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ESSENTIAL NETWORK

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MONTHLY CONTRIBUTION RATES
RATES

Income Category R0 – R120 150
Monthly Risk Contribution
Principal R1 834
Adult R1 449
Child R 852
Monthly MSA Contribution
Principal R555
Adult R440
Child R262
Total Monthly Contribution
Principal R2 389
Adult R1 889
Child R1 114
Income Category R120 151+
Monthly Risk Contribution
Principal R2 203
Adult R1 747
Child R1 022
Monthly MSA Contribution
Principal R555
Adult R440
Child R262
Total Monthly Contribution
Principal R2 758
Adult R2 187
Child R1 284
Monthly income based on Total Cost to Company of Principal Member

OTHER BENEFITS (Per Beneficiary) SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMIT
DAY TO DAY BENEFITS: BENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT

Limited to funds available in the beneficiary’s Medical Savings Account

GPs AND DENTISTS DENTAL X-RAYS PERFORMED BY DENTISTS, CONSULTATIONS AND PROCEDURES PERFORMED BY THESE PRACTITIONERS; BASIC DENTISTRY

Subject to Medical Savings Account

SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS

Subject to Medical Savings Account

ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS

Subject to Medical Savings Account

CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL

Subject to Medical Savings Account

NURSE VISITS

Subject to Medical Savings Account

SUPPLEMENTARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS, PODIATRY AND SPEECH THERAPY

Subject to Medical Savings Account

ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES

Subject to Medical Savings Account

OVER THE COUNTER MEDICATION

Subject to Medical Savings Account

LASER K/EXCIMER LASER NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS

Subject to Medical Savings Account

SPECTACLES AND LENSES FROM OPTOMETRIST ONLY; ANNUAL BENEFIT, UNLESS OTHERWISE STATED; WHERE PPN IS INDICATED AS THE DSP, THE PPN RATES AND TARIFFS WILL APPLY. FOR ALL OTHER OPTIONS, OPTICAL ASSISTANT RATES WILL APPLY

Subject to Medical Savings Account

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

Subject to Medical Savings Account

PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER

Subject to Medical Savings Account

POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS

Subject to Medical Savings Account

MEDICATION AND TREATMENT FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LIST

Depression 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, 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, INSULIN PUMPS (rent to own over 12 months), SUBJECT TO PRE-AUTHORISATION AND DSP - 4 YEAR CYCLE

Subject to Medical Savings Account

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.

R5 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 R250,000 unless additional cover is arranged.
The cover is available to members who are not older than 80 years of age.

NETCARE 911 EMERGENCY SERVICES

Unlimited
Subject to Netcare 911 authorisation

MATERNITY BENEFITS
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION

See In Hospital and Prescribed Minimum Benefits above

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

Subject to Medical Savings Account

METABOLIC SCREENING FOR NEW BORN BABIES

100% Negotiated Rate per new born baby

ANTE-NATAL FOETAL SCANS PER PREGNANCY

Subject to Annual Overall Day-to-Day Limit

ANTE-NATAL CLASSES

Subject to Medical Savings Account

UMBLICAL 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.

PREVENTATIVE WELLNESS COVER
CAMAF PREVENTATIVE PROGRAMME PER ADULT BENEFICIARY

INCLUDES: Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy and free Online Wellness Club

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 R13 760 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 961 per beneficiary

CERVICAL CANCER VACCINE (HPV) (COST OF VACCINE ONLY - SUBJECT TO IMMUNISATION AND VACCINES BENEFIT)

Females between 9 and 45 years of age (SEP plus dispensing fee)

ONE HIV VCT TEST

100% CBT per beneficiary

ONE MELANOMA SCREENING

100% CBT per adult beneficiary

IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITS
HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION

100% of Negotiated Rate in general ward and specialised units.
The DSP hospital groups are Life Healthcare and Netcare.
20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies.

ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS, MEDICAL AND SURGICAL PROCEDURES INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION

200% CBT

SUPPLEMENTARY HEALTHCARE IN HOSPITAL (EG. PHYSIOTHERAPY AND PSYCHOTHERAPY)

100% CBT

BLOOD TRANSFUSIONS (IN AND OUT OF HOSPITAL)

100% of cost

RADIOLOGY IN HOSPITAL SUBJECT TO PRE-AUTHORISATION

100% CBT

PATHOLOGY IN HOSPITAL

100% Negotiated Rate

INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION

100% of cost
Exclusions: cochlear implants

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

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 – 100% DSP Tariff
The ICON Essential benefits apply

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ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION

100% CBT

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