Displaying details for NETWORK CHOICE



 NETWORK CHOICE
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 DENTISTRY100% negotiated rate
subject to sublimit (c) – Network GP only
SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS100% CBT
Subject to limit (d) (on referral from a network GP only)
ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS100% SEP plus a dispensing fee, subject to MMAP.
Subject to limit (a) (on referral from a network GP only)
NON-DSP VISITS TO DOCTORS ROOMSOne non-network visit per beneficiary or two per family, 20% co-payment
AND
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFITOne casualty visit per family (facility fee, consumed meds and materials).
Limited to R 1 376
NURSE VISITS100% CBT subject to limit (c)
SUPPLEMENTARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS, PODIATRY AND SPEECH THERAPY100% CBT limited to R2 680 per beneficiary on referral from DSP or from a Specialist.
Subject to limit (c)
ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES100% of 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 MONTHSNo 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.


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