Displaying details for ALLIANCE



 ALLIANCE
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITS 
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION100% of Negotiated Rate in general ward and specialised units. Private ward for confinements (subject to availability)
ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS MEDICAL AND SURGICAL PROCEDURES INCLUDING CONFINEMENTS SUBJECT TO PRE-AUTHORISATIONUp to 300% CBT
300% 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
PATHOLOGY IN HOSPITAL100% Negotiated Rate
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION100% of cost
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION100% CBT
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 TREATMENTTreatment limited to R89 600 per family
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 – at 300% CBT
The ICON Enhanced benefits apply
# Please refer to the website for ICON benefit structures


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