dimension elite 2018 - sun.ac.za · RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana Road transport – Unlimited ... • Flu, tetanus and HPV vaccine • Pneumovax vaccine

Summary of benefits

• The monthly contribution does not take any employer subsidy into account.

• Older children pay child dependant rates until they are 26 years old.

Monthly contributions

Per beneficiary

• 1 combo test (blood glucose,

cholesterol, BMI and blood pressure

measurement) or individual blood

glucose or cholesterol test

• HIV testing and counselling – Unlimited

• Routine tests, including

mammograms, pap smears,

prostate tests, FOBT and bone

mineral density tests

dimension elite 2018

Principal member

R4 272

Dependant

R3 996

Childdependant <26 years

R1 164

September 2017

Dimension Elite is a top-of-the-range all-inclusive healthcare solution if you have more extensive healthcare needs. It offers rich, insured benefits for hospitalisation, chronic medicine and other day-to-day medical expenses.

Additional insured benefits

1 per beneficiary per year

• Standard kids immunisation

(< 7 years)

• Flu, tetanus and HPV vaccine

• Pneumovax vaccine for beneficiaries

registered with asthma or COPD

1 programme per beneficiary per year at

a Document-Based Care facility (subject

to protocols and pre-authorisation)

TRAUMA COVER

• Unlimited cover for trauma that

necessitates hospitalisation in the case

of motor vehicle accidents, stab wounds

and similar trauma

• Post-exposure prophylaxis in the event

of sexual assault or accidental exposure

to HIV

In beneficiary’s country of residence

RSA, Lesotho, Swaziland, Mozambique,

Namibia and Botswana

Road transport – Unlimited

Air transport – Unlimited

Outside beneficiary’s country of

residence

Road transport – R1 900 per case

Air transport – R12 400 per case

100% of the MT – any private hospital

(subject to pre-authorisation and

protocols)

ONCOLOGY

PMB – 100% of the MT

Non-PMB – R200 000 per family per year

CONFINEMENT (CHILDBIRTH)

In hospital – 100% of the MT

Home delivery – R11 900 per event

NEUROSTIMULATORS

R101 200 per beneficiary per year

HEALTH TESTS* IMMUNISATION*

1 consultation if BMI test result at

wellness provider indicates a BMI > 30

and if registered on HealthPrint

DIETICIAN CONSULTATION

• 12 pregnancy consultations & two

2D sonars

• 2 baby consultations (< 1 year)

PREGNANCY AND BABY BENEFITS

BACK TREATMENT PROGRAMME

100% of the cost for 270 PMB

and 26 chronic conditions

(DSPs, formularies, networks, protocols

and pre-authorisation apply)

ESSENTIAL COVEREMERGENCY TRANSPORT (NETCARE 911) HOSPITALISATION

Core benefits

Core benefits

Day-to-day benefits

Deductibles

POST-HOSPITAL CAREUp to 30 days after discharge for speech therapy, occupational therapy and physiotherapyMember = R1 700 per yearMember+ = R2 300 per year

ORGAN TRANSPLANTS100% of the costCornea implants – R26 100 per implant per year

PROSTATECTOMY100% of the MT• Conventional or laparoscopic Unlimited• Robotic assisted laparoscopy Hospitalisation: R100 400

INSURED DAY-TO-DAY POOLED BENEFITSMember = R2 550 per yearMember +1 = R4 300 per yearMember +2 = R5 300 per yearMember +3+ = R6 400 per year• GPs & specialists• Clinical psychology & physiotherapy• Supplementary health services

ACUTE MEDICINEMember = R3 900 per yearMember +1 = R6 550 per yearMember +2 = R8 000 per yearMember +3+ = R8 600 per year

CHRONIC MEDICINE (NON-PMB)Member = R4 100 per yearMember +1 = R6 200 per yearMember +2 = R8 300 per yearMember +3+ = R8 900 per year

PMB CHRONIC MEDICINE100% of the MHRP

PROCEDURE-SPECIFIC DEDUCTIBLESBack and neck fusion – member pays the first R7 050 per admissionEndoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopyIn a day clinic – member pays the first R1 950In hospital – member pays the first R2 950Dental procedures under general anaesthesia during hospitalisation – Removal of impacted teeth and extensive dental treatment for children < 5 years – member pays the first R790 per admission

