Benefit options 2019 - Medihelp

 
Benefit options 2019 - Medihelp
Benefit options 2019
Benefit options 2019 - Medihelp
Contact us
Medihelp                                                                                                                        Partners
Medihelp Customer Care centre                                          MRI and CT imaging                                       Netcare 911 (emergency medical transport)
Tel: 086 0100 678                                                      Tel: 086 0200 678                                        Tel: 082 911
Fax: 012 336 9540
enquiries@medihelp.co.za                                               Oncology                                                 DRC (dental services)
www.medihelp.co.za                                                     Disease management programme                             Tel: 012 741 5143
                                                                       Tel: 086 0100 678                                        Fax: 086 687 1285
Application forms (new business)                                       Fax: 086 0064 762                                        medihelp@dentalrisk.com
newbusiness@medihelp.co.za                                             oncology@medihelp.co.za                                  claims@dentalrisk.com
                                                                                                                                auth@dentalrisk.com
Membership enquiries                                                   Oncology medicine (Prime network options only)           www.dentalrisk.com
Fax: 012 336 9532                                                      Dis-Chem Oncology
membership@medihelp.co.za                                              Tel: 010 003 8948                                        HIV/Aids programme & post-exposure prophylaxis (PEP)
                                                                       Fax: 086 597 0573                                        Disease management programme
Subscriptions enquiries                                                oncology@dischem.co.za                                   LifeSense
subscriptions@medihelp.co.za                                           or                                                       Tel: 0860 50 60 80
                                                                       Medipost                                                 SMS: 31271 for a call back
E-services                                                             Tel: 012 404 4430                                        Fax: 0860 80 49 60
Access the secured site for members via www.medihelp.co.za             Fax: 086 680 3319                                        Enquiries: enquiry@lifesense.co.za
Download the member app from iStore/Google Play/                       oncology@medipost.co.za                                  Scripts & pathology: results@lifesense.co.za
Windows Store                                                                                                                   www.lifesensedm.co.za
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Submission of claims                                                   Tel: 086 0100 678                                        Dis-Chem Direct
Fax: 012 336 9556                                                      Fax: 012 336 9523                                        Tel: 011 589 2788
claims@medihelp.co.za                                                  hmanagement@medihelp.co.za                               Fax: 086 641 8311
Hospital admissions (all hospital admissions must be pre-authorised)                                                            direct.medihelp@dischem.co.za
                                                                       Chronic renal dialysis & oxygen administered at home
Electronic pre-authorisations: www.medihelp.co.za (members’                                                                     or
                                                                       Tel: 086 0100 678
secured site)                                                                                                                   Medipost
                                                                       Fax: 012 336 9540
Tel: 086 0200 678                                                                                                               Tel: 012 426 4000
                                                                       preauth@medihelp.co.za
Fax: 012 336 9535                                                                                                               Fax: 086 688 9867
hospitalauth@medihelp.co.za                                            Medihelp fraudline                                       life@medipost.co.za
                                                                       Tel: 012 334 2428
Chronic and PMB medicine and more than 30 days’ medicine supply                                                                 PPN (optometry)
                                                                       Fax: 012 336 9538
Tel: 086 0100 678                                                                                                               Tel: 086 1103 529 or 086 1101 477
                                                                       fraud@medihelp.co.za
Fax: 012 334 2466                                                                                                               info@ppn.co.za
medicineapp@medihelp.co.za                                             MobileMeds (Prime network options only)                  www.ppn.co.za
                                                                       PMB chronic medicine
Prescribed minimum benefits (PMB)                                                                                               Council for Medical Schemes
                                                                       Tel: 086 0100 678
Tel: 086 0100 678                                                                                                               Tel: 086 1123 267
                                                                       Fax: 012 336 9544
Fax: 086 0064 762                                                                                                               complaints@medicalschemes.com
                                                                       mobilemeds@medihelp.co.za
enquiries@medihelp.co.za                                                                                                        www.medicalschemes.com
Benefit options 2019 - Medihelp
Contents

01                Why Medihelp
                  Summary of benefits
                                                                              09                    Benefit comparison
                                                                                                    Core benefits
                                                                                                                                                                           20              Supporting information
                                                                                                                                                                                           Summary of exclusions
                  Added insured benefits                                                            Day-to-day benefits                                                                    Prime hospital network
                  HealthPrint                                                                       Chronic illness/PMB                                                                    Our healthcare partners
                                                                                                    Deductibles                                                                            Explanation of terms

General disclaimer

This brochure is intended for marketing purposes and contains only a summary of Medihelp’s benefits. On joining Medihelp, members will receive detailed information. In case of a
dispute, the registered Rules of Medihelp apply, which are available on request. The information in this brochure is subject to approval by the Council for Medical Schemes. The content
of this brochure may change from time to time. Please refer to Medihelp’s website for an updated brochure or consult Medihelp’s Rules for the latest information. We encourage you
to seek financial advice about your healthcare cover by speaking to your financial adviser.
Benefit options 2019 - Medihelp
1

Why Medihelp
With a value-driven mindset, we focus on fulfilling your
health and wellness needs by customising 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 and engagement.

Always there for you                                            Peace of mind

There are various ways in which Medihelp ensures consistent     Stability
interactive engagement and service delivery:                    • Medihelp’s solvency level is consistently well above the
• Phone Medihelp’s Customer Care centre                             industry requirement
• Email or write to us                                          • Being self-administered allows for reduced administration
• Use the live chat feature on Medihelp’s website to receive        costs and a hands-on approach
     instant online support                                     • Medihelp also has more than a century’s experience in the
• Get answers to Medihelp questions with our Quick Answers          medical schemes industry
     functionality on the website                               • AA– rating for claims payment ability by Global Credit Rating
• Make use of Medihelp’s digital service platforms, where           for 9 consecutive years
     you can:
     • view and share your Medihelp e-membership card,          Sustainable risk pool
     • download your annual tax certificate,                    • Medihelp’s customer base continues to grow at an average
     • update your contact details,                                 age of 37 years, contributing to a healthy risk pool
     • get hassle-free e-authorisation for hospitalisation,     • One of the five largest open medical schemes in South Africa
     • submit and track claims,
     • monitor your available benefits,
     • access your health data and share it with a healthcare
          provider,
     • create and update your unique health profile, and
     • find a healthcare provider near you.
Benefit options 2019 - Medihelp
Why Medihelp (continued)
Products                                                Care programmes
tailored for different healthcare needs                 to assist members with specific healthcare needs, such as
                                                        our Chronic Care and back treatment programmes
With a range of ten options to choose from, including
comprehensive, savings and income-based options         Large family
as well as a product for students and an affordable     On Prime options you only pay for two children younger
                                                        than 18 years, the rest receive free cover
hospital plan, we have options to suit a variety of
lifestyles and health profiles.
                                                        Kids are grown up
                                                        •   Children pay child dependant rates until they are 26
Full cover                                                  years old
270 prescribed minimum benefits &
26 chronic conditions                                   •   Ask your adviser about the option specifically for
                                                            full-time students
No overall limit
on hospital cover
                                                        Adding value to your Medihelp
                                                        experience
                                                        •   HealthPrint is Medihelp’s free online wellness
Unlimited cover                                             programme which provides relevant health support
for trauma and emergencies
                                                            and value
                                                        •   Wellness days for corporate groups
Added insured benefits                                  •   An emergency app that ensures you and your loved
Access to screening, preventive, maternity and
                                                            ones can be located in an emergency
child benefits

Networks – pay less
by using quality networks of private hospitals
and healthcare providers

                                                                                                                    2
Benefit options 2019 - Medihelp
Summary of benefits
                                                                                                                                                                                   3

Summary of benefits

 Prime1
 Hospital plan
                                              Prime2
                                              Savings
                                                                                           Prime3                                       Elite
                                                                                           Comprehensive                                Comprehensive

This hospital plan is ideal if you are       The Prime 2 savings option is ideal          With ample insured cover for                 Elite is a top-of-the-range medical
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                                                                                                                                                                                       01
Benefit options 2019 - Medihelp
Contribution
Contribution table
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                              Prime1                                                                             Prime2                                                                           Prime3
                               Prime1
                               Prime1
                                Prime1
                              Hospital plan
                                                                                                                  Prime2
                                                                                                                  Prime2
                                                                                                                   Prime2
                                                                                                                 Savings
                                                                                                                                                                                                   Prime3
                                                                                                                                                                                                   Prime3
                                                                                                                                                                                                    Prime3
                                                                                                                                                                                                  Comprehensive
                                                                                                                                                                                                                                              Elite
                     Network
                               Hospital
                               Hospital
                                Hospitalplan
                                         plan
                               Non-network
                                          plan
                                                                                     Network
                                                                                                                  Savings
                                                                                                                   Savings
                                                                                                                   Savings
                                                                                                                                           Non-network                                  Network
                                                                                                                                                                                                   Comprehensive
                                                                                                                                                                                                   Comprehensive
                                                                                                                                                                                                    Comprehensive
                                                                                                                                                                                                            Non-network                        Elite
                                                                                                                                                                                                                                               Elite
                                                                                                                                                                                                                                                Elite
                                                                                                                                                                                                                                              Comprehensive
                                                                                                                                                                                                                                               Comprehensive
                                                                                                                                                                                                                                               Comprehensive
                                                                                                                                                                                                                                                Comprehensive
                    Network
                       Network Non-network
                      Network
                      Network   Non-network
                                Non-network
                                 Non-network                                         Network
                                                                                      Network
                                                                                      Network
                                                                                       Network                                             Non-network
                                                                                                                                            Non-network
                                                                                                                                            Non-network
                                                                                                                                             Non-network                                Network
                                                                                                                                                                                         Network
                                                                                                                                                                                         Network
                                                                                                                                                                                          Network           Non-network
                                                                                                                                                                                                             Non-network
                                                                                                                                                                                                             Non-network
                                                                                                                                                                                                              Non-network
Principal                                                        R1 800 (R270 savings contribution                         R2 310 (R348 savings contribution incl.
member               R1 356                   R1 728                                                                                                                                    R2 352                   R2 940                       R4 272
 Principal
  Principal
  Principal
Principal                                                        included
                                                                 R1R1
                                                                    R1974
                                                                     R1800
                                                                        800  per
                                                                           (R294
                                                                         800 (R270
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                                                                                      savings
                                                                                       savings
                                                                                        savings    R3 240 per year)
                                                                                               contribution
                                                                                                 contribution
                                                                                                  contribution
                                                                                                   contribution            per
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                                                                                                                                                         contribution
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                     R1R1488
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                                                                                                                                                                                                                      490
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                                                                                                                                                                                                                                                R3392
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                                                                                                                                                                                                                                                R3 996
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Child                                                            R534 (R78 savings contribution included                   R690 (R102 savings contribution incl.
dependant
Child
 Child
 Child
  Child               R408                     R522                                                                                                                                      R684                     R858                        R1 164
Benefit options 2019 - Medihelp
Summary
Summary
Summary  of
 Summaryof   benefits
        ofofbenefits
            benefits
             benefits                                                                                                                                                                                                                                                             5

