Displaying details for FIRST CHOICE



 FIRST CHOICE
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITS 
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION100% of Negotiated Rate in general ward and specialised units
ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS MEDICAL AND SURGICAL PROCEDURES INCLUDING CONFINEMENTS SUBJECT TO PRE-AUTHORISATIONUp to 100% CBT
100% CBT
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-AUTHORISATION100% CBT
100% CBT limited to R36 900 per family
PATHOLOGY IN HOSPITAL100% CBT
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION100% of cost limited to R36 900 per family
Exclusions: cochlear implants
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION100% CBT (in lieu of hospitalisation only)
STEP-DOWN/PHYSICAL REHABILITATION APPROVED FACILITIES ONLY, UP TO 90 DAYS (SUBJECT TO PRE-AUTHORISATION)100% Negotiated Rate
MEDICATION IN HOSPITAL100% SEP plus dispensing fee
TTO MEDICATION UP TO ONE WEEK’S SUPPLY100% SEP plus dispensing fee
INFERTILITY TREATMENTNo benefit
SUBSTANCE ABUSEPMB 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 AND PROTOCOLS REFER TO CHRONIC DISEASE LIST100% 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-AUTHORISATIONMedication – 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
– 100% DSP Tariff
The DSP is the ICON network
The ICON Essential benefits apply
# Please refer to the website for ICON benefit structures
PREVENTATIVE WELLNESS COVER 
CAMAF PREVENTATIVE PROGRAMME PER ADULT BENEFICIARYINCLUDES: 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 YEARS100% CBT per beneficiary
PSYCHOTHERAPY100% CBT limited to R12 300 per beneficiary
ONE DIETICIAN CONSULTATION100% CBT per beneficiary
ONE DENTISTRY CONSULTATION GENERAL CHECK UP ONLY100% 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 CONSULTATIONRefer to spectacle and lenses benefits
IMMUNISATION AND VACCINES (COST OF IMMUNISATION AND VACCINE ONLY)SEP plus a dispensing fee, subject to MMAP, 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 TEST100% CBT per beneficiary
MELANOMA SCREENINGNot applicable
MATERNITY BENEFITS 
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATIONSee 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-PROGRAMMEBaby Apnoea Monitors: R2 200
Breast pumps: R3 800
METABOLIC SCREENING FOR NEW BORN BABIES100% Negotiated Rate per new born baby
ANTE-NATAL FOETAL SCANS PER PREGNANCY3 scans at 80% CBT. Subject to limit (c) of Annual Overall Day-to-Day Benefit Limit
ANTE-NATAL CLASSES80% CBT subjects to sub-limit R1 020 per pregnancy.
Subject to limit (c) of Annual Overall Day-to-Day Benefit Limit
UMBILICAL STEM CELL HARVESTINGNegotiated 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-AUTHORISATIONBasic Radiology: 100% CBT limited to R4 310 per beneficiary
Advanced scans: 100% CBT limited to R36 900 per family
PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER PRE-AUTHORISATION REQUIRED FOR ADVANCED PATHOLOGY100% Negotiated Rate limited to R6 880 per beneficiary
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYSNot applicable
MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LISTDepression only. 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 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 INSULIN PUMPS (rent to own over 12 months), SUBJECT TO PRE-AUTHORISATION AND DSP – 4 YEAR CYCLE100% NAPPI price or 100% of cost, in hospital and 80% of cost out of hospital with an overall limit of
R6 600 per beneficiary
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 SERVICESUnlimited
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 LIMITAnnual overall limit: Beneficiary specific limits:
(a) Medicines R3 190
(b) Advanced Dentistry R6 690
(c) Other R3 190
(d) Specialists R9 830
GP’S AND DENTISTS DENTAL X-RAYS PERFORMED BY DENTISTS, CONSULTATIONS AND PROCEDURES PERFORMED BY THESE PRACTITIONERS; BASIC DENTISTRY80% CBT
Subject to limit (c)
SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS80% CBT
Subject to limit (d)
ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS80% SEP plus a dispensing fee, subject to MMAP. Subject to limit (a)
NON-DSP VISITS TO DOCTORS ROOMSNot applicable
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFITMedication: 80% SEP plus a dispensing fee
subject to limit (a) Treatment: 80% CBT subject to limit (c)
NURSE VISITS80% CBT subject to limit (c)
SUPPLEMENTARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS, PODIATRY AND SPEECH THERAPY80% CBT subject to sub-limit R2 680
Subject to limit (c)
ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES50% CBT
Subject to limit (b) dental implants excluded
OVER THE COUNTER MEDICATION50% SEP plus a dispensing fee, subject to MMAP, limited to R1 640 per beneficiary. Subject to limit
(a)
LASER K/EXCIMER LASER NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS. IF THE LASER K BENEFIT IS UTILISED, NO SPECTACLE AND CONTACT LENSE BENEFIT ALLOWED FOR 2 YEARSNo Benefit
SPECTACLES AND LENSES FROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE STATEDThe benefit PER BENEFICIARY at a PPN provider would be as follows:
For the benefit cycle of 24 months from date of claiming, each beneficiary is entitled to:
One Composite Consultation inclusive of a Refraction, Tonometry and Visual Field screening AND
EITHER SPECTACLES – A PPN Frame to the value of R150 or R750 off any alternative frame and/or lens
enhancements and one pair of lenses: either One pair of Clear A quity Single Vision; Clear Aquity Bifocal
lenses or Clear Aquity Multifocal lenses OR CONTACT LENSES – Contact lenses to the value of R840.
The benefit PER BENEFICIARY at a NON PPN provider would be as follows:
One consultation per Beneficiary during the Benefit Cycle, limited to a maximum cost of R300 AND EITHER
SPECTACLES – A frame benefit of R600 towards the cost of a frame and/or lens enhancements and one
pair of lenses: either one pair of clear single vision spectacl e lenses limited to R175 per lens or one pair
of clear flat top bifocal spectacle lenses limited to R410 per lens or one pair of clear flat top Multifocal
lenses limited to R710 per lens OR CONTACT LENSES – Contact Lenses to the value of R840.
MONTHLY CONTRIBUTION RATES 
RATESMonthly income based on
Total Cost to Company of
Principal Member
Total Monthly Contribution
R0 – R9 490
Adult R1 131
Child R 689
R9 491 – R18 300
Adult R1 796
Child R1 064
R18 301 – R24 540
Adult R2 697
Child R1 568
R24 541 – R36 810
Adult R3 356
Child R2 207
R36 811+
Adult R3 670
Child R2 395


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