Overall Annual Limit: | Unlimited |
Hospitalisation: | Per Event Limit of 2 700 000 |
Hospital Alternatives: | 50 263 |
Paramedic Services: | Subject to OAL |
Blood Transfusion: | 84 730 |
Maternity: | Subject to OAL |
Maxilla Facial Surgery (Non-elective): | Subject to OAL |
Mental Health (In Hospital): | 52 371 |
General Practitioner Consultation - | 12 |
Specialist Consultation Unlimited No. of visits *Only by referral from a General Practitioner | Unlimited
|
Prescribed Medication *All Acute Medication including prescribed supplements | 4 800 |
Supplements | 1 500 |
Over the Counter (OTC) | 1 725 |
Supplements per script per beneficiary | 170
|
OTC Sublimit per script per day per beneficiary | 170 |
Major Disease Benefit Limit | 983 526 |
Oncology (includes chemo and pathology) | 327 842 |
Organ Transplant | 327 842 |
Renal Dialysis | 327 842 |
Specialized Radiology | 58 190 |
Prosthesis Benefit, with sub limits | |
Prosthesis Limit | 113 731 |
Internal Devices | 81 144 |
External/Appliances | 32 586 |
Detox Program (Non-elective) | Subject to OAL |
Chronic | 19 785 |
Immune Deficiency | 18 095 |
Dentistry - P/B | 3 213 |
Advanced Dentistry | 7 200 |
Optometry (Bi-annual Benefit) | 3 966 |
Frame (Subject to prescribed Lens) *prescribed lens is up to 100% of optometry benefit | 2 479
|
Prescribed Lens | 3 966 |
Pathology, Physical Therapy & Radiology (combined) | 16 293 |
Mental Health (Out-of-hospital, Pb/Pa) | 3 491 |