Necesse student 2018 - Email: " Classique medical aid consultants cc ( A0328 ) Contact: 0217978885

Page created by Diana Becker
 
CONTINUE READING
Necesse student 2018 - Email: " Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
September 2017

                                                                            necesse student
                                                                                      2018

                 Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
                 Email: enquiries@classmed.co.za
why medihelp
    With a value-driven mindset we focus on fulfilling your health and wellness needs
    and customise our products and services to ensure an individualised experience
    when interacting with the Scheme in terms of the following four key areas:
    • Products • Services • Value • Engagement

   A SOUND HEALTHCARE PARTNER                                                           ENGAGEMENT
               112 YEARS’ experience in the medical                                                  Member app
               schemes industry                                                                      With an electronic membership card
                                                                                                     and instant benefit verification

               As a SELF-ADMINISTERED medical scheme Medihelp
               maintains complete control and tightly manages all
                                                                                                     Call centre
               administration costs                                                                  60 helpful consultants to assist you

               LARGE AND RELIABLE
               Medihelp is one of the five largest                                                   mySOS emergency
               open medical schemes in South Africa                                                  This app ensures that you and your
                                                                                                     loved ones can be located in an emergency

               CLAIMS PAYMENT ABILITY is guaranteed with our
               AA- rating awarded by Global Credit Rating                                            Secured website
                                                                                                     An online hub with all your Medihelp
               CONSISTENCY                                                                           service functionalities
               Medihelp’s average beneficiary age of 37 years provides a
               healthy risk pool to contribute to sustainability

               OUR SOLVENCY LEVEL
               Medihelp consistently maintains a solvency level well
               above the industry requirement

   PRODUCT
   A tailor-made option to suit your lifestyle and health profile.                           What do you pay?
               Full cover                                                                    You pay only R474 if your
               • 270 prescribed minimum benefits
               • 26 chronic conditions                                                       monthly income does not exceed
                                                                                             R400 and if you can provide
               No overall limit
               for hospital cover                                                            us with a letter on an official
                                                                                             letterhead from your tertiary
               Unlimited cover
               for trauma and emergencies
                                                                                             institution confirming that you are
                                                                                             registered as a full-time student
               Additional benefits
               A choice of additional, separate benefits for preventive
               care
                                                                                        Please note
               An individualised, free wellness programme provides
                                                                                        This brochure only provides a summary of benefits. In
               relevant health support and value during every life stage
                                                                                        case of a dispute, the registered Rules of Medihelp apply.
                                                                                        A complete list of benefits and all services excluded from
               Join Medihelp MultiSport for runners, walkers and
                                                                                        benefits is available in the Medihelp Rules.
               cyclists and get access to club gear at a discount and free
               participation in Medihelp                                                Exclusions may also include services which are not mentioned
               promotional events                                                       in the Rules as well as services which in the opinion of the
                                                                                        Board of Trustees are not aimed at the generally accepted
               A national network of private                                            medical treatment of an actual or a suspected medical
                                                                                        condition or handicap, which is harmful or threatening to
               healthcare providers
                                                                                        necessary bodily functions.

Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
Email: enquiries@classmed.co.za
what are your benefits?

    Hospital cover          Emergency cover             Doctors’ visits           Specialist care              X-rays &             Prescribed medicine             Dentistry           Eye care
                                                                                                              blood tests

    preventive care benefits
    Our preventive care benefits are designed to enable you to identify potential health problems.

                         Health tests                                                    Immunisation                                       Back treatment programme
        One test per student per year requested                             One immunisation per student per year                             1 Document-Based Care (DBC) programme
              by a Necesse network GP:                                       requested by a Necesse network GP:                                  per student per year at a DBC facility
            • 1 blood glucose test (pathology: 4057)                                          • 1 flu vaccine                                (subject to protocols and pre-authorisation)
              • 1 cholesterol test (pathology: 4027)                                       • 1 tetanus vaccine

    * Benefits are subject to day-to-day benefits.

    core benefits
    These include benefits for major medical expenses such as hospitalisation, emergency benefits and
    home care as an alternative to hospitalisation.