Summary of benefits
                                        Prime1                                                          Prime2                                                        Prime3
                                    Prime1
                                     Prime1
                                       Prime1
                                        Hospital plan                                               Prime2
                                                                                                     Prime2
                                                                                                        Prime2
                                                                                                         Savings                                                   Prime3
                                                                                                                                                                    Prime3
                                                                                                                                                                      Prime3
                                                                                                                                                                      Comprehensive                                                    Elite
                        Network
                                    Hospital
                                     Hospital
                                       Hospital
                                             plan
                                               plan
                                                  plan
                                                   Non-network                          Network
                                                                                                    Savings
                                                                                                     Savings
                                                                                                        Savings
                                                                                                                   Non-network                          Network
                                                                                                                                                                   Comprehensive
                                                                                                                                                                    Comprehensive
                                                                                                                                                                      Comprehensive
                                                                                                                                                                                   Non-network
                                                                                                                                                                                                                                    Elite
                                                                                                                                                                                                                                     Elite
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                                                                                                                                                                                                                                       Comprehensive
                                                                                                                                                                                                                                    Comprehensive
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                     Network
                      Network
                        Network
                    Network                     Non-network
                                                 Non-network
                                                   Non-network
                                                Non-network                          Network
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                                                                                     Network                    Non-network
                                                                                                                 Non-network
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                                                                                                                 Non-network                         Network
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                                                                                                                                                      Network                   Non-network
                                                                                                                                                                                 Non-network
                                                                                                                                                                                   Non-network
                                                                                                                                                                                  Non-network
                         HOSPITAL BENEFITS (NO OAL)                                      HOSPITAL BENEFITS (NO OAL)                                     HOSPITAL BENEFITS (NO OAL)                                        HOSPITAL BENEFITS (NO OAL)
                      HOSPITAL
                      HOSPITAL
                       HOSPITALBENEFITS
                         HOSPITAL
                               BENEFITS
                                BENEFITS (NO
                                  BENEFITS
                                        (NO
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                                            (NO
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                                                OAL)                                   HOSPITAL
                                                                                      HOSPITAL
                                                                                       HOSPITAL
                                                                                         HOSPITALBENEFITS
                                                                                               BENEFITS
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                                                                                                         (NO  OAL)
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                                                                                                                OAL)                                   HOSPITAL
                                                                                                                                                     HOSPITAL
                                                                                                                                                      HOSPITAL
                                                                                                                                                        HOSPITAL BENEFITS
                                                                                                                                                              BENEFITS
                                                                                                                                                               BENEFITS
                                                                                                                                                                 BENEFITS
                                                                                                                                                                       (NO(NO
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                                                                                                                                                                              OAL)                                       HOSPITAL
                                                                                                                                                                                                                       HOSPITAL
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                                                                                                                                                                                                                          HOSPITAL BENEFITS
                                                                                                                                                                                                                                BENEFITS
                                                                                                                                                                                                                                 BENEFITS
                                                                                                                                                                                                                                   BENEFITS
                                                                                                                                                                                                                                         (NO(NO
                                                                                                                                                                                                                                          (NO   OAL)
                                                                                                                                                                                                                                             OAL)
                                                                                                                                                                                                                                              OAL)
                                                                                                                                                                                                                                                OAL)
                  108 network facilities                Any hospital     108 network facilities                        Any hospital             108 network facilities                 Any hospital                                     Any hospital
              115
              108
               108network
                  108
                   networkfacilities
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                            facilities
                               facilities           Any
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                                                         hospital     115
                                                            hospital 108
                                                                      108 network
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                                                                                      facilities                    AnyAny
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                                                                                                                       hospital
                                                                                                                           hospital           115
                                                                                                                                            108
                                                                                                                                             108108network
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                                                                                                                                                    network facilities
                                                                                                                                                        facilities
                                                                                                                                                          facilities
                                                                                                                                                             facilities              Any
                                                                                                                                                                                   Any
                                                                                                                                                                                    AnyAnyhospital
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                                                                                                                                                                                        hospital
                                                                                                                                                                                           hospital                                   Any
                                                                                                                                                                                                                                    Any
                                                                                                                                                                                                                                     AnyAnyhospital
                                                                                                                                                                                                                                        hospital
                                                                                                                                                                                                                                         hospital
                                                                                                                                                                                                                                            hospital
                 ESSENTIAL COVER                                                ESSENTIAL COVER                                                 ESSENTIAL COVER                                                  ESSENTIAL COVER
             CHRONIC      ILLNESS/PMB
                 Diagnosis,   treatment                                       CHRONIC      ILLNESS/PMB                                         CHRONIC      ILLNESS/PMB                                         CHRONIC      ILLNESS/PMB
             ESSENTIAL
              ESSENTIAL
                 ESSENTIALCOVERCOVER and care costs of 270
                            COVER                                               Diagnosis,
                                                                            ESSENTIAL
                                                                             ESSENTIAL
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                                                                                               COVER and care costs of 270
                                                                                           COVER                                                Diagnosis,
                                                                                                                                            ESSENTIAL
                                                                                                                                             ESSENTIAL
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                                                                                                                                                        COVERtreatment
                                                                                                                                                              COVER and care costs of 270
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                                                                                                                                                                                                             ESSENTIAL
                                                                                                                                                                                                              ESSENTIAL
                                                                                                                                                                                                                 ESSENTIAL
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                                                                                                                                                                                                                               COVER and care costs of 270
                                                                                                                                                                                                                           COVER
             Diagnosis,
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             Diagnosis,
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                       and
                 Diagnosis,  26
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     benefits
Core benefits
Core benefits
     benefits

                   POST-HOSPITAL CARE                                               POST-HOSPITAL CARE                                             POST-HOSPITAL CARE                                                POST-HOSPITAL CARE
              POST-HOSPITAL CARE                                                 POST-HOSPITAL CARE                                              POST-HOSPITAL CARE                                                 POST-HOSPITAL CARE
                   Up to 30 days
             POST-HOSPITAL
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                   POST-HOSPITAL        after
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                                                                                                                                            POST-HOSPITAL
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                                                                                                                                                                                                               POST-HOSPITAL
                                                                                                                                                                                                                 POST-HOSPITAL            after  discharge
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                   SPECIALISED
              SPECIALISED             RADIOLOGY
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                                                                                 SPECIALISED         RADIOLOGY
                                                                                                   RADIOLOGY                                       SPECIALISEDRADIOLOGY
                                                                                                                                                 SPECIALISED         RADIOLOGY                                       SPECIALISED RADIOLOGY
                                                                                                                                                                                                                    SPECIALISED         RADIOLOGY
                   Unlimited
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             SPECIALISED
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                   SPECIALISED  RADIOLOGY
                                  RADIOLOGY
                                     RADIOLOGY                                      Unlimited
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                                                                              SPECIALISED
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                                                                                    SPECIALISED RADIOLOGY
                                                                                                  RADIOLOGY
                                                                                                     RADIOLOGY                                     Unlimited
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                                                                                                                                                   SPECIALISED  RADIOLOGY
                                                                                                                                                                  RADIOLOGY
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                                                                                                                                                                                                                 SPECIALISED
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                                                                                                                                                                                                                                    RADIOLOGY
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              TRAUMA-RELATED                    BENEFITS
                                          BENEFITS                                  TRAUMA-RELATED
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              ROAD ROAD& AIR & TRANSPORT
                                 AIR TRANSPORT                                      ROAD
                                                                                 ROAD        & AIR
                                                                                          & AIR      TRANSPORT
                                                                                                  TRANSPORT                                        ROAD&&AIR
                                                                                                                                                 ROAD           AIRTRANSPORT
                                                                                                                                                                     TRANSPORT                                       ROAD&&AIR
                                                                                                                                                                                                                    ROAD           AIRTRANSPORT
                                                                                                                                                                                                                                       TRANSPORT
EMS EMS

             ROAD  (Netcare
              Netcare
                ROAD
                   ROAD
                      && 911
                          AIRAIR 911)
                             & TRANSPORT
                                AIR
                                  TRANSPORT
                                     TRANSPORT                                ROAD
                                                                                ROAD(Netcare
                                                                                 Netcare
                                                                                    ROAD
                                                                                       &&AIR911
                                                                                            AIR  911)
                                                                                             & TRANSPORT
                                                                                                AIR
                                                                                                  TRANSPORT
                                                                                                     TRANSPORT                              ROAD
                                                                                                                                              ROAD (Netcare
                                                                                                                                                 Netcare
                                                                                                                                                   ROAD
                                                                                                                                                      &&AIR  &911
                                                                                                                                                            AIR  911)
                                                                                                                                                               TRANSPORT
                                                                                                                                                                AIR
                                                                                                                                                                  TRANSPORT
                                                                                                                                                                     TRANSPORT                                 ROAD
                                                                                                                                                                                                                 ROAD(Netcare
                                                                                                                                                                                                                    Netcare
                                                                                                                                                                                                                     ROAD
                                                                                                                                                                                                                        &&AIR  &911
                                                                                                                                                                                                                              AIR  911)
                                                                                                                                                                                                                                  TRANSPORT
                                                                                                                                                                                                                                  AIR
                                                                                                                                                                                                                                    TRANSPORT
                                                                                                                                                                                                                                       TRANSPORT
EMSEMS

