| VITAL |
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IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITS | |
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION | 100% of Negotiated Rate in general ward and specialised units |
ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS MEDICAL AND SURGICAL PROCEDURES INCLUDING CONFINEMENTS SUBJECT TO PRE-AUTHORISATION | Up to 300% CBT
100% of Scheme Rate |
SUPPLEMENTARY HEALTHCARE IN HOSPITAL (EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) | 100% CBT |
BLOOD TRANSFUSIONS (IN AND OUT OF HOSPITAL) | 100% of cost |
RADIOLOGY IN HOSPITAL ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION | 100% CBT
100% CBT |
PATHOLOGY IN HOSPITAL | 100% Negotiated Rate |
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION | 100% of cost |
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION | 100% CBT |
STEP-DOWN/PHYSICAL REHABILITATION APPROVED FACILITIES ONLY, UP TO 90 DAYS (SUBJECT TO PRE-AUTHORISATION) | 100% Negotiated Rate |
MEDICATION IN HOSPITAL | 100% SEP plus dispensing fee |
TTO MEDICATION UP TO ONE WEEK’S SUPPLY | 100% SEP plus dispensing fee |
INFERTILITY TREATMENT | No benefit |
SUBSTANCE ABUSE | PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per
year, subject to pre-authorisation and limited to 21 days |
CHRONIC PMB CDL MEDICATION AND TREATMENT – SUBJECT TO PRE-AUTHORISATION, PROTOCOLS AND FORMULARIES
REFER TO CHRONIC DISEASE LIST | 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures – as per PMB
regulations |
PMB DTP TREATMENT OUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF CONDITION AND PRE-AUTHORISATION | Medication – 100% SEP plus a dispensing fee, subject to MMAP and DSP.
Consultations and procedures – as per PMB regulations |
ONCOLOGY SUBJECT TO PREAUTHORISATION AND ICON PROTOCOLS# | Medication – 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures
– at 100% Scheme Rate
The ICON Core benefits apply |
# Please refer to the website for ICON benefit structures | |
PREVENTATIVE WELLNESS COVER | |
CAMAF PREVENTATIVE PROGRAMME PER ADULT BENEFICIARY | INCLUDES: Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy |
ONE GP CONSULTATION ONLY *ICD 10 CODE SPECIFIC TO GENERAL (CHECK UP ONLY) | 100% CBT per beneficiary |
ONE SPECIALIST CONSULTATION *ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS, UROLOGISTS, OR SPECIALIST PHYSICIANS FOR BENEFICIARIES OVER 18 YEARS. PAEDIATRICIANS FOR BENEFICIARIES UNDER 18 YEARS | 100% CBT per beneficiary |
PSYCHOTHERAPY | 100% CBT limited to R12 300 per beneficiary |
ONE DIETICIAN CONSULTATION | 100% CBT per beneficiary |
ONE DENTISTRY CONSULTATION GENERAL CHECK UP ONLY – excludes consumables | 100% CBT per beneficiary |
ONE ECG (PERFORMED BY GP OR SPECIALIST PHYSICIAN) *ICD 10 CODE SPECIFIC TO GENERAL (CHECK UP ONLY) | 100% CBT per adult beneficiary |
ONE OPTOMETRIST CONSULTATION | 100% Optical Assistant Rates |
IMMUNISATION AND VACCINES (COST OF IMMUNISATION AND VACCINE ONLY) | SEP plus a dispensing fee, limited to R1 767 per beneficiary |
CERVICAL CANCER VACCINE (HPV) (COST OF VACCINE ONLY – SUBJECT TO IMMUNISATION AND VACCINES BENEFIT) | Females between 9 and 16 years of age
(SEP plus dispensing fee) |
ONE HIV VCT TEST | 100% CBT per beneficiary |
MELANOMA SCREENING | 100% CBT per adult beneficiary |
MATERNITY BENEFITS | |
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION | See In Hospital and Prescribed Minimum Benefits |
EXTERNAL APPLIANCES SUBJECT TO OVERALL EXTERNAL APPLIANCES LIMIT BREAST PUMPS AND APNOEA MONITORS – THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER-TO-BE-PROGRAMME | Baby Apnoea Monitors: R2 700
Breast pumps: R4 500 |
METABOLIC SCREENING FOR NEW BORN BABIES | 100% Negotiated Rate per new born baby |
ANTE-NATAL FOETAL SCANS PER PREGNANCY | No Benefit |
ANTE-NATAL CLASSES | No Benefit |
UMBILICAL STEM CELL HARVESTING | Negotiated discount with Cryo-Save.
