Select a scheme and option
View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.
| Benefit summaries | |
|---|---|
| In-hospital benefits |
Pre-authorisation is required for all in-hospital treatment. Emergencies must be authorised within 48 hours following admission to hospital. Failure to obtain pre-authorisation will result in the member being liable for the full cost of hospitalisation and related expenses. Benefits will be provided in accordance with the Scheme rules, benefits, clinical protocols and limits. Please call 0860 005 037 (option 2) to request pre-authorisation. |
| Out-of-hospital benefits |
The out-of-hospital benefit covers medical treatment received in doctors' rooms. |
| Community care benefits |
The Community care benefit covers private nursing and hospice care in lieu of rehabilitation, blood transfusions, technologists, alternative and other medical services. Please call 0860 005 037 (option 2) to request pre-authorisation. |
| Wellness benefits |
The Wellness benefit covers vaccinations, early detection and screening. |
| Optical benefits |
Preferred Provider Negotiators (PPN), South Africa’s largest optometry network, provides members with enhanced optical benefits on behalf of the Scheme. |
| Healthcare programmes Members need to register on health management programmes to gain access to the benefits outlined below. | |
|---|---|
| Medicine Risk Management |
The Medicine Risk Management (MRM) Programme is dedicated to managing chronic medication use in a manner that is beneficial to the health of members. |
| YourLife programme (HIV/Aids) |
The Scheme has contracted with Momentum Health Solutions to provide the YourLife Programme for the benefit of members who are at risk of being HIV positive or have been diagnosed as a person living with HIV/AIDS. Please call 0860 005 037 (option 4) or email [email protected] to register a member on the programme. |
| Maternity programme |
The Maternity Programme is specifically designed to empower members.giving them access to support, education, and advice from experts, through all stages of their pregnancy, confinement and even after the baby is born. Please call 0860 005 037 to to register a member on the Programme. |
| Oncology programme |
The Oncology Programme is specifically designed to actively empower patients. Participants on this programme generally have a more positive attitude and approach to treating their condition and improving general wellness. This positive attitude often translates into improved treatment compliance and a healthier lifestyle, which can make a real difference in the way patients respond to treatment and the general quality of their life. Please call 0860 005 037 to register a member on the programme. |
| Palliative Care programme |
Palliative care is specialised medical care for people living with a serious illness and is focused on providing relief from the symptoms and stress of their condition(s). It is based on the needs of the patient, not on the patient's prognosis (the likely course or outcome of a medical condition). Please call 0860 005 037 or email [email protected] to register a member on the programme. |
| Chronic condition lists | |
|---|---|
| Prescribed minimum benefits (PMB) | |