Cardiovascular screenings (blood pressure, blood glucose, cholesterol, body mass index)

warning Benefits are subject to Society's protocols and use of the Society's DSPs

do_not_disturb_on One per beneficiary per annum

Mammograms

warning Age limit: 40 years (benefits for beneficiaries younger than 40 are subject to motivation and prior approval)

do_not_disturb_on One per beneficiary per annum

Pap smears

do_not_disturb_on One per beneficiary per annum

Prostate-specific antigen (PSA)

warning Age limit: 50 years and older (benefits for beneficiaries younger than 50 are subject to motivation and prior approval)

do_not_disturb_on One per beneficiary per annum: 50 years and older

Faecal occult blood

warning Age limit: 50 years and older (benefits for beneficiaries younger than 50 are subject to motivation and prior approval)

do_not_disturb_on One per beneficiary per annum: 50 years and older

Vaccinations (child and infant)

do_not_disturb_on State protocols apply

Elisa test (HIV screening)

do_not_disturb_on One per beneficiary per annum

Bone density test

warning Age limit: 50 years and older (benefits for beneficiaries younger than 50 are subject to motivation and prior approval)

do_not_disturb_on One per beneficiary per annum

Child and infant vaccinations

View the approved vaccinations list

Human papillomavirus (HPV)

do_not_disturb_on Maximum of 3 per beneficiary depending on vaccination make: male and female beneficiaries between the ages of 9 and 18

View the approved vaccinations list

Pneumococcal vaccination

do_not_disturb_on One per beneficiary per annum

View the approved vaccinations list

Flu vaccination

do_not_disturb_on One per beneficiary per annum

Dental consultation

In addition to the dental services benefit (conservative and restorative dentistry, special dentistry and implants)

do_not_disturb_on One per beneficiary per annum

Eye test

Acuity, pressure and other

do_not_disturb_on One per beneficiary every two-year cycle at DSP

Dietician consultation

do_not_disturb_on One per beneficiary per annum

Male circumcision

do_not_disturb_on One per beneficiary per annum, subject to a limit of R1 610 if performed in a doctor's room

Contraceptives

do_not_disturb_on Limited to R2 040 per beneficiary per annum and subject to overall acute medication limit

General practitioner: Consultations, services and visits

warning Consultations in respect of a PMB condition are subject to a care plan

Includes consultations and treatment out of hospital, including outpatient facilities.

Consultations in respect of a PMB condition are subject to the care plan and Appendix 1 of the Society's rules.

Once the limit is reached, only services in respect of PMB conditions will be paid.

Where the service 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.

Benefit is pro-rated if member joins during benefit year.

do_not_disturb_on PMBs

Unlimited, subject to the diagnoses, treatment and care cost of PMB conditions

Specialist: Consultations, services and visits

warning Consultations in respect of a PMB condition are subject to a care plan

Includes consultations and treatment out of hospital, including outpatient facilities.

Consultations in respect of a PMB condition are subject to the care plan and Appendix 1 of the Society's rules.

Once the limit is reached, only services in respect of PMB conditions will be paid.

Where the service 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.

Benefit is pro-rated if member joins during benefit year.

do_not_disturb_on PMBs

Unlimited, subject to the diagnoses, treatment and care cost of PMB conditions

Maternity related services

do_not_disturb_on Subject to registration, pre-authorisation and Society protocols

do_not_disturb_on Additional services, such a tococardiography, external cephalic version, lecithin-sphingomyelin and amniocentesis may be granted where clinically appropriate and medically necessary.

Benefits include: Audiology, audiometry, occupational therapy, speech therapy, orthoptic services, physiotherapy, biokinetics, psychological treatment, social workers and registered councilors, clinical and technical technologists, dietician services, chiropractor, homeopath, osteopaths, naturopaths, podiatrists, chiropodists, ayurvedic and traditional healers, therapeutic massage therapist, social workers

Includes consultations and treatment out of hospital by an approved and registered paramedical and auxiliary service provider (subject to registration with the HPCSA and AHPCSA).

Consultations in respect of a PMB condition are subject to the care plan and Appendix 1 of the Society's rules.

Once the limit is reached, only services in respect of PMB conditions will be paid.

Where the service 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.

Benefit is pro-rated if member joins during benefit year.

do_not_disturb_on All out-of-hospital auxiliary services are limited to:
M: R8 500
M+1: R11 370
M+2: R14 170
M+3: R17 060

Appliances relating to chronic diseases and other medical conditions

e.g. oxygen cylinders and nebulisers (includes either hire or purchase)

warning Subject to pre-authorisation, except for nebulisers

Benefit is adjusted in proportion to the number of months of membership if member joins during benefit year

do_not_disturb_on R14 890 per beneficiary per annum

Consumables relating to chronic diseases and other medical conditions.

e.g. colostomy kits and other incontinence materials or equipment

warning Subject to pre-authorisation

Benefit is adjusted in proportion to the number of months of membership if member joins during benefit year

do_not_disturb_on R27 990 per beneficiary per annum

Diabetic consumables and appliances

including needles, strips and glucometers

warning Subject to pre-authorisation

Benefit is adjusted in proportion to the number of months of membership if member joins during benefit year

do_not_disturb_on R5 870 per beneficiary per annum

warning Examples of appliances for acute conditions include, but are not limited to:

Braces, slings, splints and corsets; cervical collars; thermomoulded shoes and post-operative sandals, including bunionectomy Arcopedico shoes; air casts; pressure garments; compression hoses; cushions; mastectomy breast prostheses; TED compression stockings; the hiring of sleep apnoea monitors for infants; and the hiring of wheelchairs, walking frames, crutches, traction equipment, toilet and bath raisers and bath swivel stools

Benefit is adjusted in proportion to the number of months of membership if member joins during benefit year

do_not_disturb_on R10 030 per family per annum

Hearing aids and its repairs

Benefit is adjusted in proportion to the number of months of membership if a member joins during benefit year

do_not_disturb_on R26 130 per beneficiary per 2 year cycle

Psychologist: Consultations and treatment

warning Subject to PMBs and pre-authorisation

Benefit is pro-rated if member joins during benefit year.

Psychiatrist: Consultations and treatment

warning Subject to PMBs and pre-authorisation

Benefit is pro-rated if member joins during benefit year.

Benefits included:

info Conservative and restorative dentistry (includes plastic dentures and extractions under conscious sedation)

info Special dentistry (including metal-based dentures)

info Implants

General anaesthetic and hospitalisation for conservative dental work excluded, except in the case of trauma and impacted third molars.

All orthodontic services are subject to prior approval.

In-hospital dentistry subject to pre-authorisation by Society's designated agent or hospital DSP.

Benefit is adjusted in proportion to the number of months of membership if a member joins during benefit year.

do_not_disturb_on All dental services limited to:
M: R13 360
M+1: R19 940
M+2: R24 700
M+3: R26 670

Comprehensive consultation (inclusive of tonometry, glaucoma screening and visual screening)

Limited to one per beneficiary per cycle

One pair of clear single-vision spectacle lenses per cycle
OR

One pair of clear bifocal lenses per cycle
OR

One pair of clear multifocal lenses per cycle

Frames and/or prescription lens enhancements

Contact lenses instead of spectacles

warning Either the spectacle or contact lenses benefit may be used

Lens enhancements

Refractive surgery

Provided for under the hospitalisation benefit and is subject to pre-authorisation and the guidelines of the Society’s designated agent