Benefit options 2019 - Medihelp
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Benefit options 2019
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
Private nursing, hospice and sub-acute care facilities Medicine
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
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.
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.
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
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
Contribution
Contribution table
Contributiontable
Contribution table
table
This table provides a guideline for contributions based on your family’s composition. You pay child dependant rates for kids until they are 26 years old and you
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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
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(R270month
(R270 savingsand
savings
savings
savings R3 240 per year)
contribution
contribution
contribution
contribution per
R2
R2
R2month
R2532
310(R378
310
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(R348
(R348
(R348 R4 176 contribution
savings
savings
savings per year)
contribution
contribution
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incl.
incl.
R1R1488
R1
R1 356
356
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R1
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R1728
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R2352
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272
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member
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included
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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
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plan
plan
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Comprehensive
Comprehensive
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Elite
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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 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
(NOOAL)
(NO
OAL)
OAL)
OAL) HOSPITAL
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BENEFITS
BENEFITS (NO
BENEFITS
(NO
(NO OAL)
(NO
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OAL) HOSPITAL
HOSPITAL
HOSPITAL
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BENEFITS
BENEFITS
BENEFITS
(NO(NO
(NO
(NO OAL)
OAL)
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HOSPITAL
HOSPITAL
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
network
facilities
facilities Any
Anyhospital
Any
hospital 115
hospital 108
108 network
108
network facilities
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108
108108network
network
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network facilities
facilities
facilities
facilities Any
Any
AnyAnyhospital
hospital
hospital
hospital Any
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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
ESSENTIALCOVERtreatment
COVER and care costs of 270
COVER Diagnosis,
ESSENTIAL
ESSENTIAL
ESSENTIAL
COVERtreatment
COVER and care costs of 270
COVER Diagnosis,
ESSENTIAL
ESSENTIAL
ESSENTIAL
COVERtreatment
COVER and care costs of 270
COVER
Diagnosis,
PMB
Diagnosis,
Diagnosis, treatment
and
Diagnosis, 26
treatment
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chronic
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and
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the
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26 chronic
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and and
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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
POST-HOSPITAL
POST-HOSPITAL after
CARE
CARECAREdischarge POST-HOSPITAL
POST-HOSPITAL
POST-HOSPITAL CARE
CARECARE Up to 30 days
POST-HOSPITAL
POST-HOSPITAL
POST-HOSPITAL after
CARE
CARECAREdischarge Up to 30 days CARE
POST-HOSPITAL
POST-HOSPITAL after discharge
Up to 30 days after discharge Up to 30 days after discharge Up to 30 days after discharge Up to 30 daysCARE
POST-HOSPITAL afterCARE
discharge
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Core
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SPECIALISED
SPECIALISED RADIOLOGY
RADIOLOGY SPECIALISED
SPECIALISED RADIOLOGY
RADIOLOGY SPECIALISEDRADIOLOGY
SPECIALISED RADIOLOGY SPECIALISED RADIOLOGY
SPECIALISED RADIOLOGY
Unlimited
Unlimited
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
SPECIALISED
SPECIALISED RADIOLOGY
RADIOLOGY
RADIOLOGY Unlimited
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SPECIALISED
SPECIALISED
SPECIALISED RADIOLOGY
RADIOLOGY
RADIOLOGY
In and
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TRAUMA-RELATED
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BENEFITS TRAUMA-RELATED BENEFITS
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ROAD ROAD& AIR & TRANSPORT
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0
0101 0
Summary of benefits
Summary of benefits
Summary of benefits (continued)
Prime1 Prime2 Prime3
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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
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BENEFITS(NO
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M = R1 150 per year 15% medical savings account M = R9 000 per year M = R2 650 per year
108=network
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ESSENTIAL COVER ESSENTIAL COVER M+3+ = R17
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POST-HOSPITAL CARE POST-HOSPITAL CARE • Standard radiology
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POST-HOSPITAL CARE BENEFITS
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SPECIALISED RADIOLOGY SPECIALISED RADIOLOGY Conservative & specialised
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TRAUMA-RELATED BENEFITS
Including post-exposure
TRAUMA-RELATED
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BENEFITS
BENEFITS
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BENEFITS
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BENEFITS
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M+2 = R8 post-exposure
TRAUMA-RELATED
TRAUMA-RELATED400 per year
TRAUMA-RELATED prophylaxis in the
BENEFITS
BENEFITS
BENEFITS
event
Includingof
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Includingpost-exposure
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post-exposureprophylaxis
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R9 000
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to HIVof
event
event
event of
ofsexual
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event
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exposure to HIVof
event
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event of
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assaultoror
oraccidental
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event
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HIV
HIV to
to
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HIV
HIV STANDARD
exposure
exposure
exposureto toRADIOLOGY
to HIV
HIV
HIV BENEFITS
ROAD & AIR TRANSPORT ROAD & AIR TRANSPORT ROAD & AIR TRANSPORT R2
ROAD650 & perAIRfamily per year
TRANSPORT
(Netcare
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ROAD
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&AIR
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&AIR
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within RSA
24-hour
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within&
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within RSA
RSAtrauma counselling
RSA 24-hour
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INSURED DENTISTRY BENEFITS
Conservative & specialised
INSURED OPTICAL BENEFITS
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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
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.