Note: Please note that CAMAF does not cover expenses related to cord blood stem cell
harvesting, testing and storage as this is not treatment for a specific medical condition. The cash
discount that is offered is passed directly on to you and is not paid from your health plan benefits. |
OTHER BENEFITS (per Beneficiary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMIT | |
BASIC AND ADVANCED RADIOLOGY OUT OF HOSPITAL MUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON REFERRAL FROM MEDICAL PRACTITIONER ONLY. ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION | 100% CBT |
PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER PRE-AUTHORISATION REQUIRED FOR ADVANCED PATHOLOGY | 100% Negotiated Rate or CBT |
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS | 300% CBT for attending practitioners
100% CBT for supplementary services |
MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LIST | 100% SEP plus a dispensing fee, subject to RP and DSP
Consultations 100% CBT |
EXTERNAL APPLIANCES (subject to referral)
IN AND OUT OF HOSPITAL PURCHASE, HIRE AND MAINTENANCE
CPAP (subject to pre-authorisation; DSP and compliance over a 3-month rental period) – 3 YEAR CYCLE
HEARING AIDS (subject to pre-authorisation) – 1 CLAIM PER 3 YEAR CYCLE FOR OVER 16 YEARS OF AGE YOUNGER THAN 16 YEARS OF AGE – 18 MONTH CYCLE WHEELCHAIRS – 3 YEAR CYCLE | 100% NAPPI price or 100% of cost, subject to the overall limit of R40 400 per beneficiary and
subject to the following sub-limits:
Hearing Aids: R35 100
Wheelchairs for
Quadriplegics: R35 100
Standard Wheelchairs: R24 700
Insulin Pumps: R40 400
Other external appliances: R 8 800 |
INTERNATIONAL TRAVEL COVER – PROVIDED BY TRAVEL INSURANCE CONSULTANTS (TIC) AND SUBJECT TO THEIR POLICY REQUIREMENTS. ARRANGE COVER PRIOR TO YOUR TRAVEL. VISIT OUR WEBSITE FOR FULL DETAILS. | R10 million per beneficiary per journey for emergency medical costs while you travel outside
South Africa. This cover is for a period of 90 days from your departure from South Africa. Cover for
pre-existing conditions is limited to R150,000 unless additional cover is arranged. |
NETCARE 911 EMERGENCY SERVICES | Unlimited
Subject to Netcare 911 authorisation |
OTHER BENEFITS (per Beneficiary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMIT | |
DAY TO DAY BENEFITS BENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT | No Benefit |
GP’S AND DENTISTS DENTAL X-RAYS PERFORMED BY DENTISTS, CONSULTATIONS AND PROCEDURES PERFORMED BY THESE PRACTITIONERS; BASIC DENTISTRY | No Benefit |
SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS | No Benefit |
ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS | No Benefit |
NON-DSP VISITS TO DOCTORS ROOMS | Not applicable |
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT | No Benefit |
NURSE VISITS | No Benefit |
SUPPLEMENTARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS, PODIATRY AND SPEECH THERAPY | No Benefit |
ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES | No Benefit |
OVER THE COUNTER MEDICATION | No Benefit |
LASER K/EXCIMER LASER NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS | No Benefit |
SPECTACLES AND LENSES FROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE STATED | No Benefit |
MONTHLY CONTRIBUTION RATES | |
RATES | Monthly income based on
Total Cost to Company of
Principal Member
Total Monthly Contribution
R0 – R44 520
Adult R2 295
Child R1 177
R44 521 – R111 300
Adult R2 602
Child R1 328
R111 301+
Adult R2 886
Child R1 478 |