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CLASSIC NETWORK

New generation plan with a savings component that assists members in managing their day to day benefits. Unlimited cover in any private hospital for Classic members. Classic Network members can benefit from discounted contributions but need to utilise a designated service provider. Cover for comprehensive pre- and post-natal healthcare services for maternity and early childhood. Additional non PMB conditions are also covered, full cover for chronic medicines on our formulary for all Chronic conditions on the Disease List (CDL) subject to use of a designated service provider. Free preventative screening benefits and ER made EASY via Health Maximiser.

ANNUAL SAVINGS LIMIT (ASL)

OPTIONMEMBERADULTCHILD
Classic NetworkR6 228R5 304R1 560

MONTHLY CONTRIBUTION

OPTIONMEMBERADULTCHILD
Classic NetworkR2 883R2 452R723

DESIGNATED SERVICE PROVIDERS (DSPs)

MHC’s philosophy is to provide quality, comprehensive healthcare while maintaining affordable contributions. In order to strike the necessary balance to achieve our philosophy, it is necessary to introduce DSPs. In this way, MHC can contain spiralling healthcare costs but nevertheless ensure that members receive the most appropriate treatment.

Members may choose not to use the DSP but will be liable for any co-payment over and above what is charged by the DSP.

OUT-OF-HOSPITAL BENEFITS

CLASSIC NETWORK
General practitioners (GPs) and specialists Subject to ASL
Medicines
Acute
Over the counter (OTC)
Preventative medicines
     
Subject to ASL
R190 per event per day
Paid from ASL – refer to page 7 of member guide
Optometry
Subject to ASL
Per beneficiary: 1 examination, a frame of up to R780 and 2 lenses every 24 months OR contact lenses of up to R1 530 instead of glasses per year
Dentistry: Basic and specialised
Please note that, while dentures are covered, there is a limit of 1 set of dentures every 4 years per beneficiary. General anaesthetic is available for children under the age of 8 for extensive basic treatment and this is limited to once every 24 months per beneficiary. Cover is available for the removal of impacted wisdom teeth in theatre but must be preauthorised by emailing a detailed quotation and clear panoramic radiograph.
Subject to ASL
Auxiliary services Subject to ASL

ADDITIONAL BENEFITS (not paid from ASL)

CLASSIC NETWORK
Chronic medicines
Non-CDL chronic medicine
26 conditions – unlimited (page 12) – plus 10 conditions, subject to sub-limits:
M0 – R4 300
M1 – R8 400
M2 – R10 500
M3 – R11 500
M4 – R13 000
M5+ – R15 000
Network provider Medipost Pharmacy
Co-payment for non-formulary medicine 20%
Co-payment for use of non-network provider 30%
Maternity
Subject to registration onto the patient
care programme
12 antenatal visits
x2 2D scans per pregnancy. 3D and 4D scans are paid up to the rate of 2D scans
2 paediatric visits
Pregnancy vitamins
Medical and surgical appliances
General appliances per family per annum R12 627
Sub-limits to Appliance Benefit:
Glucometer per beneficiary every 2 years
R750
Nebuliser per family every 3 years R750
External Prosthesis per family per annum R22 344
MRI, CT, PET and radio isotope scans Per beneficiary = 2 scans paid from risk benefits thereafter ASL
Subject to pre-authorisation and managed care protocols
Hearing aids Subject to medical and surgical appliance limit
Hearing aid maintenance R1 000 per beneficiary per annum
Mental health Subject to ASL
Health Maximiser™ Refer to page 7 of member guide
Extra consultations and medicine (Only once ASL reaches R300) Single member = 2 visits
Family = 5 visits
Patient care programmes (Diabetes, HIV, oncology) Subject to registration and managed care protocols

IN-HOSPITAL BENEFITS

Subject to pre-authorisation and
managed care protocols
CLASSIC NETWORK
In-hospital limits Network hospital - Life Healthcare
State and private hospital Unlimited
30% co-payment for using non-network provider
GPs and specialists At Scheme rate
Specialists subject to preferred provider rates
To-take-out medicine Up to 7 days
Organ transplant (non-PMB cases) Per family = R61 520 (limit includes harvesting and transportation costs)
National donor only
Internal Prostheses Per family per annum = R33 516
Refractive eye surgery Per eye = R5 300; maximum of R10 600 for both eyes once per lifetime
Reconstructive surgery (as part of PMBs) Per family = R61 520
MRI, CT, PET and radio isotope scans Per beneficiary = 2 scans paid from risk thereafter from ASL
Alternate care instead of hospitalisation Per family = 30 days to a maximum of R33 130
Mental health (in- and out-of-hospital) 100% of Scheme rate
Alcohol and drug rehabilitation 100% of negotiated rate, at a South African National Council on Alcoholism and Drug Dependence (SANCA)-approved facility
Dialysis At Scheme rate
Oncology in and out of hospital
Non-PMB cases
Per family = R500 000
20% co-payment after limit has been reached
PMB cases Unlimited
Pathology and radiology At Scheme rate
General dentistry Subject to ASL and dental protocols
Ambulance transport Emergency – road and air