General
The following benefits will be implemented with effect from 1 January 2026.- HIV
info And related illnesses
Pathology, medication, consultations, and hospitalisations, and related services
warning Medication and hospital pre-authorisation is required
warning Use of a DSP and formulary medication is required, failing which a co-payment for the voluntary use of a non-DSP and non-formulary medication will apply
Pathology, medication, consultations, and hospitalisations, and related services are subject to PMBs
do_not_disturb_on Post-exposure prophylactics: Members will be covered for 28 days on triple therapy
100% of single exit price, plus the lower of the agreed upon or regulated dispensing fee at DSP for medication
100% of agreed tariff at DSP or 90% of cost at other providers - Infertility
Infertility Treatment
warning Only if a PMB
Will be paid in respect of services obtained at the DSP and from State and public hospitals
100% of cost
- Oncology Programme/Chemo- and Radiotherapy
Oncology Treatment
warning Subject to pre-authorisation, once-off registration on the programme and use of a specialist affiliated with ICON.
Medipost is the DSP for oncology medication.
R731 220 per beneficiary per annum, subject to PMBs and Appendix 1 of the Society's rules.
These benefits apply to in- and out-of-hospital chemo- and radiotherapy.
Medication to treat the side-effects of chemo and radiotherapy are to be paid from this benefit.
Not subject to chronic medication limits.
Includes all treatment in terms of the care plans.
Consultations are subject to authorised treatment plans and not the limits for specialist consultations.
Where the treatment is deemed to be clinically appropriate and medically necessary by the Society's designated agent, an additional benefit may be granted by the Trustees in excess of the limit, provided that application is made for the additional benefit prior to the service being rendered.
100% of agreed tariff at DSP for medication. Claims in respect of medication obtained from a non-DSP will be paid at the single exit price, plus the lower of the dispensing fee, as set out in medicine pricing regulations or agreed upon with DSP