81.
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%
100%
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ofof
of
the
the
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cost
cost 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
Unlimited 100% of the cost*
Unlimited
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Unlimited
Unlimited
Unlimited 100% of the cost*
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Unlimited
Unlimited
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cover
cover
Subject
Subject
Subject
Subject
conditions onto
toto
to
protocols,
theprotocols,
protocols,
protocols,
CDL (please pre-authorisation
pre-authorisation
pre-authorisation
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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
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HOSPITALISATION
HOSPITALISATION
HOSPITALISATION
HOSPITALISATION
TRAUMA BENEFITS IN
ININ
IN
THE
THE
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THECASE
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OF: Unlimited
Unlimited
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•• •• for
Benefits Motor
Motor
Motor
Motor
major vehicle
vehicle
vehicle
vehicle
trauma accidents
accidents
accidents
accidents
that necessitates hospitalisation in the
•• •• Stab
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wounds
wounds
wounds
case of:
Trauma
Trauma
•• •• Gunshot
Gunshot
Gunshot
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wounds
wounds
wounds
• Motor
•• •• Head vehicle
Head
Head
Head traumaaccidents
trauma
trauma
trauma
• Stab wounds
•• •• Burns
Burns
Burns
Burns
• 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
Subject
Subject to
toto
trauma toauthorisation,
authorisation,
authorisation,
authorisation, PMB
PMB
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and
and
and
case
case
case
case
management
management
management
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• 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
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(Netcare
(Netcare
(Netcare 911)
911)
911)
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MT
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Subject to authorisation, PMB protocols and case management
RSA,
RSA,
RSA,
RSA,Lesotho,
Lesotho,
Lesotho,
Lesotho, Swaziland,
Swaziland,
Swaziland,
Swaziland, Mozambique,
Mozambique,
Mozambique,
Mozambique, Namibia
Namibia
Namibia
Namibia and
and
and
andBotswana
Botswana
Botswana
Botswana Unlimited
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Unlimited Unlimited
Unlimited
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Unlimited Unlimited
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Subject
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POST-EXPOSURE to
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PROPHYLAXIS and and
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beneficiary’s
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EMERGENCY
•• •• TransportTRANSPORT
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byby
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road
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road SERVICES
•• •• 911
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byby
byair
air
air
air 100% of the MT 100% of the MT 100% of the MT 100% of the MT
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beneficiary’s
beneficiary’s
beneficiary’s
to pre-authorisation country
country
country
country of
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•• •• Transport
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by
countryby
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per
per
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case R1
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900
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case
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per
per
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In the RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana
•• •• Transport
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air 100%
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R12
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400
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400
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per
per
percase
case
case
case R12
R12
R12
R12
400
400
400
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per
per
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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
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082
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the911
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of 911
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the MT
(Netcare
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911)
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• 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
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medical
medical
medicalservices
services
services
services
• Transport by air 100% ofCDL
CDL
CDL
CDL–– ––Chronic
the MTChronic
Chronic
Chronic
Diseases
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List
List
List
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100% MT
MT
MT
MT–– ––Medihelp
of the Medihelp
Medihelp
Medihelp
MT tariff
tariff
tariff
tariff
paid
paid
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by
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by
Medihelp
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100% for
for
for
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benefits
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benefits
that
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that
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include
include
include
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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
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