Comprehensive
(High Cover)
Subject to PPN Provider. Consultation 1 pb. Frame R1,040 covered AND 100% of cost of std lenses (single vision OR bifocal OR multifocal) AND lens enhancement R750 OR Contact lenses R2,010. Non-network Provider Consultation R365, Frame R780, Single vision lenses R215 OR Bifocal lenses
R460 OR Multifocal lenses R982.50 In lieu of glasses
Subject to Savings and ATB. Limit to R3,860
per beneficiary. PPN. Sub-limit per
beneficiary: 1 eye test or R380 at a non-DSP. Lenses covered 100% at networkrates or R215 (single vision), R460 (bifocal), R860 (multifocal) per lens at non-DSP
Subject to available Savings and Threshold.
DEB limit of R6,950 per beneficiary before and after Threshold
Subject to Savings and Threshold. R3,740 pbpa, R11,400 pfpa. Limits apply before and after Threshold. Optical Screening for children age 5 – 8 years – 1 per lifetime is covered from risk
Benefits pb per 24 months and subject to PPN Network. 1 consultation, single vision/bi-focal/multi-focal lenses, limit of
R1,080 (PPN frames) and/or lens enhancements OR R1,780 contact lenses
Subject to available Savings & Threshold (Extender Cover limit of R5,030 pb, sub-limit of R2,740 for frames)
Subject to day-to-day benefit. Sub-limit for Frames R1,437 or Contact lenses R3,389
Comprehensive
(High Cover)
Subject to PPN Provider. Consultation 1 pb. Frame R1,040 covered AND 100% of cost of std lenses (single vision OR bifocal OR multifocal) AND lens enhancement R750 OR Contact lenses R2,010. Non-network Provider Consultation R365, Frame R780, Single vision lenses R215 OR Bifocal lenses
R460 OR Multifocal lenses R982.50 In lieu of glasses
R6,440 per family (every 2 years). Subject to the use of a PPN. Sub-limit per beneficiary:
1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860
(multifocal) per lens at non-DSP. Frames R1,280 at DSP, R960 at non-DSP. Contact
lenses R2,065
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–
Benefits pb per 24 months and subject to PPN Network. 1 consultation, single vision/bi-focal/multi-focal lenses, limit of
R1,080 (PPN frames) and/or lens enhancements OR R1,780 contact lenses
Subject to available Savings & Threshold (Extender Cover limit of R5,030 pb, sub-limit of R2,740 for frames)
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Comprehensive
(Medium to High Cover)
Subject to PPN Provider. Consultation 1 pb. Frame R1,000 covered AND 100% of cost of std lenses (single vision OR bifocal OR multifocal) OR Contact lenses R1,840. Nonnetwork Provider Consultation R365, Frame R750, Single vision lenses R215 OR Bifocal lenses R460 OR Multifocal lenses R982.50
In lieu of glasses
Subject to Savings and ATB: PPN. Sub-limit per beneficiary: 1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860 (multifocal) per lens at non-DSP. Frames R945 at DSP. Contact lenses R2,320
Subject to available Savings and Threshold .
DEB limit of R6,300 per beneficiary before and after Threshold
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Benefits pb per 24 months and subject to PPN Network. 1 consultation, signle vision/bi-focal/multi-focal lenses, limit of
R865 (PPN frames) and/or lens
enhancements OR R1,270 contact lenses
Subject to Savings, if available
Subject to day-to-day benefit. Sub-limit for Frames R1,027 or Contact lenses R2,054
Comprehensive
(Medium to High Cover)
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R7,385 per family (every 2 years). Subject to the use of a PPN. Sub-limit per beneficiary:
1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860
(multifocal) per lens at non-DSP. Frames R1,340 at DSP, R1,005 at non-DSP. Contact lenses R2,060
Subject to available Savings and Threshold .
DEB limit of R6,300 per beneficiary before and after Threshold
Subject to Savings or self-funded and Threshold. R3,740 pbpa, R11,400 pfpa. Limits apply before and after Threshold. Optical Screening for children age 5 – 8 years – 1 per lifetime is covered from risk
Benefits pb per 24 months and subject to PPN Network. 1 consultation, signle vision/bi-focal/multi-focal lenses, limit of
R865 (PPN frames) and/or lens
enhancements OR R1,270 contact lenses
Subject to Savings, if available
Subject to day-to-day benefit. Sub-limit for Frames R1,027 or Contact lenses R2,054
Comprehensive
(Medium to High Cover)
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R7,385 per family (every 2 years). Subject to the use of a PPN. Sub-limit per beneficiary:
1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860
(multifocal) per lens at non-DSP. Frames R1,340 at DSP, R1,005 at non-DSP. Contact lenses R2,060
Subject to available Savings and Threshold .