                   Unlimited
             (Netcare
                (Netcare
                   (Netcare
              Unlimited    911)
                             911) within
                                 911)
                             within   RSA RSA                                       Unlimited
                                                                              (Netcare
                                                                                (Netcare
                                                                                    (Netcare
                                                                                 Unlimited 911)
                                                                                             911) within
                                                                                                 911)
                                                                                               within   RSA RSA                                    Unlimited
                                                                                                                                            (Netcare
                                                                                                                                              (Netcare
                                                                                                                                                   (Netcare
                                                                                                                                                 Unlimited 911)
                                                                                                                                                             911) withinRSA
                                                                                                                                                                911)
                                                                                                                                                                 within     RSA                                      Unlimited
                                                                                                                                                                                                               (Netcare
                                                                                                                                                                                                                 (Netcare
                                                                                                                                                                                                                     (Netcare
                                                                                                                                                                                                                    Unlimited911)
                                                                                                                                                                                                                               911) withinRSA
                                                                                                                                                                                                                                   911)
                                                                                                                                                                                                                                   within     RSA
EMS

                   24-hour
             Unlimited
                Unlimited
                   Unlimited    helpline
                            within
                              within
                                  within
                                     RSARSA &
                                            RSA trauma counselling                  24-hour
                                                                              Unlimited
                                                                                Unlimited
                                                                                    Unlimited   helpline
                                                                                            within
                                                                                              within
                                                                                                  within
                                                                                                     RSARSA&
                                                                                                           RSA trauma counselling                  24-hour
                                                                                                                                            Unlimited
                                                                                                                                              Unlimited
                                                                                                                                                   Unlimited   helpline
                                                                                                                                                            within
                                                                                                                                                              within
                                                                                                                                                                  within
                                                                                                                                                                     RSARSA&
                                                                                                                                                                           RSA trauma counselling                    24-hour
                                                                                                                                                                                                               Unlimited
                                                                                                                                                                                                                 Unlimited
                                                                                                                                                                                                                     Unlimited    helpline
                                                                                                                                                                                                                              within
                                                                                                                                                                                                                                within
                                                                                                                                                                                                                                    within
                                                                                                                                                                                                                                       RSARSA&
                                                                                                                                                                                                                                             RSA trauma counselling
             24-hour
                24-hour
                   24-hour
                         helpline
                            helpline
                                helpline
                                     &&trauma
                                           trauma
                                            & trauma counselling
                                                       counselling
                                                          counselling         24-hour
                                                                                24-hour
                                                                                    24-hour
                                                                                         helpline
                                                                                            helpline
                                                                                               helpline
                                                                                                     &&trauma
                                                                                                          trauma
                                                                                                           & trauma counselling
                                                                                                                      counselling
                                                                                                                         counselling        24-hour
                                                                                                                                              24-hour
                                                                                                                                                   24-hour
                                                                                                                                                         helpline
                                                                                                                                                            helpline
                                                                                                                                                               helpline
                                                                                                                                                                     &&trauma
                                                                                                                                                                          trauma
                                                                                                                                                                           & trauma counselling
                                                                                                                                                                                      counselling
                                                                                                                                                                                         counselling           24-hour
                                                                                                                                                                                                                 24-hour
                                                                                                                                                                                                                     24-hour
                                                                                                                                                                                                                           helpline
                                                                                                                                                                                                                              helpline
                                                                                                                                                                                                                                 helpline
                                                                                                                                                                                                                                       &&trauma
                                                                                                                                                                                                                                            trauma
                                                                                                                                                                                                                                             & trauma counselling
                                                                                                                                                                                                                                                        counselling
                                                                                                                                                                                                                                                           counselling

                                                                                                                                                                                                                                                                                           0
                                                                                                                                                                                                                                                                                      0101 0
Benefit options 2019 - Medihelp
Summary of benefits
Summary of benefits
Summary of benefits (continued)
                                                           Prime1                                                         Prime2                                                Prime3
                                                           Prime1
                                                           Prime1
                                                           Hospital plan                                                  Prime2
                                                                                                                           Prime2
                                                                                                                          Savings                                               Prime3
                                                                                                                                                                                Prime3
                                                                                                                                                                                Comprehensive                                                Elite
                                            Network
                                                           Hospital
                                                           Hospital
                                                           Hospitalplan
                                                                    plan
                                                                    plan
                                                                      Non-network                         Network
                                                                                                                          Savings
                                                                                                                          Savings
                                                                                                                           Savings
                                                                                                                                       Non-network                 Network
                                                                                                                                                                                Comprehensive
                                                                                                                                                                                Comprehensive
                                                                                                                                                                                 Comprehensive
                                                                                                                                                                                           Non-network
                                                                                                                                                                                                                                             Elite
                                                                                                                                                                                                                                             Elite
                                                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                                                              Comprehensive
                                            Network
                                            Network
                                            Network
                                           Network                    Non-network
                                                                      Non-network
                                                                       Non-network
                                                                      Non-network                         Network
                                                                                                          Network
                                                                                                          Network
                                                                                                         Network                       Non-network
                                                                                                                                       Non-network
                                                                                                                                        Non-network
                                                                                                                                       Non-network                 Network
                                                                                                                                                                   Network
                                                                                                                                                                   Network
                                                                                                                                                                  Network                  Non-network
                                                                                                                                                                                           Non-network
                                                                                                                                                                                           Non-network
                                              HOSPITAL BENEFITS (NO OAL)                                HOSPITAL BENEFITS (NO OAL)                                  HOSPITAL BENEFITS (NO OAL)                                    HOSPITAL BENEFITS (NO OAL)
                                     INSURED DAY-TO-DAY BENEFITS                                 DAY-TO-DAY MEDICAL EXPENSES                                INSURED DAY-TO-DAY POOLED BENEFITS                       INSURED DAY-TO-DAY POOLED BENEFITS
                                              HOSPITAL
                                              HOSPITAL
                                              HOSPITALBENEFITS
                                                           BENEFITS
                                                            BENEFITS(NO
                                                                      (NO
                                                                      (NOOAL)
                                                                            OAL)
                                                                            OAL)                        HOSPITAL
                                                                                                        HOSPITAL
                                                                                                         HOSPITALBENEFITS
                                                                                                                    BENEFITS
                                                                                                                    BENEFITS(NO
                                                                                                                             (NO
                                                                                                                             (NOOAL)
                                                                                                                                 OAL)
                                                                                                                                  OAL)                              HOSPITAL
                                                                                                                                                                    HOSPITAL
                                                                                                                                                                     HOSPITALBENEFITS
                                                                                                                                                                                  BENEFITS
                                                                                                                                                                                  BENEFITS(NO (NO
                                                                                                                                                                                              (NOOAL)
                                                                                                                                                                                                    OAL)
                                                                                                                                                                                                    OAL)                         HOSPITAL
                                                                                                                                                                                                                                  HOSPITAL
                                                                                                                                                                                                                                   HOSPITALBENEFITS BENEFITS
                                                                                                                                                                                                                                                    BENEFITS(NO   (NO
                                                                                                                                                                                                                                                                  (NOOAL)
                                                                                                                                                                                                                                                                        OAL)
                                                                                                                                                                                                                                                                        OAL)
                                     M = R1 150 per year                                         15% medical savings account                                M = R9 000 per year                                      M = R2 650 per year
                                      108=network
                                     M+              facilities
                                            R2 300 per   year           Any hospital             108 network facilities       Any hospital                   108 network
                                                                                                                                                            M+1   = R14 300facilities
                                                                                                                                                                               per year        Any hospital          M+1 = R4 500 perAny           yearhospital
                                      108
                                       108
                                       108specialists,
                                     GPs,  network
                                           network
                                            networkfacilities
                                                     facilities
                                                      facilities
                                                       physiotherapy, Any
                                                                        Any
                                                                        Anyhospital
                                                                        acutehospital
                                                                              hospital
                                                                               and               108
                                                                                                  108
                                                                                                  108network
                                                                                                      network
                                                                                                      networkfacilities
                                                                                                              facilities
                                                                                                              facilities      Any
                                                                                                                               Any
                                                                                                                               Anyhospital
                                                                                                                                   hospital
                                                                                                                                   hospital                108
                                                                                                                                                             108
                                                                                                                                                             108network
                                                                                                                                                            M+2  network
                                                                                                                                                                  network
                                                                                                                                                                  = R16 800facilities
                                                                                                                                                                            facilities
                                                                                                                                                                            facilities
                                                                                                                                                                               per year        Any
                                                                                                                                                                                                Any
                                                                                                                                                                                                Anyhospital
                                                                                                                                                                                                     hospital
                                                                                                                                                                                                      hospital       M+2 = R5 550 perAny          Any
                                                                                                                                                                                                                                                   Any
                                                                                                                                                                                                                                                   yearhospital
                                                                                                                                                                                                                                                         hospital
                                                                                                                                                                                                                                                          hospital
                                     self-medication
                                      ESSENTIAL COVER                                            ESSENTIAL COVER                                            M+3+    = R17
                                                                                                                                                           ESSENTIAL COVER 800   per  year                           M+3+       =  R6
                                                                                                                                                                                                                      ESSENTIAL COVER   700    per   year
                                      Diagnosis,
                                      ESSENTIALtreatment
                                     ESSENTIAL
                                      ESSENTIAL    COVER and care costs of 270
                                                  COVER
                                                   COVER                                         Diagnosis,
                                                                                                  ESSENTIALtreatment
                                                                                                 ESSENTIAL
                                                                                                 ESSENTIAL    COVER and care costs of 270
                                                                                                             COVER
                                                                                                              COVER                                        Diagnosis,
                                                                                                                                                                 GPs &treatment
                                                                                                                                                            •ESSENTIAL
                                                                                                                                                           ESSENTIAL
                                                                                                                                                           ESSENTIAL     COVER and care costs of 270
                                                                                                                                                                         specialists
                                                                                                                                                                        COVER
                                                                                                                                                                         COVER                                        Diagnosis,
                                                                                                                                                                                                                     •ESSENTIAL
                                                                                                                                                                                                                       ESSENTIAL
                                                                                                                                                                                                                        ESSENTIAL      treatment
                                                                                                                                                                                                                                         COVER and care costs of 270
                                                                                                                                                                                                                            GPs & specialists
                                                                                                                                                                                                                                        COVER
                                                                                                                                                                                                                                        COVER
                                      PMB  and
                                     Diagnosis,
                                      Diagnosis,26  chronic conditions
                                      Diagnosis,treatment
                                                  treatment
                                                  treatment   and
                                                               and
                                                               andcare
                                                                   care  on the
                                                                   carecosts
                                                                        costs
                                                                         costs ofCDL
                                                                              of
                                                                               of 270
                                                                                  270
                                                                                   270           PMB  and
                                                                                                 Diagnosis,
                                                                                                 Diagnosis,26  chronic conditions
                                                                                                  Diagnosis,treatment
                                                                                                             treatment
                                                                                                             treatment  and
                                                                                                                         and
                                                                                                                         andcare
                                                                                                                             care  on the
                                                                                                                             carecosts
                                                                                                                                  costs
                                                                                                                                   costs ofCDL
                                                                                                                                        of
                                                                                                                                         of 270
                                                                                                                                            270
                                                                                                                                             270           PMB
                                                                                                                                                            •    and
                                                                                                                                                           Diagnosis,
                                                                                                                                                           Diagnosis, 26
                                                                                                                                                                 Clinical chronic
                                                                                                                                                                          psychology
                                                                                                                                                             Diagnosis,treatment
                                                                                                                                                                        treatment
                                                                                                                                                                        treatment   conditions
                                                                                                                                                                                      and&care
                                                                                                                                                                                     and
                                                                                                                                                                                      and care
                                                                                                                                                                                           care  on the
                                                                                                                                                                                               costs
                                                                                                                                                                                                costs
                                                                                                                                                                                                costs  ofCDL
                                                                                                                                                                                            physiotherapy
                                                                                                                                                                                                      of
                                                                                                                                                                                                       of 270
                                                                                                                                                                                                          270
                                                                                                                                                                                                           270        PMB     and
                                                                                                                                                                                                                     •Diagnosis,
                                                                                                                                                                                                                            Clinical
                                                                                                                                                                                                                       Diagnosis,   26    chronic conditions
                                                                                                                                                                                                                                         psychology
                                                                                                                                                                                                                        Diagnosis,treatment
                                                                                                                                                                                                                                       treatment
                                                                                                                                                                                                                                        treatment      and
                                                                                                                                                                                                                                                        and& care
                                                                                                                                                                                                                                                         and  care   on the
                                                                                                                                                                                                                                                              physiotherapy
                                                                                                                                                                                                                                                              carecosts
                                                                                                                                                                                                                                                                    costs
                                                                                                                                                                                                                                                                     costs  ofCDL
                                                                                                                                                                                                                                                                           of
                                                                                                                                                                                                                                                                           of  270
                                                                                                                                                                                                                                                                               270
                                                                                                                                                                                                                                                                                270
                                      DSPs
                                     PMB
                                      PMB
                                      PMBand&
                                           andspecialist
                                            and 26
                                                26
                                                 26chronicnetwork
                                                    chronic
                                                    chronic         applyon
                                                             conditions
                                                              conditions
                                                              conditions  on
                                                                          onthe
                                                                             the
                                                                             theCDL
                                                                                  CDL
                                                                                  CDL            DSPs
                                                                                                 PMB
                                                                                                 PMB  &
                                                                                                  PMBand
                                                                                                      and
                                                                                                      andspecialist
                                                                                                           26
                                                                                                           26       network
                                                                                                            26chronic
                                                                                                               chronic
                                                                                                               chronic        applyon
                                                                                                                       conditions
                                                                                                                       conditions
                                                                                                                        conditions  on
                                                                                                                                    onthe
                                                                                                                                       the
                                                                                                                                       theCDL
                                                                                                                                            CDL
                                                                                                                                            CDL            DSPs
                                                                                                                                                           PMB
                                                                                                                                                           PMB    & specialist
                                                                                                                                                            •PMBSupplementary
                                                                                                                                                                 and
                                                                                                                                                                 and
                                                                                                                                                                  and 26
                                                                                                                                                                      26
                                                                                                                                                                       26chronicnetwork
                                                                                                                                                                          chronic
                                                                                                                                                                          chronic          apply
                                                                                                                                                                                    conditions
                                                                                                                                                                                    conditions
                                                                                                                                                                                     conditions
                                                                                                                                                                                    health       on
                                                                                                                                                                                                 on
                                                                                                                                                                                                  onthe
                                                                                                                                                                                            services the
                                                                                                                                                                                                     theCDL
                                                                                                                                                                                                          CDL
                                                                                                                                                                                                          CDL         DSPs
                                                                                                                                                                                                                     •PMB
                                                                                                                                                                                                                       PMB
                                                                                                                                                                                                                        PMB    &
                                                                                                                                                                                                                              and
                                                                                                                                                                                                                              and
                                                                                                                                                                                                                               andspecialist
                                                                                                                                                                                                                                    26
                                                                                                                                                                                                                                     26
                                                                                                                                                                                                                                     26chronic
                                                                                                                                                                                                                            Supplementary chronic
                                                                                                                                                                                                                                          chronic network      applyon
                                                                                                                                                                                                                                                      conditions
                                                                                                                                                                                                                                                       conditions
                                                                                                                                                                                                                                                       conditions
                                                                                                                                                                                                                                                     health   serviceson
                                                                                                                                                                                                                                                                      onthe
                                                                                                                                                                                                                                                                         the
                                                                                                                                                                                                                                                                          theCDL
                                                                                                                                                                                                                                                                               CDL
                                                                                                                                                                                                                                                                               CDL
                          benefits