PRE-AUTHORISATION IS IMPORTANT Always pre-authorise services such as hospitalisation, emergency transport and oxygen to prevent a deductible

MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCESIn and out of hospitalBenefits per beneficiary per 3-year cycle:• Artificial eyes – R7 150• Speech and hearing aids – R7 150• Artificial limbs – R5 750• Wheelchairs – R5 750• Medical appliances and hyperbaric

oxygen treatment – R1 400 per beneficiary per year

• CPAP apparatus – R8 850 per beneficiary per 24-month cycle

OPTOMETRYPPN network appliesSpectacles or contact lenses per

beneficiary per 24-month cycleR750 for a frameR1 620 for contact lenses

DENTISTRYSubject to DSP’s managed care protocolsConservative & specialised services

SPECIALISED RADIOLOGYIn and out of hospitalSubject to pre-authorisationMRI and CT imaging100% of the MT – UnlimitedMember pays the first R1 050 per examination

STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICESIn hospital – 100% of the MTOut of hospitalRadiology – R2 550 per family per yearPathology – R2 550 per family per year

INTERNALLY IMPLANTED PROSTHESES100% of the MT per beneficiary per year• EVARS prosthesis – R118 100• Vascular/cardiac prosthesis – R50 600• Health-essential functional prosthesis – R56 000 • Hip, knee and shoulder replacements (non-PMB): • In case of acute injury where replacement is the only clinically appropriate treatment modality: Hospitalisation: 100% of the MT Prosthesis: Health-essential functional prosthesis benefit applies • In case of wear and tear: subject to DSP if patient qualifies in terms of clinical criteria (hip and knee only). If not, a R17 800 benefit applies for the hospital account and prosthesis components (combined) • Intra-ocular lenses – R3 800 per lens, 2 lenses per beneficiary year, health-essential functional prosthesis benefit applies• Prosthesis with reconstructive or restorative surgery

and external breast prostheses (in and out of hospital) – R8 750 per family per year

• Implantable hearing devices (including devices and components) – R95 100 per beneficiary per year

086 0100 678www.medihelp.co.za

Medihelp is an authorised financial services provider (FSP No 15738)

Important:This brochure provides only a summary of the available benefits. Please consult the registered Rules of Medihelp for more information and details of services that are excluded from benefits. In case of a dispute, the Rules of Medihelp will apply (subject to approval by the Council for Medical Schemes).

* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care and may be linked to a specific age/gender/item code. Services are available at Clicks and Dis-Chem pharmacy clinics and benefits are paid at 100% of the MT.

BMI – Body mass indexCOPD – Chronic obstructive pulmonary diseaseCPAP – Continuous positive airway pressureCT – Computerised tomographyDSP – Designated service providerEVARS – Endovascular aortic replacement surgeryFOBT – Faecal occult blood test

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PSYCHIATRIC TREATMENT OF A MENTAL HEALTH CONDITIONR32 000 per beneficiary per year (maximum R44 400 per family per year)

OTHER COVERED BENEFITSRenal dialysis, oxygen, and hospice, sub-acute care and private nursing services as an alternative to hospitalisationPre-authorisation and protocols apply

APPENDECTOMY100% of the MT• Conventional – Unlimited• Laparoscopic – Hospitalisation: R15 800

Prostheses benefits

GP – General practitionerMHRP – Medihelp Reference PriceMRI – Magnetic resonance imagingMT – Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit pricePMB – Prescribed minimum benefitsPPN – Preferred Provider Negotiators

• The monthly contribution does not take any employer subsidy into account. • You only pay for two children younger than 18 years after which child dependant rates will apply

from the beginning of the year following the year in which they turn 18, until they are 26 years old.• Older children pay child dependant rates until they are 26 years old.


Per beneficiary

• 1 combo test (blood glucose, cholesterol, BMI and blood pressure measurement) or individual blood glucose or cholesterol test

• HIV counselling and testing Unlimited• Routine tests, including

mammograms, pap smears, prostate tests, FOBT and bone mineral density tests

dimension prime 3 2018Network and Non-network

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The popular Dimension Prime 3 option delivers insured family cover encompassing comprehensive benefits for hospitalisation, preventive care and day-to-day medical expenses, and the freedom to obtain services at any provider. You can choose a network of quality providers and save 20% in premiums per month.