DEB limit of R6,300 per beneficiary before and after Threshold
Subject to Savings or self-funded and Threshold. R3,740 pbpa, R11,400 pfpa. Limits apply before and after Threshold. Optical Screening for children age 5 – 8 years – 1 per lifetime is covered from risk
Benefits pb per 24 months and subject to PPN Network. 1 consultation, signle vision/bi-focal/multi-focal lenses, limit of
R865 (PPN frames) and/or lens
enhancements OR R1,270 contact lenses
Subject to Savings, if available
Subject to day-to-day benefit. Sub-limit for Frames R1,027 or Contact lenses R2,054
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
Subject to Savings: PPN. Sub-limit per beneficiary: 1 eye test or R380 at a non-DSP. Lenses covered 100% at network
rates or R215 (single vision), R460 (bifocal), R860 (multifocal) per lens at non-DSP
Subject to available Savings
Benefits directly from risk up to the value of R1,930 pb every 2yrs: 1 consultation, 1 pair
of single vision or bifocal lenses. Thereafter subject to Savings or self-funded
Subject to Savings
Subject to Savings, if available
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Hospital & Savings
(Low to Medium Cover)
Subject to Savings
R5,695 per family (every 2 years). Subject to the use of a PPN. Sub-limit per beneficiary:
1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860
(multifocal) per lens at non-DSP. Frames R605 at DSP, R454 at non-DSP. Contact
lenses R1,430
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Benefits pb per 24 months and subject to use of PPN Network: 1 eye test, 1 pair clear single vision/ bifocal/ multifocal lenses, R595 (PPN frame) and/or lens enhancements, OR
R800 contact lenses
Subject to Savings, if available
1 Eye test every 2 years, subject day-to-day, thereafter subject to PPS Wallet, if available
Hospital & Savings
(Low to Medium Cover)
Subject to Savings
R5,695 per family (every 2 years). Subject to the use of a PPN. Sub-limit per beneficiary:
1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860
(multifocal) per lens at non-DSP. Frames R605 at DSP, R454 at non-DSP. Contact
lenses R1,430
Subject to available Savings
Subject to Savings/ Wallet or self-funded
Benefits pb per 24 months and subject to use of PPN Network: 1 eye test, 1 pair clear single vision/ bifocal/ multifocal lenses, R300 (PPN frame) and/or lens enhancements, OR
R690 contact lenses
Subject to Savings, if available
1 Eye test every 2 years, subject day-to-day, thereafter subject to PPS Wallet, if available
Hospital & Savings
(Low to Medium Cover)
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Subject to Savings: PPN. Sub-limit per beneficiary: 1 eye test or R380 at a non-DSP. Lenses covered 100% at network rates or R215 (single vision), R460 (bifocal), R860 (multifocal) per lens at non-DSP
Subject to available Savings
Subject to Saving or self-funded
Benefits pb per 24 months and subject to use of PPN Network: 1 eye test, 1 pair clear single vision/ bifocal/ multifocal lenses, R300 (PPN frame) and/or lens enhancements, OR
R690 contact lenses
Subject to Savings, if available
1 Eye test every 2 years, subject day-to-day, thereafter subject to PPS Wallet, if available
Capitation
(Low Cover)
–
Subject to the use of a PPN. Managed Care protocols apply. 1 eye test pbpa. Limited to R380 at non-network provider. R110 copayment applies
One eye test pbpa, at a Smart Network. R65 co-payment is applicable
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–
Subject to Health Saver, if available
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Capitation
(Low Cover)
–
Subject to the use of a PPN. Managed Care protocols apply. 1 eye test pbpa. Limited to R380 at non-network provider. R110 copayment applies
One eye test pbpa, at a Smart Network. R120 co-payment is applicable
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1 Consultation per person per 24-month cycle. R110 co-payment per visit
Subject to Health Saver, if available
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Hospital Plan
(Hospitalization Cover)
–
No Benefit
No Benefit
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–
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Hospital Plan
(Hospitalization Cover)
No Benefit
No Benefit
No Benefit
Subject to Saving or self-funded
No Benefit
Subject to Health Saver, if available
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Hospital Plan
(Hospitalization Cover)
No Benefit
No Benefit
No Benefit
Subject to Savings/ Wallet or self-funded
No Benefit
Subject to Health Saver, if available
Subject to PPS Wallet, if available
Primary Care
(Network & Income Based)
Subject to PPN Provider. Consultation 1 per beneficiary. No benefit for frames, lenses or contact lenses
Subject to the use of a PPN. Managed Care protocols apply. 1 eye test or R380 per beneficiary at a non-DSP. Lenses covered 100% at network rates or R215 (single
vision), R460 (bifocal), R860 (multifocal) per lens for out of network. Frames R260 pb at
network provider, R195 at non-network provider. Contact lenses R1,255 pb
One eye test pbpa. A specific range of glasses to choose from, or a set of contact lenses every 2 years per beneficiary
DSP: KeyCare Optometry Network
Subject to Savings or self-funded
Benefits pb per 24 months and subject to use of PPN Network: 1 eye test, 1 pair clear single vision/ bifocal/ multifocal lenses, R595 (PPN frame) and/or lens enhancements, OR
R800 contact lenses
Primary Care Network facility: 1 eye test, 1 pair of clear standard or bi-focal lenses with standard frame pbp2a (min 0.5 refractive measurement to qualify)
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