| MONTHLY CONTRIBUTION RATES |
| RATES | Total Monthly Contribution
Income Category R0 – R48 060
Adult R2 304
Child R1 181
Income Category R48 061 – R120 150
Adult R2 612
Child R1 333
Income Category R120 151+
Adult R2 897
Child R1 484
Monthly income based on Total Cost to Company of Principal Member
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| 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 | 100% CBT
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| PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER | 100% Negotiated Rate or CBT
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| POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS | 300% CBT for attending practitioners
100% CBT for supplementary services
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| MEDICATION AND TREATMENT FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LIST | 100% SEP plus a dispensing fee, subject to RP and DSP
Consultations 100% CBT
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| 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, subject to the overall limit of R43 340 per beneficiary and subject to the following sub-limits:
Hearing Aids: R37 660
Wheelchairs for Quadriplegics: R37 660
Standard Wheelchairs: R26 460
Insulin Pumps: R43 340
Other external appliances: R 9 440
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| 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.
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| NETCARE 911 EMERGENCY SERVICES | Unlimited
Subject to Netcare 911 authorisation
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| MATERNITY BENEFITS |
| HOSPITAL ACCOMMODATION INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION | See In Hospital and Prescribed Minimum Benefits above
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| 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 890
Breast pumps: R4 820
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| METABOLIC SCREENING FOR NEW BORN BABIES | 100% Negotiated Rate per new born baby
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| 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.
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| 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
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| ONE GP CONSULTATION ONLY *ICD 10 CODE SPECIFIC TO GENERAL (CHECK UP ONLY) | 100% CBT per beneficiary
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| 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
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| PSYCHOTHERAPY | 100% CBT limited to R13 760 per beneficiary
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| ONE DIETICIAN CONSULTATION | 100% CBT per beneficiary
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| ONE DENTISTRY CONSULTATION GENERAL CHECK UP ONLY - excludes consumables | 100% CBT per beneficiary
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| ONE ECG (PERFORMED BY GP OR SPECIALIST PHYSICIAN) *ICD 10 CODE SPECIFIC TO GENERAL (CHECK UP ONLY) | 100% CBT per adult beneficiary
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| ONE OPTOMETRIST CONSULTATION | 100% Optical Assistant Rates
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| IMMUNISATION AND VACCINES (COST OF IMMUNISATION AND VACCINE ONLY) | SEP plus a dispensing fee, limited to R1 961 per beneficiary
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| 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)
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| ONE HIV VCT TEST | 100% CBT per beneficiary
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| ONE MELANOMA SCREENING | 100% CBT per adult beneficiary
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| 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.
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| ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS, MEDICAL AND SURGICAL PROCEDURES INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION | 300% CBT
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| SUPPLEMENTARY HEALTHCARE IN HOSPITAL (EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) | 100% CBT
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| BLOOD TRANSFUSIONS (IN AND OUT OF HOSPITAL) | 100% of cost
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| RADIOLOGY IN HOSPITAL SUBJECT TO PRE-AUTHORISATION | 100% CBT
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| PATHOLOGY IN HOSPITAL | 100% Negotiated Rate
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| INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION | 100% of cost
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| HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE AUTHORISATION | 100% CBT
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| STEP-DOWN/PHYSICAL REHABILITATION APPROVED FACILITIES ONLY, UP TO 90 DAYS (SUBJECT TO PRE-AUTHORISATION) | 100% Negotiated Rate
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| MEDICATION IN HOSPITAL | 100% SEP plus dispensing fee
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| TTO MEDICATION UP TO ONE WEEK’S SUPPLY | 100% SEP plus dispensing fee
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| 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
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| 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
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| 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
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| 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 Core benefits apply
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| More |
| ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION | 100% CBT
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