In-hospital treatment
Overall Annual Limit (OAL): R1 000 000 per beneficiary
- Hospitalisation
info Including ward and theatre fees, ICU and high care wards, medication, material, equipment, blood transfusions and transfer of blood.
warningSubject to pre-authorisation
Excluding: Cost of dental implants, accommodation in a private ward, refractive surgery, organ transplants (see organ transplant benefit) and to-take-out (TTO) medication (see acute medication benefit).
infoIn-hospital benefits subject to OAL
100% of Scheme rate
- Motor vehicle accidents (MVAs) and injuries
warningSubject to pre-authorisation
Including injuries relating to third-party cases. Subject to accident/injury report and legal undertaking – to be completed and submitted by you.info In-hospital benefits subject to OAL
100% of Scheme rate
- Maternity benefits
Confinements in hospital
warningSubject to pre-authorisation
Vaginal and caesarean deliveries in private and State hospitals (includes complications for mother and child).
info In-hospital benefits subject to OAL
100% of Scheme rate
Home deliveries by a registered nurse/midwife and antenatal visits
warningSubject to pre-authorisation
Benefit includes all costs relating to hospitalisation.
info In-hospital benefits subject to OAL
100% of cost
- Medical practitioners
info In-hospital treatment (consultations and services in hospital)
warningSubject to pre-authorisation
Treatment and consultations in hospital by specialist and general practitioners (GPs), technicians and physiotherapists.
Excluding costs for maxillofacial and oral surgery, except for oncology cases.info In-hospital benefits subject to OAL
100% of Scheme rate
- Ambulance services (emergency services)
info Road ambulances, emergency services, general advice line, air evacuation and transportation.
warningPre-authorisation required - contact Netcare 911 on 082 911.
info R3 908 per family if Netcare 911 is not used
100% of Scheme rate
- Internal prostheses and appliances
info Including pacemakers, electronic devices, coronary stents and joint replacements.
warningSubject to pre-authorisation
info R63 144 per family per annum subject to OAL
100% of agreed cost
- Renal disorders (kidney and home dialysis)
info Including related medication therapy (through approved healthcare providers only).
warningAll cases subject to full investigation, registration on the Renal Management Programme and pre-authorisation
info R278 430 per family subject to OAL
100% of cost
- Organ transplants
info Subject to prescribed minimum benefits [PMBs]
warningSubject to transplant motivation, PMBs and pre-authorisation.
Including organ harvesting and immunosuppressive medication therapy.
100% of cost
- Mental Health
info In and out of hospital including psychological conditions
warningSubject to pre-authorisation of all related services at approved facilities
Hospital admissions for mental health conditions include anorexia nervosa, bulimia nervosa, treatment for alcohol and chemical substance abuse and other mental health conditions.
info R58 940 per family per annum - 21 days per beneficiary
100% of cost