                                     DSPs
                                      DSPs
                                      DSPs& &
                                            &specialist
                                              specialist
                                               specialistnetwork
                                                          network
                                                          networkapply
                                                                    apply
                                                                    apply                        DSPs
                                                                                                 DSPs
                                                                                                  DSPs&&
                                                                                                       &specialist
                                                                                                         specialist
                                                                                                          specialistnetwork
                                                                                                                    network
                                                                                                                     networkapply
                                                                                                                              apply
                                                                                                                              apply                        DSPs
                                                                                                                                                           DSPs
                                                                                                                                                            •DSPsAcute
                                                                                                                                                                 &&
                                                                                                                                                                  &specialist
                                                                                                                                                                     specialist
                                                                                                                                                                     specialist
                                                                                                                                                                        medicinenetwork
                                                                                                                                                                                network
                                                                                                                                                                                 network   apply
                                                                                                                                                                                           apply
                                                                                                                                                                                            apply
                                                                                                                                                                                     and self-medication              DSPs
                                                                                                                                                                                                                       DSPs
                                                                                                                                                                                                                        DSPs&  &
                                                                                                                                                                                                                               &specialist
                                                                                                                                                                                                                                  specialist
                                                                                                                                                                                                                                   specialistnetwork
                                                                                                                                                                                                                                                  network
                                                                                                                                                                                                                                                   networkapplyapply
                                                                                                                                                                                                                                                                apply
                       benefits

                                     POST-HOSPITAL CARE                                          POST-HOSPITAL CARE                                         • Standard radiology
                                                                                                                                                           POST-HOSPITAL      CARE and pathology                     CHRONIC          MEDICINE
                                                                                                                                                                                                                      POST-HOSPITAL CARE                BENEFITS
                                     Up   to 30 days after
                                     POST-HOSPITAL
                                      POST-HOSPITAL
                                       POST-HOSPITAL        CARE
                                                             CARE
                                                             CAREdischarge                       POST-HOSPITAL
                                                                                                 POST-HOSPITAL
                                                                                                  POST-HOSPITALCARE
                                                                                                               CARE
                                                                                                                CARE                                       Up  to 30 days
                                                                                                                                                           POST-HOSPITAL
                                                                                                                                                           POST-HOSPITAL   after
                                                                                                                                                            POST-HOSPITALCARE    discharge
                                                                                                                                                                              CARE
                                                                                                                                                                              CARE                                   (Non-PMB)
                                                                                                                                                                                                                      Up    to 30 days after
                                                                                                                                                                                                                      POST-HOSPITAL
                                                                                                                                                                                                                       POST-HOSPITAL
                                                                                                                                                                                                                        POST-HOSPITAL            CARE
                                                                                                                                                                                                                                                 CARE
                                                                                                                                                                                                                                                  CAREdischarge
                     Core

                                     Up
                                      Up
                                       Uptoto
                                           to30
                                              30
                                              30days
                                                  days
                                                   daysafter
                                                         after
                                                          afterdischarge
                                                                 discharge
                                                                 discharge                                                                                  INSURED
                                                                                                                                                           Up
                                                                                                                                                           Up
                                                                                                                                                            Upto
                                                                                                                                                               to
                                                                                                                                                                to30
                                                                                                                                                                  30  DENTISTRY
                                                                                                                                                                   30days
                                                                                                                                                                     days
                                                                                                                                                                      daysafter
                                                                                                                                                                           after    BENEFITS
                                                                                                                                                                           afterdischarge
                                                                                                                                                                                 discharge
                                                                                                                                                                                 discharge                           MUp
                                                                                                                                                                                                                       Up
                                                                                                                                                                                                                        Up=toR4
                                                                                                                                                                                                                            to
                                                                                                                                                                                                                             to30300
                                                                                                                                                                                                                                30
                                                                                                                                                                                                                                30  days
                                                                                                                                                                                                                                     days
                                                                                                                                                                                                                                     daysperafter
                                                                                                                                                                                                                                               yeardischarge
                                                                                                                                                                                                                                              after
                                                                                                                                                                                                                                              after   discharge
                                                                                                                                                                                                                                                      discharge
                 Core

                                     SPECIALISED RADIOLOGY                                       SPECIALISED RADIOLOGY                                      Conservative  &  specialised
                                                                                                                                                           SPECIALISED RADIOLOGY                                     M+1      = R6   500
                                                                                                                                                                                                                      SPECIALISED RADIOLOGY  per   year
 Day-to-day benefits