• Standard kids immunisation (< 7 years)

• Flu, tetanus and HPV vaccine• Pneumovax vaccine for beneficiaries


1 programme per beneficiary per year at a Document-Based Care facility (subject to protocols and pre-authorisation)

TRAUMA COVER• Unlimited cover for trauma that necessitates hospitalisation in the case

of motor vehicle accidents, stab wounds and similar trauma

• Post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV

In beneficiary’s country of residenceRSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana

Road transport – UnlimitedAir transport – Unlimited

Outside beneficiary’s country of residence

Road transport – R1 900 per caseAir transport – R12 400 per case

100% of the MT (subject to pre-authorisation and protocols)Dimension Prime 3 – any hospitalDimension Prime 3 Network – 108 network hospitals

ONCOLOGYPMB – 100% of the MTNon-PMB – R150 000 per family per year

CONFINEMENT (CHILDBIRTH)In hospital – 100% of the MTHome delivery – R11 900 per event

NEUROSTIMULATORSR101 200 per beneficiary per year

1 consultation if BMI test result at wellness provider indicates a BMI > 30 and if registered on HealthPrint

• 12 pregnancy consultations & two 2D sonars• 2 baby consultations (< 1 year)

100% of the cost for 270 PMB and 26 chronic diseases (DSPs, formularies, networks, protocols and pre-authorisation apply)

Core benefits

Network Non-Network

Principal member

R2 352 R2 940

Dependant

R1 986 R2 490


R684 R858

Summary of benefitsAdditional insured benefits

HEALTH TESTS* IMMUNISATION* PREGNANCY AND BABY BENEFITS




Core benefits

Day-to-day benefits

Deductibles

POST-HOSPITAL CAREUp to 30 days after discharge for speech therapy, occupational therapy and physiotherapy

Member = R1 700 per yearMember+ = R2 300 per year


INSURED DAY-TO-DAY BENEFITSM = R8 600 per yearM +1 = R13 700 per yearM +2 = R16 000 per yearM +3+ = R17 000 per yearGPs, specialists and emergency units, physiotherapy, clinical psychology and psychiatric nursing, contraceptives, acute and self-medication, radiology,pathology and supplementary health services

PMB CHRONIC MEDICINE100% of the MHRPDimension Prime 3 Network: DSP & formulary apply

OPTOMETRYPPN network appliesSpectacles or contact lensesper beneficiary per 24-month cycleR600 for a frameR1 155 for contact lenses

PROCEDURE-SPECIFIC DEDUCTIBLESBack and neck fusion – member pays the first R8 250Endoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopyIn a day clinic – member pays the first R1 950In hospital – member pays the first R2 950Dental procedures under general anaesthesia during hospitalisation – Removal of impacted teeth (dentist’s account covered for item codes 8941/8943/8945) and extensive dental treatment for children < 5 years (dentist’s account for member’s account) – member pays the first R840 per admission




INTERNALLY IMPLANTED PROSTHESES100% of the MT per beneficiary per year• EVARS prosthesis – R118 100• Vascular/cardiac prosthesis – R50 600• Health-essential functional prosthesis – R56 000 • Hip, knee and shoulder replacements (non-PMB): • In case of acute injury where replacement is the only clinically appropriate treatment modality Hospitalisation: 100% of the MT Prosthesis: Health-essential functional prosthesis benefit applies • In case of wear and tear – no benefits • Intra-ocular lenses – R3 800 per lens, 2 lenses per beneficiary per year, health-essential functional prosthesis benefit applies• Prosthesis with reconstructive or restorative

surgery and external breast prostheses (in and out of hospital) – R8 750 per family per year

• Implantable hearing devices (including devices and components) – R95 100 per beneficiary per year

BMI – Body mass indexCOPD – Chronic obstructive pulmonary diseaseCPAP – Continuous positive airway pressureCT – Computerised tomographyDSP – Designated service providerEVARS – Endovascular aortic replacement surgeryFOBT – Faecal occult blood testGP – General practitioner

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Prostheses benefits

HPV – Human papilloma virusMHRP – Medihelp Reference PriceMRI – Magnetic resonance imagingMT – Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit pricePMB – Prescribed minimum benefitsPPN – Preferred Provider Negotiators

086 0100 678www.medihelp.co.zaMedihelp is an authorised financial services provider (FSP No 15738)


* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care. Benefits may be linked to a specific age/gender/item code. Services are available at Clicks and Dis-Chem pharmacy clinics and benefits are paid at 100% of the MT.

MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCESIn and out of hospitalBenefits per family per 3-year cycle:• Artificial eyes – R4 300• Speech and hearing aids – R4 300• Artificial limbs – R4 300• Wheelchairs – R4 300• Medical appliances and hyperbaric oxygen treatment – R1 150 per family per year• CPAP apparatus – R8 850 per beneficiary per 24-month cycle

DENTAL SERVICESSubject to DSP’s managed care protocolsConservative and specialised services

• The monthly contribution does not take any employer subsidy into account.• You only pay for two children younger than 18 years after which child dependant rates will apply from

the beginning of the year in which they turn 18, until they are 26 years old. • Older children pay child dependant rates until they are 26 years old.


Per beneficiary


• HIV counselling and testing – Unlimited• Routine tests, including


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Dimension Prime 2 is ideal for young, healthy couples and provides the value of private hospital cover combined with a 15% savings account and added preventive care and insured benefits, should you plan on starting a family. By choosing the wide network of 108 private hospitals you save 22% in monthly premiums.


• Standard kids immunisation (< 7 years)• Flu, tetanus and HPV vaccine• Pneumovax vaccine for beneficiaries



TRAUMA COVER• Unlimited cover for trauma that

necessitates hospitalisation in the case of motor vehicle accidents, stab wounds

and similar trauma• Post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV















100% of the cost for 270 PMB and 26 chronic conditions (DSPs, formularies, networks, protocols and pre-authorisation apply)


Core benefits

Network Non-Network

Principal member

R1 800 (R270 savings contribution included per month and R3 240 per year)


Dependant




R534 (R78 savings contribution included per month and R936 per year)

R690 (R102 savings contribution included per month and R1 224 per year)




PROSTATECTOMY100% of the MT• Conventional or laparoscopic – Unlimited• Robotic assisted laparoscopy – Hospitalisation: R100 400

DAY-TO-DAY BENEFITS15% savings account

INSURED DAY-TO-DAY BENEFITS• PMB chronic medicine 100% of the MHRP Dimension Prime 2 Network: DPS and formulary apply

• Dental services Subject to DSP’s managed care protocols • Conservative and specialised dental services – savings account • Dental procedures under conscious sedation in the dentist’s chair (sedation cost) 100% of the MT – removal of impacted teeth only (dentist’s account only for item codes 8941/8943/8945)

PROCEDURE-SPECIFIC DEDUCTIBLESBack and neck fusion – member pays the first R9 500 per admissionEndoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopyIn a day clinic – member pays the first R2 550In hospital – member pays the first R3 550Dental procedures under general anaesthesia during hospitalisation – Removal of impacted teeth (dentist’s account covered for item codes 8941/8943/8945) and extensive dental treatment for children < 5 years (dentist’s account: available funds in savings account) – member pays the first R2 900 per admission




STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICESIn hospital – 100% of the MTOut of hospital – savings account

INTERNALLY IMPLANTED PROSTHESES100% of the MT per beneficiary per year• EVARS prosthesis – R118 100• Vascular/cardiac prosthesis – R50 600• Health-essential functional prosthesis – R56 000

• Hip, knee and shoulder replacements (non-PMB): • In case of acute injury where replacement is the only clinically appropriate treatment modality Hospitalisation: 100% of the MT Prosthesis: Health-essential functional prosthesis benefit applies • In case of wear and tear – no benefits

• Intra-ocular lenses – R3 800 per lens, 2 lenses per beneficiary per year, health-essential functional prosthesis benefit applies• Prosthesis with reconstructive or restorative surgery (in

and out of hospital) – R8 750 per family per year• External breast prostheses (in and out of hospital)

– savings account


* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care. Benefits may also be linked to a specific age/gender/item code. Services are available at Clicks and Dis-Chem pharmacy clinics and benefits are paid at 100% of the MT.

BMI – Body mass indexCOPD – Chronic obstructive pulmonary diseaseCT – Computerised tomographyDSP – Designated service providerEVARS – Endovascular aortic replacement surgeryFOBT – Faecal occult blood testHPV – Human papilloma virus

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MHRP – Medihelp Reference PriceMRI – Magnetic resonance imagingMT – Medihelp tariff paid by Medihelp for benefits

that can include a contracted tariff or the single exit price

PMB – Prescribed minimum benefits

Core benefits

Day-to-day benefits Prostheses benefits

Deductibles


• The monthly contribution does not take any employer subsidy into account. • You only pay for two children younger than 18 years after which child dependant rates will apply

from the beginning of the year following the year in which they turn 18, until they are 26 years old.• Older children pay child dependant rates until they are 26 years old.


