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MONTHLY CONTRIBUTION RATES
RATES

Total Monthly Contribution
Income Category R0 – R19 760
Principal R1 737
Adult R1 453
1st Child R755 (rest are free)
Income Category R19 761 – R26 490
Principal R2 065
Adult R1 648
1st Child R928 (rest are free)
Income Category R26 491 – R39 740
Principal R2 472
Adult R1 914
Child R1 232
Income Category R39 741+
Principal R3 307
Adult R2 669
Child R1 624
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

Annual overall limit: Beneficiary specific limits:
(a) Medicines R3 430
(b) Advanced Dentistry R7 180
(c) Other R3 430
(d) Specialists R10 550

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

100% negotiated rate
subject to sublimit (c) – Nominated Network GP only

SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS

100% CBT
Subject to limit (d) (on referral from a nominated network GP only)

ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS

100% SEP plus a dispensing fee, subject to MMAP.
Subject to limit (a) (on referral from a nominated network GP only)

NON-DSP VISITS TO DOCTOR’S ROOMS

One non-network or non-nominated visit per beneficiary or two per family, 20% co-payment

CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL

One casualty visit per family (facility fee, consumed meds and materials).
Limited to R1 477

NURSE VISITS

100% CBT subject to limit (c)

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

100% CBT limited to R2 880 per beneficiary on referral from a nominated network GP or from a Specialist.
Subject to limit (c)

ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES

100% of CBT
Subject to limit (b) dental implants excluded

OVER THE COUNTER MEDICATION

50% SEP plus a dispensing fee, subject to MMAP, limited to R1 760 per beneficiary.
Subject to limit (a)

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

The 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 R782 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 R875.
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 R600 AND
EITHER SPECTACLES – A frame benefit of R782 towards the cost of a frame and/or lens enhancements and one pair of lenses:
either one pair of clear single vision spectacle lenses limited to R210 per lens
or one pair of clear flat top bifocal spectacle lenses limited to R445 per lens or one pair of clear flat top Multifocal lenses limited to R770 per lens
OR CONTACT LENSES – Contact Lenses to the value of R875.

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

Basic Radiology: Referrals by DSP or specialist, 100% CBT limited to R4 630 per beneficiary
Advanced scans: 100% CBT limited to R39 590 per family (on referral by a nominated network GP or specialist)

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

Referred by DSP or specialist, 100% Negotiated Rate, limited to R7 390 per beneficiary

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

100% NAPPI price or 100% of cost, limited to R7 070 per beneficiary and subject to a nominated network GP or Specialist referral

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

Baby Apnoea Monitors: R2 360
Breast pumps: R4 060

METABOLIC SCREENING FOR NEW BORN BABIES

100% Negotiated Rate per new born baby

ANTE-NATAL FOETAL SCANS PER PREGNANCY

3 scans at 80% CBT.
Subject to the Advanced Scans limit

ANTE-NATAL CLASSES

80% CBT subjects to sub-limit R1 090 per pregnancy.
Subject to limit (c) of Annual Overall Day-to-Day Benefit Limit

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 (Nominated Network GP)

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 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

Refer 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 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

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

100% DSP tariff as per protocols.
The DSP hospital group is Netcare.

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

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 SUBJECT TO PRE-AUTHORISATION

100% CBT

PATHOLOGY IN HOSPITAL

100% Negotiated Rate

INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION

100% of cost limited to R39 590 per family
Exclusions: cochlear implants

HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE AUTHORISATION

100% CBT (in lieu of hospitalisation only)

STEP-DOWN/PHYSICAL REHABILITATION APPROVED FACILITIES ONLY, UP TO 90 DAYS (SUBJECT TO PRE-AUTHORISATION)

100% DSP Tariff

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 limited to R39 590 per family

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