s Disease
- Multiple Sclerosis
- Cardiac Failure