Comprehensive
(High Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,715 per family. Sub-limits apply
Refer to member guide for full list and limits
R64,300 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R32,700 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(High Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R134,028 per family. Sub-limits apply
Refer to member guide for full list and limits
R67,670 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
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–
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R222,000 pb per event (max 1 event pa); Intraocular lenses: R8,670 pb per event (max 2 events pa); Other internal prostheses: R83,800 pb per event (max 2 events pa)
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Comprehensive
(Medium to High Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R104,366 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
–
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(Medium to High Cover)
–
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip – shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Comprehensive
(Medium to High Cover)
–
R54,780 per family. Sub-limits and Managed Care protocols apply. Subject to preauthorisation and use of a preferred provider
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip –
shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits for wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R92,145 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
R39,040 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacement subject to PMB
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Combined benefit limit of R27,900 per family for unlisted prosthesis (elbow – hip –
shoulder replacements, spinal plates and screws etc.)
Sub-limits apply for listed prosthesis (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
–
Hospital & Savings
(Low to Medium Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Hospital & Savings
(Low to Medium Cover)
–
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network
Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Cochlear implants: R203,200 pb per event (max 1 event pa); Intraocular lenses: R8,110
pb per event (max 2 events pa); Other internal prostheses: R61,000 pb per event (max 2 events pa)
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Capitation
(Low Cover)
–
R18,180 per family. Managed Care
protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements are excluded
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Smart Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
–
–
Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities
–
Capitation
(Low Cover)
–
Subject to PMB. Managed Care protocols apply
Unlimited at a Dynamic Smart Network Provider. Subject to Prescribed Minimum Benefits, else *EXCLUSIONS apply.
Refer to last page, and Member Guide for full list, limits and exclustions
–
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Intraocular lenses: R6,000 pb per event;
Other internal prostheses: R40,000 pb per event
All limited to maximum of 2 events per year.
Joint replacements limited to PMBs and state facilities
–
Hospital Plan
(Hospitalization Cover)
–
R51,590 per family. Managed Care protocols apply. Subject to pre-authorisation and use of a preferred provider Joint replacements and back and neck surgery subject to PMB
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
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–
–
–
Hospital Plan
(Hospitalization Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case managment. Sub-limits
apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year
–
Hospital Plan
(Hospitalization Cover)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R91,183 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB. Managed Care protocols apply
Shoulder Joint Prostheses, Major Joints Surgery, Prosthetic devices used in Spinal Surgery: Unlimited at a Delta Network Provider – otherwise limits apply
Refer to Member Guide for full list and limits
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Prosthesis subject to pre-authorisation, protocols and case management. Sub-limits apply
(Benefits not applicable to wear/tear)
Refer to member guide for full list and limits
Intraocular lenses: R6,600 pb per event;
Other internal prostheses: R56,000 pb per event
All limited to maximum of 2 events per year.
All limited to maximum of 2 events per year
Limit of R55,055 per family per annum, subject to Prescribed Minimum Benefits, preauthorisation and protocols. Sub-limits apply. Refer to Member Guide for full list and
limits
Primary Care
(Network & Income Based)
Prosthesis subject to preferred provider, otherwise limits and co-payments apply
Limit of R61,384 per family. Sub-limits apply
Joint Replacements, subject to Prescribed Minimum Benefits
Refer to member guide for full list and limits
Subject to PMB and Network Provider.
Managed Care protocols apply
Subject to PMB and Network Hospitals
Unlimited at cost at PMB level of care (e.g. aorta stent grafts, intraocular lenses etc.)
Refer to member guide for full details
Subject to Prescribed Minimum Benefits.
Listed essential cases – clinical guidelines and pre-authorisation apply
Refer to member guide for full list and limits
Limited to Prescribed Minimum Benefits at State facilities
–