Per beneficiary


• HIV counselling and testing – Unlimited• Routine tests, including



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The Dimension Prime 1 hospital plan is an affordable solution if you are healthy, but want the assurance of cover for private hospitalisation and minor day-to-day medical expenses. You save 22% in monthly premiums when choosing a network of 108 quality private hospitals as an alternative.


• Standard kids immunisation (< 7 years)

• Flu, tetanus and HPV vaccine• Pneumovax vaccine for beneficiaries



TRAUMA COVER• Unlimited cover for trauma that necessitates hospitalisation in the case

of motor vehicle accidents, stab wounds and similar trauma

• Post-exposure prophylaxis in the event of sexual assault or accidental exposure to HIV











100% of the MT for 270 PMB conditions and 26 chronic diseases (DSPs, formularies, networks, protocols and pre-authorisation apply)

Core benefits

Network Non-Network

Principal member

R1 356 R1 728

Dependant

R1 104 R1 422


R408 R522


HEALTH TESTS* IMMUNISATION* PREGNANCY AND BABY BENEFITS




Core benefits

Day-to-day benefits

Deductibles

POST-HOSPITAL CAREUp to 30 days after discharge for speech therapy, occupational therapy and physiotherapy

Member = R1 700 per yearMember+ = R2 300 per year


INSURED DAY-TO-DAY BENEFITSM = R1 100 per yearM+ = R2 200 per yearGPs, specialists, physiotherapy, contraceptives, acute and self-medication

PMB CHRONIC MEDICINE100% of the MHRPDimension Prime 1 Network:DSP and formulary apply

MEDICAL, SURGICAL AND ORTHOPAEDIC APPLIANCESIn and out of hospitalBenefits per family per 3-year cycle:• Artificial eyes – R4 300• Speech and hearing aids – R4 300• Artificial limbs – R4 300• Wheelchairs – R4 300• CPAP apparatus – R8 850 per beneficiary per 24-month cycle

DENTAL SERVICESSubject to DSP’s managed care protocolsDental procedures under conscious sedation in the dentist’schair (sedation cost)100% of the MT – removal of impacted teeth only (dentist’s account only for item codes 8941/8943/8945)

PROCEDURE-SPECIFIC DEDUCTIBLESBack and neck fusion – member pays the first R10 600Endoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopyIn a day clinic – member pays the first R1 950In hospital – member pays the first R2 950Dental procedures under general anaesthesia during hospitalisation – Removal of impacted teeth (dentist’s account covered for item codes 8941/8943/8945) and extensive dental treatment for children < 5 years (dentist’s account for member’s account) – member pays the first R2 900 per admission




INTERNALLY IMPLANTED PROSTHESES100% of the MT per beneficiary per year• EVARS prosthesis – R31 400• Vascular/cardiac prosthesis – R31 400• Health-essential functional prosthesis – R20 900 • Hip, knee and shoulder replacements (non-PMB): • In case of acute injury where replacement is the only clinically appropriate treatment modality Hospitalisation: 100% of the MT Prosthesis: Health-essential functional prosthesis benefit applies • In case of wear and tear – no benefits • Intra-ocular lenses – R3 800 per lens, 2 lenses per beneficiary per year, health-essential functional prosthesis benefit applies• Prosthesis with reconstructive or restorative surgery and external

breast prostheses (in and out of hospital) – R3 900 per family per year

BMI – Body mass indexCOPD – Chronic obstructive pulmonary diseaseCPAP – Continuous positive airway pressureCT – Computerised tomographyDSP – Designated service providerEVARS – Endovascular aortic replacement surgeryFOBT – Faecal occult blood test

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Prostheses benefits

GP – General practitionerMHRP – Medihelp Reference PriceMRI – Magnetic resonance imagingMT – Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit pricePMB – Prescribed minimum benefits



* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care. Benefits may be linked to a specific age/gender/item code. Services are available at Clicks and Dis-Chem pharmacy clinics and benefits are paid at 100% of the MT.

