Overall Annual Limit: | 1 500 000 |
Hospitalisation: | Subject to OAL |
Hospital Alternatives: | 31 334 |
Paramedic Services: | Subject to OAL |
Blood Transfusion: | 61 363 |
Maternity: | Subject to OAL |
Maxilla Facial Surgery | Subject to OAL |
Mental Health (In-Hospital): | 39 675 |
General Practitioner Consultation - | 10
|
Specialist Consultation Unlimited No. of visits *Only by referral from a General Practitioner | Unlimited
|
Prescribed Medication *All Acute Medication including prescribed supplements | 3 600 |
Supplements | 900 |
Over the Counter (OTC) | 1 250 |
Supplements per script per beneficiary | 170
|
OTC Sublimit per script per day per beneficiary | 170 |
Major Disease Benefit Limit | 634 800 |
Oncology (includes chemo and pathology) | 211 600 |
Organ Transplant | 211 600 |
Renal Dialysis | 211 600 |
Specialized Radiology | 31 740 |
Prosthesis Benefit, with sub limits | |
Prosthesis Limit | 71 944 |
Internal Devices | 57 132 |
External/Appliances | 14 812 |
Detox Program (Non-elective) | Subject to OAL |
Chronic | 8 464 |
Immune Deficiency | 11 750 |
Dentistry - P/B | 2 651 |
Advanced Dentistry | N/A
|
Optometry (Bi-annual Benefit) | 3 268 |
Frame (Subject to prescribed Lens) *prescribed lens is up to 100% of optometry benefit | 1 803 |
Prescribed Lens | 3 268 |
Pathology, Physical Therapy & Radiology (combined) | 7 406 |
Mental Health (Out-of-hospital, Pb/Pa) | 2 645 |