You are covered when your service provider charge a higher rate
than your Medical Aid rate while in hospital or day clinic. This
option provides an additional 500% cover related to the following
accounts: Doctors and Specialists. Dentistry limited to R5,000. The
Radiologist performing Specialised services - R2,000. Pathology.
Physiotherapy. Consumable items. Medication.
If your medical aid requires you to pay a co-payment or
pre-admission fee prior to undergo certain in- and out- of hospital
procedures or specialised radiology scans. Limited to R50,000 per
year. You are also covered for up to R8,500 per policy per year,
for the voluntary use of a hospital outside the designated network.
Your Oncology optimiser benefit covers you when your medical scheme
applies a Rand amount limit. Once you reach the limit you will be
liable to pay all the treatment costs.
Your cancer diagnosis benefit provides a once-off payment of
R30,000 when you are diagnosed with cancer for the first time and
the diagnosis aligns to specific qualifying criteria. (Page 27
paragraph 4 of Brochure). This benefit ends at age 65.
When your medical aid applies a Rand amount limit for internal
prosthesis and the device cost more. Limited to R30,000 per event
and R60,000 per person per year.
You are covered at a registered medical facility when immediate
treatment is required for a phisical injury due to an externel
force. Limited to R10,000 per year.
If you have witnessed, or are directly affected by an act of
physical violence or accident resulting en serious bodily injury or
death or when you or a loved one are diagnosed with a dread disease
or death. We will cover consiltation fees of psychologist's or
psychiatrist's up to R10,000 per year.
Normally your medical scheme covers certain preventative care tests
from risk, but not the consultation fee. We will now cover your for
the consultation fee or test up to R500 per policy per year.
When your medical scheme provides a rehabilitation benefit for
accidental events, but apply a rand amount or limit the number of
days you may spent in a stepdown facility. Limited to R10,000 per
person per year.
In the event of death or permanent disability of the premium payer,
your Medical Scheme premium will be paid for 6 months. Limited to
R4,500 per month.