Summary of benefits

• The contributions in the table exclude late-joiner penalties and employer subsidies. Ask your accredited adviser to calculate the monthly contribution based on

your information.• You pay child dependent rates for kids until they are 26 years old


Per beneficiary


• HIV counselling and testing – Unlimited

unify 2018

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Unify is the smart choice when you want to invest in the protection of your health, with generous essential and hospital cover at any hospital and a 25% savings account that earns interest and provides ample cover for other medical expenses.


Per beneficiary

• Flu vaccine – one per year• Tetanus vaccine – one per 2-year

cycle

1 programme per beneficiary per year at a Document-Based Care facility (Subject to protocols and pre-authorisation)








100% of the MT in any private hospital Pre-authorisation and protocols apply





1 consultation per beneficiary if BMI test result at wellness provider indicates a BMI > 30 and if registered on HealthPrint





Core benefits

Contribution per month Annual savings amount

Principal member

R2 088 (R522 savings contribution included per month)

Annual savings amount R6 264

Dependant

R1 716 (R426 savings contribution included per month)



R624 (R150 savings contribution included per month)


Core benefits

Day-to-day benefits

Deductibles


ORGAN TRANSPLANTSPMB – 100% of the cost


DAY-TO-DAY BENEFITS25% savings account

INSURED DAY-TO-DAY BENEFITS• PMB chronic medicine 100% of the MHRP• Dental benefits Subject to pre-authorisation and DSP’s managed care protocols Only for removal of impacted teeth (item codes 8941/8943/8945 on dentist’s account) • In hospital – 100% of the MT Member pays the first R2 900 per admission • In the dentist’s chair – conscious sedation (sedation cost) – 100% of the MT

PROCEDURE-SPECIFIC DEDUCTIBLESBack and neck fusion – member pays the first R9 500 per admissionEndoscopic procedures – Gastroscopy, colonoscopy, arthroscopy and sigmoidoscopyIn a day clinic – member pays the first R2 550In hospital – member pays the first R3 550Doctor’s rooms – 100% of the MT (gastroscopy or colonoscopy)


SPECIALISED RADIOLOGYIn and out of hospitalSubject to pre-authorisationMRI and CT imaging100% of the MT – UnlimitedMember pays the first R1 550 per examinationAngiography – 100% of the MT

STANDARD RADIOLOGY, PATHOLOGY AND MEDICAL TECHNOLOGIST SERVICESIn hospital – 100% of the MTOut of hospital – savings acount

INTERNALLY IMPLANTED PROSTHESES100% of the MT per beneficiary per year• EVARS prosthesis – R118 100 • Vascular/cardiac prosthesis – R50 600 • Health-essential functional prosthesis – R56 000 • Hip, knee and shoulder replacements (non-PMB): • In case of acute injury where replacement is the only clinically appropriate treatment modality Hospitalisation: 100% of the MT Prosthesis: Health-essential functional prosthesis benefit applies • In case of wear and tear – no benefits • Intra-ocular lenses – R3 800 per lens, 2 lenses per beneficiary per year, health-essential functional prosthesis benefit applies• Prosthesis with reconstructive or restorative surgery – R8 780 per family per year• External breast prostheses (in and out of hospital) – savings account



* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care. Services are available at Clicks and Dis-Chem pharmacy clinics and benefits are paid at 100% of the MT.

BMI – Body mass indexCT – Computerised tomographyDSP – Designated service providerEVARS – Endovascular aortic replacement surgeryMHRP – Medihelp Reference PriceMRI – Magnetic resonance imaging

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Prostheses benefits

MT – Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit pricePMB – Prescribed minimum benefits

summary of benefits


One test per beneficiary per year requested by a Necesse network GP:• Blood glucose and cholesterol• HIV• Routine tests, including

mammograms, pap smears, prostate tests and bone mineral density tests

necesse 2018

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An income-based option that provides quality private cover through an extensive network of private hospitals and healthcare providers for your medical expenses incurred in and out of hospital. Necesse is an affordable healthcare solution for students and corporates alike.