                                     Unlimited
                                     SPECIALISED
                                      SPECIALISED
                                       SPECIALISEDRADIOLOGY
                                                       RADIOLOGY
                                                       RADIOLOGY                                 Unlimited
                                                                                                 SPECIALISED
                                                                                                  SPECIALISED
                                                                                                   SPECIALISEDRADIOLOGY
                                                                                                                  RADIOLOGY
                                                                                                                  RADIOLOGY                                Unlimited
                                                                                                                                                           SPECIALISED
                                                                                                                                                            SPECIALISED
                                                                                                                                                             SPECIALISEDRADIOLOGY
                                                                                                                                                                            RADIOLOGY
                                                                                                                                                                            RADIOLOGY                                M+2      = R8 700RADIOLOGY
                                                                                                                                                                                                                      Unlimited
                                                                                                                                                                                                                      SPECIALISED
                                                                                                                                                                                                                       SPECIALISED
                                                                                                                                                                                                                        SPECIALISED          per year
                                                                                                                                                                                                                                           RADIOLOGY
                                                                                                                                                                                                                                           RADIOLOGY
                                     In  and out of hospital                                     In  and out of hospital                                    INSURED
                                                                                                                                                           In  and out OPTICAL
                                                                                                                                                                         of hospital BENEFITS                        M+3+
                                                                                                                                                                                                                      In  and   =
                                                                                                                                                                                                                                outR9   300
                                                                                                                                                                                                                                       of      per year
                                                                                                                                                                                                                                           hospital
                                     Unlimited
                                      Unlimited
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                                                                                                                                                                                                                                             the   BENEFITS
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                                     TRAUMA-RELATED BENEFITS                                     TRAUMA-RELATED BENEFITS                                   TRAUMA-RELATED BENEFITS                                   M+1      = R6 850 per year
                                                                                                                                                                                                                      TRAUMA-RELATED                 BENEFITS
                                     Including    post-exposure
                                     TRAUMA-RELATED
                                      TRAUMA-RELATED
                                       TRAUMA-RELATED                  prophylaxis in the
                                                                BENEFITS
                                                                BENEFITS
                                                                 BENEFITS                        Including   post-exposure
                                                                                                 TRAUMA-RELATED
                                                                                                  TRAUMA-RELATED
                                                                                                   TRAUMA-RELATED                prophylaxis in the
                                                                                                                          BENEFITS
                                                                                                                          BENEFITS
                                                                                                                           BENEFITS                        Including   post-exposure
                                                                                                                                                           TRAUMA-RELATED
                                                                                                                                                            TRAUMA-RELATED
                                                                                                                                                             TRAUMA-RELATED                prophylaxis in the
                                                                                                                                                                                    BENEFITS
                                                                                                                                                                                    BENEFITS
                                                                                                                                                                                     BENEFITS                         Including
                                                                                                                                                                                                                     M+2      = R8 post-exposure
                                                                                                                                                                                                                      TRAUMA-RELATED
                                                                                                                                                                                                                       TRAUMA-RELATED400 per year
                                                                                                                                                                                                                        TRAUMA-RELATED                      prophylaxis in the
                                                                                                                                                                                                                                                     BENEFITS
                                                                                                                                                                                                                                                     BENEFITS
                                                                                                                                                                                                                                                      BENEFITS
                                     event
                                     Includingof
                                      Including  sexual    assault
                                       Includingpost-exposure
                                                   post-exposure     or  accidental in
                                                   post-exposureprophylaxis
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                                                                                                                                                                                                                                   R9   000
                                                                                                                                                                                                                        Includingpost-exposure assault
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                                                                                                                                                                HIV
                                                                                                                                                                HIV                                                  STANDARD
                                                                                                                                                                                                                      exposure
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                                                                                                                                                                                                                                     to  HIV
                                                                                                                                                                                                                                          HIV
                                                                                                                                                                                                                                          HIV                BENEFITS
                                     ROAD & AIR TRANSPORT                                        ROAD & AIR TRANSPORT                                      ROAD & AIR TRANSPORT                                      R2
                                                                                                                                                                                                                      ROAD650 &  perAIRfamily     per year
                                                                                                                                                                                                                                           TRANSPORT
                                     (Netcare
                                     ROAD
                                      ROAD
                                       ROAD&   &  911)
                                               &AIR
                                                  AIR
                                                  AIRTRANSPORT
                                                       TRANSPORT
                                                       TRANSPORT                                 (Netcare
                                                                                                 ROAD
                                                                                                  ROAD
                                                                                                   ROAD&  &  911)
                                                                                                          &AIR
                                                                                                             AIR
                                                                                                             AIRTRANSPORT
                                                                                                                  TRANSPORT
                                                                                                                  TRANSPORT                                (Netcare
                                                                                                                                                           ROAD
                                                                                                                                                            ROAD
                                                                                                                                                             ROAD&  &  911)
                                                                                                                                                                    &AIR
                                                                                                                                                                       AIR
                                                                                                                                                                       AIRTRANSPORT
                                                                                                                                                                            TRANSPORT
                                                                                                                                                                            TRANSPORT                                 (Netcare
                                                                                                                                                                                                                      ROAD
                                                                                                                                                                                                                       ROAD
                                                                                                                                                                                                                        ROAD&    &  911)
                                                                                                                                                                                                                                 &AIR
                                                                                                                                                                                                                                    AIR
                                                                                                                                                                                                                                     AIRTRANSPORT
                                                                                                                                                                                                                                           TRANSPORT
                                                                                                                                                                                                                                           TRANSPORT
      EMSEMS

                                     Unlimited
                                     (Netcare
                                      (Netcare
                                       (Netcare911) within RSA
                                                  911)
                                                   911)                                          Unlimited
                                                                                                 (Netcare
                                                                                                  (Netcare
                                                                                                   (Netcare911)within RSA
                                                                                                             911)
                                                                                                              911)                                         Unlimited
                                                                                                                                                           (Netcare
                                                                                                                                                            (Netcare
                                                                                                                                                             (Netcare911)within RSA
                                                                                                                                                                       911)
                                                                                                                                                                        911)                                         PATHOLOGY
                                                                                                                                                                                                                      Unlimited
                                                                                                                                                                                                                      (Netcare
                                                                                                                                                                                                                       (Netcare
                                                                                                                                                                                                                        (Netcare911) 911)
                                                                                                                                                                                                                                     911)  BENEFITS
                                                                                                                                                                                                                                       within    RSA
                                     24-hour
                                     Unlimited
                                      Unlimited
                                       Unlimited helpline
                                                    within&
                                                   within
                                                    within   RSA
                                                             RSAtrauma counselling
                                                              RSA                                24-hour
                                                                                                 Unlimited
                                                                                                  Unlimited
                                                                                                   Unlimitedhelpline
                                                                                                               within&
                                                                                                              within
                                                                                                               within  RSA
                                                                                                                       RSAtrauma counselling
                                                                                                                        RSA                                24-hour
                                                                                                                                                           Unlimited
                                                                                                                                                            Unlimited
                                                                                                                                                             Unlimitedhelpline
                                                                                                                                                                         within&
                                                                                                                                                                        within
                                                                                                                                                                         within  RSA
                                                                                                                                                                                 RSAtrauma counselling
                                                                                                                                                                                  RSA                                 24-hour
                                                                                                                                                                                                                     R2   650 per
                                                                                                                                                                                                                      Unlimited
                                                                                                                                                                                                                       Unlimited
                                                                                                                                                                                                                        Unlimited  helpline
                                                                                                                                                                                                                                       within&
                                                                                                                                                                                                                                       family
                                                                                                                                                                                                                                      within
                                                                                                                                                                                                                                       within     per
                                                                                                                                                                                                                                                 RSA
                                                                                                                                                                                                                                                  RSA
                                                                                                                                                                                                                                                  RSAtrauma
                                                                                                                                                                                                                                                        year counselling
                                     24-hour
                                      24-hour
                                       24-hourhelpline
                                                 helpline
                                                  helpline&  &
                                                             &trauma
                                                                trauma
                                                                 traumacounselling
                                                                          counselling
                                                                           counselling           24-hour
                                                                                                  24-hour
                                                                                                   24-hourhelpline
                                                                                                            helpline
                                                                                                             helpline& &
                                                                                                                       &trauma
                                                                                                                          trauma
                                                                                                                           traumacounselling
                                                                                                                                    counselling
                                                                                                                                     counselling           24-hour
                                                                                                                                                            24-hour
                                                                                                                                                             24-hourhelpline
                                                                                                                                                                      helpline
                                                                                                                                                                       helpline& &
                                                                                                                                                                                 &trauma
                                                                                                                                                                                    trauma
                                                                                                                                                                                     traumacounselling
                                                                                                                                                                                              counselling
                                                                                                                                                                                               counselling            24-hour
                                                                                                                                                                                                                       24-hour
                                                                                                                                                                                                                        24-hourhelpline
                                                                                                                                                                                                                                   helpline
                                                                                                                                                                                                                                    helpline&    &&trauma
                                                                                                                                                                                                                                                     trauma
                                                                                                                                                                                                                                                      traumacounselling
                                                                                                                                                                                                                                                                counselling
                                                                                                                                                                                                                                                                 counselling
                                                                                                                                                                                                                     INSURED DENTISTRY BENEFITS
                                                                                                                                                                                                                     Conservative & specialised

                                                                                                                                                                                                                     INSURED OPTICAL BENEFITS
                                                                                                                                                                                                                     Spectacles/contact lenses
                                                                                                                                                                                                                                                                                           01
CDL                        –         Chronic Diseases List                   M      –    Member                                                        PMB    –   Prescribed minimum benefits                                                                                              01
                                                                                                                                                                                                                                                                                           01
                                                                                                                                                                                                                                                                                            01
DSP                        –         Designated service provider             MT     –    Medihelp tariff paid by Medihelp for benefits which
EMS                        –         Emergency medical services                          can include a contracted tariff or the single exit price
GP                         –         General practitioner                    OAL    –    Overall annual limit
                                                                                                                                                                                                                                                                                       6
Benefit options 2019 - Medihelp
7

Added insured benefits
These benefits are provided in addition to other insured benefits
and available annually unless otherwise indicated.