                       Trauma cover                                                 Emergency cover                                                      Essential cover
        Unlimited cover for trauma that necessitates                      • Unlimited emergency cover in South Africa for                    We offer 100% cover for 270 conditions and
                 hospitalisation in the case of                                 transport by road or air by Netcare 911                        26 chronic diseases treated by designated
           motor vehicle accidents, stab wounds,                          • R1 000 per student for outpatient emergency                      service providers and networks according to
          gunshot wounds, head trauma, burns and                               unit services, non-network doctors’ visits,                   treatment protocols. This includes oncology,
                        near drowning.                                     as well as medicine and services rendered by a                      HIV, prostheses and medical, surgical and
                                                                                      non-network medical doctor.                                       orthopaedic appliances.

       Hospitalisation                                                     Radiology & pathology                                             Alternative care to
       100% cover for hospitalisation in a network                         • R27 700 per year for standard radiology,                        hospitalisation
       hospital (subject to pre-authorisation and                                                                                            R20 200 per year for sub-acute care and
                                                                              pathology and medical technologist
       protocols)                                                                                                                            private nursing services as an alternative to
                                                                              services in hospital
                                                                           • R15 000 per year for specialised radiology                      hospitalisation
       Physio- and occupational                                               in and out of hospital. Services must be
       therapy                                                                requested by a specialist on referral by a                     Appendectomy
       R8 950 per year in hospital                                                                                                           • Conventional procedure – unlimited
                                                                              network GP and benefits are subject to
                                                                              clinical protocols.                                            • Laparoscopic procedure –
       Clinical technologist services                                         • MRI, CT imaging (subject to pre-                                 R15 800 for hospital costs
       R20 200 per year in hospital
                                                                                  authorisation) and angiography

    * Benefits are paid at 100% of the Medihelp tariff (MT). Consult the registered Rules of Medihelp for definitions of the various tariffs paid by Medihelp for different services.
Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
Email: enquiries@classmed.co.za
day-to-day benefits
                                      Day-to-day benefits include GP visits, dental procedures and eye care.

                                         Consultations                                                  Optometry
                                         • 9 network GP consultations 		                                Available per student in a 24-month cycle:
                                             per student per year                                       • 1 complete consultation
                                         • R2 950 per student per year for                              • Spectacles or contact lenses
                                             specialist care (subject to referral                           Spectacles
                                             by a Necesse network GP and pre-                               • R200 for the frame
                                             authorisation)                                                 • 1 pair of standard clear Aquity single
                                                                                                               vision, bifocal or multifocal lenses
                                         Other medical services                                             Contact lenses
                                         • R1 900 per student per year for                                  • R450 per student
                                             physiotherapy and occupational
                                             therapy out of hospital, if requested 		                   Dental
                                             by a network GP                                            • Routine check-ups
                                         • 100% of the Medihelp tariff for black                        • 4 fillings per student, 1 filling
                                             and white X-rays and soft-tissue                               per tooth in 365 days
                                             ultrasound scans (subject to codes)                        • Tooth extractions
                                         • 100% for blood tests 		                                      • Root canal treatment in the dentist’s
                                             (subject to a list of pathology codes                          chair for 2 teeth per student per year
                                             and tests), done by Lancet/PathCare                        • Laughing gas (in the dentist’s chair)
                                             on request of a network GP                                 • Extensive dental treatment under
                                                                                                            conscious sedation in the dentist’s
                                         Medicine                                                           chair (sedation cost), subject to pre-
                                         • Acute medicine dispensed by a                                    authorisation
                                             dispensing network GP                                      • X-rays
                                         • A list of approved medicine obtained                             • 4 intra-oral X-rays per student
                                             from a network pharmacy and                                       per year
                                             prescribed by a network GP or network                          • 1 extra-oral X-ray per student
                                             dentist                                                           in a 3-year period
                                         • Self-medication obtained from a
                                             network pharmacy
                                            • R100 per event
                                            • R270 per student per year