One immunisation per beneficiary per year requested by a Necesse network GP:• Flu vaccine• Tetanus vaccine

1 programme per beneficiary per year ata Document-Based Care facility (subjectto protocols and pre-authorisation)




Transport by road or air within the borders of South Africa100% of the MT – Unlimited(Pre-authorisation and protocols apply)

Emergency unit services• Outpatient emergency unit services• Non-network doctors’ visits• Medicine and services rendered by a

non-network medical doctor80% of the MTMember = R1 000 per yearMember+ = R2 050 per year

Only in a network hospital

100% of the MT – Unlimited(Subject to pre-authorisation, case management and protocols)

CONFINEMENT (CHILDBIRTH)

PMB – 100% of the MTNon-PMB – R23 900 per confinement for an elective caesarean sectionHome delivery – R11 900 per event



• Gynaecologist consultations (subject to referral by a Necesse network GP and pre-authorisation)• 2D-sonars





Core benefits

Gross monthly income

Full-timestudents R0 –R400

R401 –R5 000

R5 001 – R7 000

R7 001 – R11 000

R11 001 and more

R474 R1 512 R1 578 R1 782 R2 076

R474 R1 194 R1 260 R1 386 R1 620

R474 R648 R708 R780 R900

The contributions in the table exclude late-joiner penalties and employer subsidies – ask your accredited adviser to calculate the monthly contribution based on your information.

Principal member

Dependant

Child dependant< 21 years

Core benefits

Day-to-day benefits

Deductibles

PHYSIOTHERAPY** AND OCCUPATIONAL THERAPYIn hospitalR8 950 per family per year** Must be referred by the attending medical doctor


GP SERVICES WITHIN THE NECESSE NETWORK9 consultations per beneficiary per year, including:• Necesse network GP consultations• Medical & surgical services as well as anaesthesia• Material and discretionary medicine used during services• Pre- and post-natal care provided by a Necesse network GP• Pre- and post-natal midwife services by a registered nursing practitioner

SPECIALIST CAREIncludes all specialist services (consultations, radiology, pathology at Lancet/PathCare, surgical and non-surgical procedures)Member = R2 950 per yearMember+ = R4 100 per year

To avoid deductibles visit the Necesse network service providers, follow the correct pre-authorisation process and use the Necesse formularies.

MEDICINE• Acute medicine obtained from a dispensing Necesse network GP (formulary applies) 100% of the MT• Formulary medicine obtained from a network pharmacy and prescribed by a Necesse network GP or the DSP for dental services 100% of the MMAP according to the Necesse formularies• Self-medication obtained from a network pharmacy 100% of the MMAP R100 per event R270 per beneficiary per year• PMB chronic medicine obtained from a network pharmacy according to the formulary 100% of the MHRP – Unlimited

SPECIALISED RADIOLOGYIn and out of hospitalServices requested by a specialist on referral by a network GPMRI and CT imaging (subject to pre-authorisation) and angiography100% of the MTR15 000 per family per year

STANDARD RADIOLOGY, PATHOLOGY (LANCET/PATHCARE ONLY) AND MEDICAL TECHNOLOGIST SERVICESIn hospital: R27 700 per family per yearOut of hospital: 100% of the MT (subject to a list of codes, referal by a Necesse network GP and protocols apply).

PHYSIOTHERAPY AND OCCUPATIONAL THERAPYMember = R1 900 per yearMember+ = R2 950 per year

BASIC OPTOMETRYPPN network appliesBenefits per 24-month cycle1 composite examinationSpectacles or contact lenses• Spectacles: • R200 for a frame • 1 pair of standard clear Aquity lenses• Contact lenses – R450

CONSERVATIVE DENTAL SERVICESSubject to the managed care protocols of the DSP and services rendered by a DSP network dentist



* These benefits are not available if you have been registered for a chronic/PMB condition as it is no longer considered as preventive care and may be linked to a specific age/gender/item code.

CT – Computerised tomographyDSP – Designated service providerGP – General practitionerMHRP – Medihelp Reference PriceMMAP – Maximum Medical Aid PriceMRI – Magnetic resonance imaging

SUB-ACUTE CARE AND PRIVATE NURSING SERVICES AS AN ALTERNATIVE TO HOSPITALISATIONR20 200 per family per year


CLINICAL TECHNOLOGIST SERVICESIn hospitalR20 200 per family per year

MT – Medihelp tariff paid by Medihelp for benefits that can include a contracted tariff or the single exit pricePMB – Prescribed minimum benefitsPPN – Preferred Provider Negotiators

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Documents

dimension elite 2018 - sun.ac.za · RSA, Lesotho, Swaziland, Mozambique, Namibia and Botswana Road transport – Unlimited ... • Flu, tetanus and HPV vaccine • Pneumovax vaccine