Women’s health                                                     Routine screening and
                                                                   immunisation benefits
Women have access to benefits for:
• A pap smear requested by a medical                               Available at Clicks/Dis-Chem pharmacy clinics
  doctor                                                           per person:
• A mammogram for women 40 years and                               • One combo test (blood glucose, cholesterol,
  older requested by a medical doctor                                  BMI and blood pressure measurement) or
• A flu vaccination at Clicks/Dis-Chem                                 individual blood glucose or cholesterol test
  pharmacy clinics                                                 • HIV testing, counselling and support
                                                                   • A tetanus vaccine
Enhanced maternity benefits                                        • Two HPV vaccinations for girls and boys
                                                                       between 10-14 years or three between
•     Free registration for and participation in the                   15-26 years
      Medihelp HealthPrint pregnancy and baby
      programme with support and baby goodies                      Men’s health
•     Up to 12 antenatal and postnatal
      consultations per family at a gynaecologist,                 •    A prostate test (PSA level) requested by a
      GP or midwife (up to 8 on Prime 2)                                medical doctor for men 40 years and older
•     One amniocentesis screening per pregnancy                    •    A flu vaccination at Clicks/Dis-Chem
•     Two 2D ultrasound scans per family                                pharmacy clinics
•     Flu vaccination during your pregnancy at
                                                                                                                      Supporting wellness
      Clicks/Dis-Chem pharmacy clinics                             Additional screenings and
                                                                   immunisation for over 50s                          Maintain a healthy weight                          Chronic Care programme
Child benefits
                                                                                                                      • Free registration for and participation in 		 • People who suffer from high blood
                                                  •                     An FOBT test for people over 50 years             Medihelp’s HealthPrint BMI programme               pressure, high cholesterol and diabetes
•     Child flu vaccination at Clicks/Dis-Chem 		 •                     Women over 50 years have access to one 	     • One dietician consultation per registered            simultaneously have access to Medihelp’s
      pharmacy clinics                                                  bone mineral density test requested by a          HealthPrint member if a BMI test result at
                                                                                                                                                                             Chronic Care programme, which will provide
•     Babies under a year receive two additional                        medical doctor                                    Clicks/Dis-Chem indicates a BMI higher than 30
                                                                                                                                                                             personal support through a care coordinator
      visits to a GP or specialist                •                     A Pneumovax vaccine in a 5-year cycle per
                                                                                                                      An alternative to surgery                              to assist in maintaining and optimising
•     Full schedule of standard child                                   person older than 55 years registered on
                                                                        Medihelp’s asthma/COPD programme              • Back treatment at a Document-Based Care              their well-being
      immunisations covered up to 7 years at
      Dis-Chem and Clicks pharmacy clinics        •                     A flu vaccination at Clicks/Dis-Chem              facility for patients who qualify for this benefit
                                                                        pharmacy clinics

This is a summary of the added insured benefits – please consult the member guides for details.
HealthPrint
HealthPrint is a free online health and wellness
platform specifically designed for Medihelp
members, to add value in a unique and
individualised manner to members’
Medihelp experience.

How to join
Any member of Medihelp may register via the Medihelp
website to join HealthPrint.

After free registration you will be able to download the
Medihelp member app which will also give you access to
certain HealthPrint functionalities.

What does HealthPrint offer?
Once you’ve joined, you will have access to the following
functionalities and value:

     Run and cycle for FREE
HealthPrint members enjoy FREE participation in all
Medihelp-sponsored running and cycling events.

      Access, update and share health data
Apart from enabling you to check your available benefits,                 Pregnancy and baby programme                                    Special offer on Planet Fitness gym membership
HealthPrint also lets you view and forward a detailed record         •   Once you’ve registered for the baby programme, you will     HealthPrint members have access to a special discount offer from
of your Medihelp claims history and results of screening tests           receive a special gift for your baby.                       Planet Fitness for gym membership.
to a healthcare provider. The programme also integrates with         •   Through HealthPrint you can also access information about
certain fitness devices and displays your activity updates online.       your pregnancy benefits and the procedures to access             Discount on complementary health products
                                                                         benefits, as well as receive a regular newsletter.          HealthPrint has negotiated special discounts ranging between
      Medihelp MultiSport                                            •   Children of members of Medihelp MultiSport get free         30% and 10% on health-related products.
Runners/walkers in the Gauteng North area and cyclists                   membership of MultiSport and a kids’ MultiSport T-shirt
nationwide may join Medihelp MultiSport and only pay R265                (under 12 years).
for their annual membership. You also get the following:
• A free club starter pack with goodies                                    A healthy weight
• 50% discount on club cycling and running gear                      If your BMI is 30 and higher, you can register on HealthPrint
• The club will support you at various events throughout the         for a 12-week weight loss support programme, and Health-
     year with refreshments at the club gazebo                       Print will also assist you on your journey to a healthier
• Regular time trials and social run and rides are also planned      weight.
     througout the year.
                                                                                                                                                                                                        8
1.
 1.1.
    1. Addison’s
        Addison’s
         Addison’s
          Addison’sdisease
                   disease
                     disease
                     disease                                 8.
                                                             8.8.
                                                                8. Chronic
                                                                    Chronic
                                                                     Chronic
                                                                     Chronicrenal
                                                                             renal
                                                                                renal
                                                                                 renaldisease
                                                                                      disease
                                                                                        disease
                                                                                        disease                                           15.
                                                                                                                                          15.
                                                                                                                                            15.
                                                                                                                                            15.Epilepsy
                                                                                                                                                Epilepsy
                                                                                                                                                 Epilepsy
                                                                                                                                                 Epilepsy                                                              22.
                                                                                                                                                                                                                       22.
                                                                                                                                                                                                                        22.
                                                                                                                                                                                                                         22.Parkinson’s
                                                                                                                                                                                                                            Parkinson’s
                                                                                                                                                                                                                              Parkinson’s
                                                                                                                                                                                                                              Parkinson’sdisease
                                                                                                                                                                                                                                          disease
                                                                                                                                                                                                                                            disease
                                                                                                                                                                                                                                            disease
2.
 2.2.
    2. Asthma
        Asthma
         Asthma
          Asthma                                             9.
                                                             9.9.
                                                                9. Coronary
                                                                    Coronary
                                                                     Coronary
                                                                     Coronary  artery
                                                                                artery
                                                                                   artery
                                                                                    artery
                                                                                         disease
                                                                                         disease
                                                                                           disease
                                                                                            disease                                       16.
                                                                                                                                          16.
                                                                                                                                            16.
                                                                                                                                            16.Glaucoma
                                                                                                                                                Glaucoma
                                                                                                                                                 Glaucoma
                                                                                                                                                 Glaucoma                                                              23.
                                                                                                                                                                                                                       23.
                                                                                                                                                                                                                        23.
                                                                                                                                                                                                                         23.Rheumatoid
                                                                                                                                                                                                                            Rheumatoid
                                                                                                                                                                                                                              Rheumatoid
                                                                                                                                                                                                                              Rheumatoid   arthritis
                                                                                                                                                                                                                                           arthritis
                                                                                                                                                                                                                                             arthritis
                                                                                                                                                                                                                                              arthritis                                  9
3.
 3.3.
    3. Bipolar
        Bipolar
         Bipolar
          Bipolar
                mood
                mood
                  mood
                  mood disorder
                        disorder
                         disorder
                          disorder                           10.
                                                             10.10.
                                                                10.Crohn’s
                                                                    Crohn’s
                                                                     Crohn’s
                                                                     Crohn’sdisease
                                                                            disease
                                                                               disease
                                                                                disease                                                   17.
                                                                                                                                          17.
                                                                                                                                            17.
                                                                                                                                            17. Haemophilia
                                                                                                                                                Haemophilia
                                                                                                                                                 Haemophilia
                                                                                                                                                 Haemophilia  AAAand
                                                                                                                                                                 Aand
                                                                                                                                                                   and
                                                                                                                                                                   andBBBB                                             24.
                                                                                                                                                                                                                       24.
                                                                                                                                                                                                                        24.
                                                                                                                                                                                                                         24.Schizophrenia
                                                                                                                                                                                                                            Schizophrenia
                                                                                                                                                                                                                              Schizophrenia
                                                                                                                                                                                                                              Schizophrenia

