Overall Annual Limit: | 800 000 |
Hospitalisation: | Subject to OAL |
Hospital Alternatives: | 18 278 |
Paramedic Services: | Subject to OAL |
Blood Transfusion: | 23 501
|
Maternity: | 30 000
|
Maxilla Facial Surgery | Subject to OAL |
Mental Health (In-Hospital): | 21 160 |
General Practitioner Consultation - | 6
|
Specialist Consultation Unlimited No. of visits *Only by referral from a General Practitioner | Unlimited
|
Prescribed Medication *All Acute Medication including prescribed supplements | 2 800
|
Supplements | 700 |
Over the Counter (OTC) | 750 |
Supplements per script per beneficiary | 170
|
OTC Sublimit per script per day per beneficiary | 170 |
Major Disease Benefit Limit | 380 880 |
Oncology (includes chemo and pathology) | 126 960 |
Organ Transplant | 126 960 |
Renal Dialysis | 126 960 |
Specialized Radiology | 12 696 |
Prosthesis Benefit, with sub limits | |
Prosthesis Limit | 39 675 |
Internal Devices | 31 740 |
External/Appliances | 7 935 |
Detox Program (Non-elective) | Subject to OAL |
Chronic | 3 174 |
Immune Deficiency | 7 833 |
Dentistry - P/B | 1 537 |
Advanced Dentistry | N/A |
Optometry (Bi-annual Benefit) | 2 028 |
Frame (Subject to prescribed Lens) *prescribed lens is up to 100% of optometry benefit | 1 127
|
Prescribed Lens | 2 028 |
Pathology, Physical Therapy & Radiology (combined) | 3 703 |
Mental Health (Out-of-hospital, Pb/Pa) | 1 587
|