                                      explanation of terms
                                      An emergency medical condition means any sudden                  Network benefit options offer benefits to members in
                                      and unexpected onset of a health condition that requires         collaboration with a medical provider network. Members
                                      immediate medical or surgical treatment, where failure to        must make use of the network to qualify for benefits and
                                      provide such treatment would result in serious impairment        prevent payments.
                                      to bodily functions or serious dysfunction of a bodily organ
                                      or part, or would place the person’s life in serious jeopardy.   Prescribed minimum benefits (PMB) are paid for 26
                                      An emergency medical condition must be certified as such         chronic conditions on the CDL and 270 diagnoses with their
                                      by a medical practitioner. Emergencies qualify for PMB and       treatments as published in the Regulations of the Medical
                                      must therefore also be registered for PMB (see also “PMB”).      Schemes Act 131 of 1998. In terms of these Regulations,
                                                                                                       medical schemes are compelled to grant benefits for
                                      Hospital benefits refer to benefits for services rendered        the diagnosis, treatment and care costs of any of these
                                      by a hospital during a patient’s stay in hospital. Services      conditions as well as emergency medical conditions (that
                                      include ward accommodation and ward medicine, standard           meet the published definition) without imposing any limits.
                                      radiology and pathology, physiotherapy and other                 PMB are subject to pre-authorisation, protocols and the
                                      supplementary services rendered during hospitalisation.          utilisation of designated service providers, where applicable,
                                      Hospital benefits are subject to pre-authorisation and           e.g. Lancet/PathCare for pathology tests. Benefits for
                                      an 80% benefit will apply to the hospital account if the         PMB services are first funded from the related day-to-day
                                      admission is not pre-authorised. Emergency admissions            benefits.
                                      must be registered on the first workday following the
                                      admission. A 65% benefit applies for voluntary admission to      * Benefits are paid at 100% of the Medihelp tariff (MT).
                                      a non-network hospital.                                            Consult the registered Rules of Medihelp for definitions of
                                                                                                         the various tariffs paid by Medihelp for different services.

Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
Email: enquiries@classmed.co.za
A16783
  necesse private hospital and day clinic network
  Limpopo                                                                   Gauteng                                                         Western Cape
   City/town          Name                              Practice No          City/town        Name                            Practice No   City/town          Name                            Practice No

   Bela Bela          St Vincent’s Hospital             5706548              Krugersdorp      Pinehaven Hospital              604968        George             Mediclinic Geneva               5709059
   Lephalale          Marapong Private Hospital         5708125                               Netcare Waterfall City                        George             Mediclinic George               5807905
                                                                             Midrand                                          426024
   Makhado            Zoutpansberg Private Hospital     253871                                Hospital                                      Hermanus           Mediclinic Hermanus             5709091
   Polokwane          Mediclinic Limpopo                5808189              Midrand          Mediclinic Midstream            0579068       Knysna             Knysna Private Hospital         5808960
   Polokwane          Mediclinic Limpopo Day Clinic     0603120              Pretoria         Akasia Hospital                 5808618       Mossel Bay         Bayview Hospital                5808790
   Thabazimbi         Mediclinic Thabazimbi             5709202              Pretoria         Bougainville Private Hospital   5808952       Oudtshoorn         Mediclinic Klein Karoo          5808928
   Tzaneen            Mediclinic Tzaneen                132454                                Life Groenkloof Hospital                      Paarl              Mediclinic Paarl                5808251
                                                                             Pretoria                                         5804043
                                                                                              (oncology only)
                                                                                                                                            Plettenberg Bay    Mediclinic Plettenberg Bay      283207
  Free State                                                                                  Mediclinic Gynaecological
                                                                             Pretoria                                         5703638       Somerset West      Mediclinic Vergelegen           5808030
   City/town          Name                              Practice No                           Hospital
                                                                                                                                            Stellenbosch       Mediclinic Stellenbosch         5808405
   Bethlehem          Mediclinic Hoogland               5808707              Pretoria         Mediclinic Heart Hospital       5808634
                                                                                                                                            Strand             Mediclinic Strand               5709075
   Bloemfontein       Mediclinic Bloemfontein           5808154
                                                                             Pretoria         Mediclinic Kloof                120928
                                                                                                                                            Vredenburg         West Coast Private Hospital     5808979
                      Koinonia Theatre
                                                                             Pretoria         Mediclinic Legae                5808499
   Kroonstad          (Dr LJ van Wyk)                   7600658                                                                             Worcester          Mediclinic Worcester            5808006
                      (dental procedures only)                               Pretoria         Mediclinic Medforum             5807867