 Benefit comparison
4.
 4.4.
5.
6.
    4. Bronchiectasis
 5.5.
 6.6.
        Bronchiectasis
         Bronchiectasis
          Bronchiectasis
    5. Cardiac
        Cardiac
         Cardiac
          Cardiac
                failure
                 failure
                  failure
                   failure
    6. Cardiomyopathy
        Cardiomyopathy
         Cardiomyopathy
          Cardiomyopathy
                                                             11.
                                                             11.
                                                             12.
                                                             12.
                                                             13.
                                                             13.
                                                                11.
                                                                11.Diabetes
                                                                12.
                                                                13.
                                                                    Diabetes
                                                                     Diabetes
                                                                     Diabetes
                                                                12.Diabetes
                                                                    Diabetes
                                                                     Diabetes
                                                                     Diabetes
                                                                13.Diabetes
                                                                    Diabetes
                                                                     Diabetes
                                                                     Diabetes
                                                                              insipidus
                                                                               insipidus
                                                                                  insipidus
                                                                                   insipidus
                                                                              mellitus
                                                                               mellitus
                                                                                  mellitus
                                                                                   mellitus
                                                                              mellitus
                                                                               mellitus
                                                                                  mellitus
                                                                                   mellitus
                                                                                           type
                                                                                            type
                                                                                             type
                                                                                              type
                                                                                           type
                                                                                            type
                                                                                             type
                                                                                                 1111
                                                                                              type
                                                                                                 2222
                                                                                                                                          18.
                                                                                                                                          18.
                                                                                                                                            18.
                                                                                                                                            18.Hyperlipidaemia
                                                                                                                                          19.
                                                                                                                                          19.
                                                                                                                                            19.
                                                                                                                                                Hyperlipidaemia
                                                                                                                                                 Hyperlipidaemia
                                                                                                                                                 Hyperlipidaemia
                                                                                                                                            19.Hypertension
                                                                                                                                          20.
                                                                                                                                          20.
                                                                                                                                            20.
                                                                                                                                                Hypertension
                                                                                                                                                 Hypertension
                                                                                                                                                 Hypertension
                                                                                                                                            20.Hypothyroidism
                                                                                                                                                Hypothyroidism
                                                                                                                                                 Hypothyroidism
                                                                                                                                                 Hypothyroidism
                                                                                                                                                                                                                       25.
                                                                                                                                                                                                                       25.
                                                                                                                                                                                                                        25.
                                                                                                                                                                                                                         25.Systemic
                                                                                                                                                                                                                       26.
                                                                                                                                                                                                                       26.
                                                                                                                                                                                                                        26.
                                                                                                                                                                                                                            Systemic
                                                                                                                                                                                                                              Systemic
                                                                                                                                                                                                                              Systemic
                                                                                                                                                                                                                                     lupus
                                                                                                                                                                                                                         26.Ulcerative
                                                                                                                                                                                                                            Ulcerative
                                                                                                                                                                                                                                      lupus
                                                                                                                                                                                                                              Ulcerative
                                                                                                                                                                                                                              Ulcerative
                                                                                                                                                                                                                                        lupus
                                                                                                                                                                                                                                         lupus
                                                                                                                                                                                                                                             erythematosus
                                                                                                                                                                                                                                       colitis
                                                                                                                                                                                                                                              erythematosus
                                                                                                                                                                                                                                         colitis
                                                                                                                                                                                                                                                erythematosus
                                                                                                                                                                                                                                                erythematosus
                                                                                                                                                                                                                                          colitis
                                                                                                                                                                                                                                           colitis
                                                                                                                                                                                                                                                            (SLE)
                                                                                                                                                                                                                                                             (SLE)
                                                                                                                                                                                                                                                              (SLE)
                                                                                                                                                                                                                                                               (SLE)

7.7.7.The
    7. Chronic
        Chronic
         Chronic
          Chronic
                obstructive
                 obstructive
                  obstructive
                   obstructive
           following         pulmonary
                              pulmonary
                               pulmonary
                               pulmonary
                            provides   disease
                                        disease
                                         adisease
                                          disease
                                                (COPD)
                                                 (COPD)
                                                  (COPD)
                                                   (COPD) comparison
                                             detailed        14.
                                                             14.14.
                                                                14.Dysrhythmia
                                                                    Dysrhythmia
                                                                     Dysrhythmia
                                                                     Dysrhythmia
                                                                         of the benefits                       provided by            each21.
                                                                                                                                          21.
                                                                                                                                            21.
                                                                                                                                            21.Multiple
                                                                                                                                                Multiple
                                                                                                                                                 Multiple
                                                                                                                                                 Multiple
                                                                                                                                            benefit      sclerosis
                                                                                                                                                          sclerosis
                                                                                                                                                           sclerosis
                                                                                                                                                            sclerosis
                                                                                                                                                        option.

Core
Core benefits
     benefits                                                                                                   Prime1
                                                                                                                 Prime1
                                                                                                                Hospital
                                                                                                                Hospital
                                                                                                                 Hospital
                                                                                                                 Hospitalplan
                                                                                                                         plan
                                                                                                                           plan
                                                                                                                           plan
                                                                                                                                                               Prime2
                                                                                                                                                                Prime2
                                                                                                                                                               Savings
                                                                                                                                                               Savings
                                                                                                                                                                Savings
                                                                                                                                                                 Savings
                                                                                                                                                                                                             Prime3
                                                                                                                                                                                                              Prime3
                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                              Comprehensive
                                                                                                                                                                                                               Comprehensive
                                                                                                                                                                                                                                                            Elite
                                                                                                                                                                                                                                                             Elite
                                                                                                                                                                                                                                                            Comprehensive
                                                                                                                                                                                                                                                            Comprehensive
                                                                                                                                                                                                                                                             Comprehensive
                                                                                                                                                                                                                                                              Comprehensive

    Description
       Description
        Description
         Description
         Description                                                                                              Benefit
                                                                                                                  Benefit
                                                                                                                   Benefit
                                                                                                                    Benefit
                                                                                                                    Benefit                                       Benefit
                                                                                                                                                                  Benefit
                                                                                                                                                                   Benefit
                                                                                                                                                                   Benefit                                       Benefit
                                                                                                                                                                                                                 Benefit
                                                                                                                                                                                                                  Benefit
                                                                                                                                                                                                                  Benefit                                       Benefit
                                                                                                                                                                                                                                                               Benefit
                                                                                                                                                                                                                                                               Benefit
                                                                                                                                                                                                                                                                Benefit
         DIAGNOSIS,
          DIAGNOSIS,
            DIAGNOSIS,
             DIAGNOSIS,       TREATMENT
                               TREATMENT
                                TREATMENT
                                 TREATMENT
                                 AND PMB AND       AND
                                                    AND
                                                     AND  CARE
                                                           CARE
                                                            CARE
                                                             CARE  COSTS
                                                                    COSTS
                                                                      COSTS
                                                                      COSTS  OF
                                                                             OFOF
                                                                               OF270
                                                                                  270
                                                                                   270
                                                                                    270
                                                                                      PMB
                                                                                       PMB
                                                                                        PMB
                                                                                         PMB
 Essential
 Essential

    CHRONIC        ILLNESS                                                                         100%
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         AND
          AND
            AND
             AND
    Diagnosis,    26
                  2626
                     26CHRONIC
                        CHRONIC
                          CHRONIC
                           CHRONIC
                   treatment        andCONDITIONS
                                        CONDITIONS
                                          CONDITIONS
                                           CONDITIONS
                                           care   costs ofON  ON ON
                                                                 ON
                                                               270  THE
                                                                    THE
                                                                      THE
                                                                       THE
                                                                      PMB  CDL
                                                                           CDL
                                                                            CDL
                                                                            CDL26 chronic
                                                                            and                    100%  of the cost*
                                                                                                   Unlimited
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                                                                                                     Unlimited                                    100%  of the cost*
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                                                                                                                                                   Unlimited                                    100%  of the cost*
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                                                                                                                                                                                                                                              Unlimited
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 cover
 cover

         Subject
          Subject
            Subject
             Subject
    conditions      onto
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                                             pre-authorisation
                                              pre-authorisation
                                              pre-authorisation
                                                  refer to page 18)   and
                                                                       and
                                                                         and
                                                                         andDSPs
                                                                            DSPs
                                                                              DSPs
                                                                              DSPs                 Unlimited                                      Unlimited                                     Unlimited                                       Unlimited
    Subject to protocols, pre-authorisation and DSPs
         BENEFITS
          BENEFITS
            BENEFITS
             BENEFITS     FOR
                           FOR
                             FOR
                             FOR MAJOR
                                  MAJOR
                                    MAJOR
                                    MAJOR     TRAUMA
                                               TRAUMA
                                                TRAUMA
                                                 TRAUMA     THAT
                                                            THAT
                                                              THAT
                                                               THAT  NECESSITATES
                                                                      NECESSITATES
                                                                       NECESSITATES
                                                                        NECESSITATES               100%
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                                                                                                                                                                                                                                                              cost
         HOSPITALISATION
          HOSPITALISATION
            HOSPITALISATION
             HOSPITALISATION
    TRAUMA BENEFITS                     IN
                                         ININ
                                            IN
                                             THE
                                              THE
                                               THE
                                                THECASE
                                                    CASE
                                                      CASE
                                                      CASE  OF:
                                                             OF:
                                                               OF:
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         •• •• for
    Benefits    Motor
                 Motor
                  Motor
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                     major  vehicle
                            vehicle
                              vehicle
                               vehicle
                                trauma accidents
                                       accidents
                                          accidents
                                          accidents
                                             that necessitates hospitalisation in the
         •• •• Stab
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                         wounds
                           wounds
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    case of:
  Trauma
  Trauma

