Emergency Room Cover
A sub-limit of R4 000 is applicable. This benefit covers an emergency at any registered emergency facility when you require immediate medical treatment due to an accident or illness. The following benefits collectively accumulate to the sub-limit: Accident benefit: all costs related to the accidental event will be covered and paid to a maximum value of the sub-limit available, whether you are liable to pay the costs related to the emergency event out of your own pocket or if your medical scheme pays from your savings account. Illness benefit: when you visit an emergency room in a medical emergency as a result of illness, we will cover the Gap portion only if the medical scheme has paid a portion. We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.
Preventative Care Cover
A sub-limit of R1 800 applies. Claims will be paid up to R600 per claim, limited to 2 claims per beneficiary. The following tests or treatments are covered: Pap smear, cholesterol test, blood glucose test, flu vaccination,
childhood immunisation (Department of Health formulary) – up to the age of 12 years, bone-density scans, prostate-specific antigen tests, mammogram, and contraceptive implantation only.