   Kroonstad          Kroon Hospital                    5808383              Pretoria         Mediclinic Muelmed              5808065       Northern Cape
   Welkom             Mediclinic Welkom                 5808758              Pretoria         Montana Private Hospital        5809002       City/town          Name                            Practice No

                                                                                                                                            Kathu              Lenmed Health Kathu
  North West                                                                 Pretoria
                                                                                              Medkin Clinic
                                                                                                                              7700121                                                          580619
                                                                                              (dental procedures only)                                         Private Hospital
   City/town          Name                              Practice No
                                                                                                                                            Kimberley          Mediclinic Kimberley            5808049
                                                                                              Pretoria North Day Clinic
   Brits              Mediclinic Brits                  5808723              Pretoria                                         7700156
                                                                                              (dental procedures only)                      Upington           Mediclinic Upington             5808804
   Klerksdorp         Wilmed Park Private Hospital      5808812
   Klerksdorp         Sunningdale Hospital              5706696
                                                                             Soweto/Lenasia   Lenmed Clinic                   5808324       KwaZulu-Natal
                                                                                              Lenmed Daxina Private
                                                                             Soweto/Lenasia                                   490296        City/town          Name                            Practice No
   Marikana           Andrew Saffy Memorial             78468                                 Hospital
                      Hospital                                                                                                              Amanzimtoti        Kingsway Hospital               5808200
                                                                                              East Rand N17 Private
                                                                             Springs                                          5809029
   Potchefstroom      Mediclinic Potchefstroom          5808057                               Hospital                                      Ballito            Alberlito Hospital              250562
   Rustenburg         Peglerae Hospital                 5808359              Vanderbijlpark   Mediclinic Emfuleni             5808375       Durban             Chatsmed Garden Hospital        5808219
   Rustenburg         Ferncrest Hospital                5808391                               PJ Schutte Theatre Unit                       Durban             Bluff Medical & Dental Centre   7700687
                                                                             Vanderbijlpark                                   7600534
                                                                                              (dental procedures only)
   Vryburg            Vryburg Private Hospital          5808553                                                                             Durban             St Augustine’s Hospital         5802563
                                                                             Vereeniging      Mediclinic Vereeniging          5808081
                                                                                                                                            Durban             Pinetown Medicross Theatre      7700954
  Gauteng
                                                                            Eastern Cape                                                    Durban             Parklands Hospital              5802466
   City/town          Name                              Practice No
                                                                             City/town        Name                            Practice No   Empangeni          Empangeni Garden Clinic         5708494
   Alberton           Clinton Clinic                    5708877
                                                                             East London      Life Beacon Bay Hospital        357669        Howick             Mediclinic Howick               122092
   Alberton           Union Hospital                    5804981
                                                                                                                                            Kokstad            Kokstad Private Hospital        174602
                                                                             Grahamstown      Settlers Hospital               348090
                      Lakeview Hospital
   Benoni                                               5709121                                                                             Margate            Margate Private Hospital        5808529
                      (dental procedures only)                               Humansdorp       Isivivana Private Hospital
                                                                                                                              168386
                                                                                              (maternity & neonatal only)                   Newcastle          Mediclinic Newcastle            5808871
   Benoni             Linmed Hospital                   5808588
                                                                             Port Alfred      Port Alfred Hospital            328871        Nongoma            Nongoma Private Hospital        147362
                      Boksburg Medical &
   Boksburg           Dental Centre                     7700741              Port Elizabeth   Greenacres Hospital             5807875       Pietermaritzburg   Mediclinic Pietermaritzburg     5808073
                      (dental procedures only)                               Port Elizabeth   Medical Forum Theatre           7700873       Pinetown           Malvern Medical & Dental        7700695
                                                                                                                                                               Centre
   Boksburg           Sunward Park Hospital             5808227              Queenstown       Life Queenstown Private
                                                                                                                              5709156
                                                                                              Hospital                                      Pongola            Pongola Hospital                5707803
   Bronkhorstspruit   Bronkhorstspruit Hospital         5808561
                                                                             Uitenhage        Cuyler Clinic                   5808642       Port Shepstone     Hibiscus Hospital               5808901
                      Suikerbosrand Clinic
   Heidelberg                                           5808987
                      (maternity & neonatal only)                           Western Cape                                                    Richards Bay       The Bay Hospital                5808472