         •• •• Gunshot
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                   Gunshot     wounds
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                                  wounds
                                  wounds
    • Motor
         •• •• Head vehicle
                 Head
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                   Head   traumaaccidents
                           trauma
                             trauma
                             trauma
    • Stab       wounds
         •• •• Burns
                 Burns
                  Burns
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    • Gunshot
         •• •• Near
                 Near
                  Near
                   Near wounds
                         drowning
                          drowning
                            drowning
                             drowning                                                              100% of the cost*                              100% of the cost*                               100% of the cost*                              100% of the cost*
         Subject
    • HeadSubject
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             Subject  to
                       toto
                  trauma toauthorisation,
                            authorisation,
                              authorisation,
                              authorisation,     PMB
                                                 PMB
                                                   PMB
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                                                           protocols   and
                                                                        and
                                                                          and
                                                                          and
                                                                            case
                                                                             case
                                                                              case
                                                                               case
                                                                                  management
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                                                                                     management    Unlimited                                      Unlimited                                       Unlimited                                      Unlimited
    • Burns
         POST-EXPOSURE
          POST-EXPOSURE
            POST-EXPOSURE
             POST-EXPOSURE           PROPHYLAXIS
                                      PROPHYLAXIS
                                        PROPHYLAXIS
                                         PROPHYLAXIS
    • Near drowning
         EMERGENCY
          EMERGENCY
            EMERGENCY
             EMERGENCY         TRANSPORT
                                TRANSPORT
                                 TRANSPORT
                                  TRANSPORT        SERVICES
                                                   SERVICES
                                                     SERVICES
                                                      SERVICES    (Netcare
                                                                   (Netcare
                                                                     (Netcare
                                                                     (Netcare  911)
                                                                               911)
                                                                                911)
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    Subject to authorisation, PMB protocols and case management
         RSA,
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                  Lesotho,
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                                Swaziland,
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                                  Swaziland,     Mozambique,
                                                 Mozambique,
                                                   Mozambique,
                                                   Mozambique,        Namibia
                                                                      Namibia
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                                                                        Namibia  and
                                                                                 and
                                                                                   and
                                                                                   andBotswana
                                                                                      Botswana
                                                                                        Botswana
                                                                                        Botswana   Unlimited
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                               PROPHYLAXIS and         and
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                                                              HIV/Aids)
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                beneficiary’s     country
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    EMERGENCY
         •• •• TransportTRANSPORT
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                                       road
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         •• •• 911
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         Outside
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             Outside   beneficiary’s
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         •• •• Transport
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                                 by
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    In the RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana
         •• •• Transport
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                                 byby
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                                                                                                                                                                                                         the
                                                                                                                                                                                                          the
                                                                                                                                                                                                           the
                                                                                                                                                                                                            the
                                                                                                                                                                                                              MT
                                                                                                                                                                                                               MT
                                                                                                                                                                                                                MT
                                                                                                                                                                                                                MT                            100%
                                                                                                                                                                                                                                              100%
                                                                                                                                                                                                                                               100%
                                                                                                                                                                                                                                                100%of
                                                                                                                                                                                                                                                     ofof
                                                                                                                                                                                                                                                       of
                                                                                                                                                                                                                                                        the
                                                                                                                                                                                                                                                         the
                                                                                                                                                                                                                                                          the
                                                                                                                                                                                                                                                           the
                                                                                                                                                                                                                                                             MT
                                                                                                                                                                                                                                                              MT
                                                                                                                                                                                                                                                               MT
                                                                                                                                                                                                                                                               MT
    • Transport by road
    • Transport by air                                                                             R12
                                                                                                   R12
                                                                                                    R12
                                                                                                     R12
                                                                                                       400
                                                                                                       400
                                                                                                         400
                                                                                                         400 per
                                                                                                             per
                                                                                                               per
                                                                                                               percase
                                                                                                                  case
                                                                                                                   case
                                                                                                                    case                         R12
                                                                                                                                                 R12
                                                                                                                                                  R12
                                                                                                                                                   R12
                                                                                                                                                     400
                                                                                                                                                     400
                                                                                                                                                       400
                                                                                                                                                       400 per
                                                                                                                                                           per
                                                                                                                                                             per
                                                                                                                                                             percase
                                                                                                                                                                case
                                                                                                                                                                 case
                                                                                                                                                                  case                         R12
                                                                                                                                                                                               R12
                                                                                                                                                                                                R12
                                                                                                                                                                                                 R12
                                                                                                                                                                                                   400
                                                                                                                                                                                                   400
                                                                                                                                                                                                     400
                                                                                                                                                                                                     400 per
                                                                                                                                                                                                         per
                                                                                                                                                                                                           per
                                                                                                                                                                                                           percase
                                                                                                                                                                                                              case
                                                                                                                                                                                                               case
                                                                                                                                                                                                                case                          R12
                                                                                                                                                                                                                                              R12
                                                                                                                                                                                                                                               R12
                                                                                                                                                                                                                                                R12
                                                                                                                                                                                                                                                  400
                                                                                                                                                                                                                                                  400
                                                                                                                                                                                                                                                    400
                                                                                                                                                                                                                                                    400 per
                                                                                                                                                                                                                                                        per
                                                                                                                                                                                                                                                          per
                                                                                                                                                                                                                                                          percase
                                                                                                                                                                                                                                                             case
                                                                                                                                                                                                                                                              case
                                                                                                                                                                                                                                                               case
       24-HOUR
        24-HOUR
         24-HOUR
          24-HOUR
    Outside       HELPLINE
                   HELPLINE
                    HELPLINE
                    HELPLINE
            beneficiary’s   AND
                            AND
                             AND
                              AND
                          countryTRAUMA
                                  TRAUMA
                                   TRAUMA
                                   TRAUMA
                                  of       COUNSELLING
                                           COUNSELLING
                                            COUNSELLING
                                            COUNSELLING
                                     residence                                                     Phone
                                                                                                   Phone
                                                                                                    Phone
                                                                                                     Phone
                                                                                                   100%  082
                                                                                                          082
                                                                                                         of082
                                                                                                            082
                                                                                                            the911
                                                                                                               911
                                                                                                                911
                                                                                                                 911
                                                                                                                MT                               Phone
                                                                                                                                                 Phone
                                                                                                                                                  Phone
                                                                                                                                                   Phone
                                                                                                                                                  100% 082
                                                                                                                                                       082
                                                                                                                                                        of082
                                                                                                                                                          082
                                                                                                                                                            911
                                                                                                                                                             911
                                                                                                                                                           the911
                                                                                                                                                              911
                                                                                                                                                               MT                              Phone
                                                                                                                                                                                               Phone
                                                                                                                                                                                                Phone
                                                                                                                                                                                                 Phone
                                                                                                                                                                                                100% 082
                                                                                                                                                                                                     082
                                                                                                                                                                                                       082
                                                                                                                                                                                                       082
                                                                                                                                                                                                      of  911
                                                                                                                                                                                                          911
                                                                                                                                                                                                           911
                                                                                                                                                                                                         the911
                                                                                                                                                                                                             MT                               Phone
                                                                                                                                                                                                                                              Phone
                                                                                                                                                                                                                                               Phone
                                                                                                                                                                                                                                                Phone
                                                                                                                                                                                                                                                100%082
                                                                                                                                                                                                                                                    082
                                                                                                                                                                                                                                                      082
                                                                                                                                                                                                                                                      082
                                                                                                                                                                                                                                                      of 911
                                                                                                                                                                                                                                                         911
                                                                                                                                                                                                                                                          911
                                                                                                                                                                                                                                                           911
                                                                                                                                                                                                                                                         the MT
       (Netcare
        (Netcare
         (Netcare
          (Netcare
                 911)
                 911)
                   911)
                   911)
    • Transport by road                                                                            R1 950 per case                                R1 950 per case                               R1 950 per case                                 R1 950 per case
           PMB
           PMB
            PMB
             PMB–– ––Prescribed
                     Prescribed
                       Prescribed
                        Prescribed
                                minimum
                                 minimum
                                   minimum
                                   minimum
                                         benefits
                                          benefits
                                           benefits
                                            benefits      EMS
                                                           EMS
                                                            EMS
                                                            EMS–– ––Emergency
                                                                     Emergency
                                                                      Emergency
                                                                      Emergencymedical
                                                                               medical
                                                                                medical
                                                                                medicalservices
                                                                                        services
                                                                                         services
                                                                                          services
    •        Transport by air                                                                      100% ofCDL
                                                                                                           CDL
                                                                                                            CDL
                                                                                                            CDL–– ––Chronic
                                                                                                           the MTChronic
                                                                                                                     Chronic
                                                                                                                      Chronic
                                                                                                                            Diseases
                                                                                                                            Diseases
                                                                                                                              Diseases
                                                                                                                              Diseases
                                                                                                                                     List
                                                                                                                                      List
                                                                                                                                        List
                                                                                                                                        List
                                                                                                                                             100% MT
                                                                                                                                                   MT
                                                                                                                                                    MT
                                                                                                                                                    MT–– ––Medihelp
                                                                                                                                                   of the Medihelp
                                                                                                                                                            Medihelp
                                                                                                                                                             Medihelp
                                                                                                                                                            MT      tariff
                                                                                                                                                                     tariff
                                                                                                                                                                       tariff
                                                                                                                                                                        tariff
                                                                                                                                                                            paid
                                                                                                                                                                            paid
                                                                                                                                                                               paid
                                                                                                                                                                               paid
                                                                                                                                                                                  by
                                                                                                                                                                                  byby
                                                                                                                                                                                     by
                                                                                                                                                                                     Medihelp
                                                                                                                                                                                      Medihelp
                                                                                                                                                                                        Medihelp
                                                                                                                                                                                        Medihelp
                                                                                                                                                                                          100% for
                                                                                                                                                                                                for
                                                                                                                                                                                                  for
                                                                                                                                                                                                   for
                                                                                                                                                                                                    benefits
                                                                                                                                                                                                     benefits
                                                                                                                                                                                                    of benefits
                                                                                                                                                                                                       benefits
                                                                                                                                                                                                             that
                                                                                                                                                                                                        the MTthat
                                                                                                                                                                                                                that
                                                                                                                                                                                                                 that
                                                                                                                                                                                                                   can
                                                                                                                                                                                                                    can
                                                                                                                                                                                                                      can
                                                                                                                                                                                                                      can
                                                                                                                                                                                                                        include
                                                                                                                                                                                                                         include
                                                                                                                                                                                                                           include
                                                                                                                                                                                                                            include
                                                                                                                                                                                                                                 aacontracted
                                                                                                                                                                                                                                    acontracted
                                                                                                                                                                                                                                     a contracted
                                                                                                                                                                                                                                       contracted
                                                                                                                                                                                                                                                tariff
                                                                                                                                                                                                                                             100%tariff
                                                                                                                                                                                                                                                   tariff
                                                                                                                                                                                                                                                    tariff
                                                                                                                                                                                                                                                       or
                                                                                                                                                                                                                                                        oror
                                                                                                                                                                                                                                                       of  or
                                                                                                                                                                                                                                                           the
                                                                                                                                                                                                                                                            the
                                                                                                                                                                                                                                                              the
                                                                                                                                                                                                                                                            thethe
                                                                                                                                                                                                                                                                single
                                                                                                                                                                                                                                                                 single
                                                                                                                                                                                                                                                                   single
                                                                                                                                                                                                                                                                  MTsingle
                                                                                                                                                                                                                                                                        exit
                                                                                                                                                                                                                                                                         exit
                                                                                                                                                                                                                                                                           exit
                                                                                                                                                                                                                                                                           exit
                                                                                                                                                                                                                                                                              price
                                                                                                                                                                                                                                                                              price
                                                                                                                                                                                                                                                                                price
                                                                                                                                                                                                                                                                                 price

                                                                                                   R13 000 per case                          R13 000 per case                             R13 000 per case                                   R13 000 per case

  CDL       –    Chronic Diseases List                     PMB     –    Prescribed minimum benefits                     * Contracted tariffs may apply
  DSP       –    Designated service provider
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