                      Garden City Clinic                                     City/town        Name                            Practice No   Shelly Beach       Shelly Beach Day Clinic         380059
   Johannesburg                                         5805988
                      (maternity & neonatal only)                                                                                           Tongaat            Victoria Hospital               5708567
                                                                             Atlantis         Wesfleur Private Clinic         7700814
   Johannesburg       Mediclinic Morningside            5807824                                                                             Umhlanga           Umhlanga Hospital               5808936
                                                                             Cape Town        Mediclinic Cape Gate            366714
   Johannesburg       Mediclinic Sandton                5805139              Cape Town        Mediclinic Cape Town            5808995       Mpumalanga
   Johannesburg       Mulbarton Hospital                5808278              Cape Town        Mediclinic Constantiaberg       5807999       City/town          Name                            Practice No
                      Parklane Clinic                                        Cape Town        Mediclinic Durbanville          5808766
   Johannesburg                                         5803004                                                                             Barberton          Mediclinic Barberton            5709148
                      (maternity & neonatal only)
                                                                                              Mediclinic Durbanville                        eMalahleni         eMalahleni Private Hospital     413615
                                                                             Cape Town                                        592781
   Johannesburg        Rand Clinic                      5804620                               Day Hospital
                                                                                                                                            eMalahleni         eMalahleni Day Hospital         7700520
                       Wits University Donald                                Cape Town        Mediclinic Louis Leipoldt       5806860
   Johannesburg                                         5806682                                                                             Ermelo             Mediclinic Ermelo               5808863
                       Gordon Medical Centre                                 Cape Town        Mediclinic Milnerton            5808669
                                                                                                                                            Middelburg         Middelburg Private Hospital     5808243
                       Birchmed Surgical Centre                              Cape Town        Mediclinic Panorama             5807913
   Kempton Park                                         7700504                                                                             Nelspruit          Mediclinic Nelspruit            5808340
                       (dental procedures only)                              Cape Town        Melomed Gatesville              5808103
   Krugersdorp         Krugersdorp Private Hospital     5808111                                                                             Secunda            Mediclinic Secunda              540110
                                                                             Ceres            Ceres Private Hospital          5709032
   Krugersdorp         Protea Clinic                    7700369                                                                             Trichardt          Mediclinic Highveld             5807956

     086 0100 678
     www.medihelp.co.za
     Medihelp is an authorised financial services provider (FSP No 15738)

Classique medical aid consultants cc ( A0328 ) Contact: 0217978885
Email: enquiries@classmed.co.za
You can also read