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ESSENTIAL OPTION

Entry level option with unlimited cover at any public hospital. GP consultations are unlimited subject to use of a primary care provider. Treatment for 5 chronic conditions can be accessed via our network provider. This option includes cover for optometry and dentistry, and a rich preventative care benefit.

MONTHLY CONTRIBUTION

SALARY BANDMEMBERADULTCHILD
R0 – R3 000R345R207R139
R3 001 – R6 500R362R217R143
R6 501 – R9 500R525R315R211
R9 501 +R603R362R242

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.

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Click here to look up your Medication Formulary

View the Chronic Conditions covered by the Essential Option

OUT-OF-HOSPITAL BENEFITS

Not sure what we mean? Refer to glossary.

PRIMARY CARE NETWORK ONLY
General practitioners (GPs) Unlimited at the primary care network service provider
Prescribed medicines  
Acute Unlimited at the primary care network service provider - subject to network formulary
Over the counter (OTC) Single member = 3 prescriptions
Family = 5 prescriptions
Chronic Five conditions covered (see page 12 of member guide)
Subject to primary care network service provider protocols
No benefit if a non-network service provider is used
Optometry
Optical benefit available per beneficiary every 24 months
1 optical test per beneficiary per year
1 pair of clear, standard mono- or bifocal lenses in a standard frame
OR
Contact lenses to the value of R480
R185 towards a frame outside the standard range
Subject to primary care network service provider protocols
No benefit if a non-network provider is used
Basic dentistry Per beneficiary per annum:
• one dental examination
• scaling
• eight primary extractions
• eight fillings
• polishing
External prostheses Per family = R5 720
Medical and surgical appliances (in- and out-of-hospital) The following appliances are subject to the annual limit of R2 480 per family
Glucometers R750 per beneficiary every 2 years
Nebulisers R750 per family every 3 years
Other Appliances – once every 4 years Subject to clinical protocols
ADDITIONAL BENEFITS
Maternity Antenatal care from the primary care network service provider
x2 2D scans per pregnancy. 3D and 4D scans are paid up to the rate of 2D scans
Out-of-area or emergency visits Per family = three visits to a maximum of R1 000
Preventative care
High Risk members as identified by GP Subject to GP referral and case management
Cholesterol
Blood glucose
Blood pressure
Tuberculosis screening
Clinical breast examination (ultrasound)
Prostate-specific antigen
Pneumococcal and influenza vaccines
Patient care programmes
(Diabetes, HIV, oncology)
Subject to registration and clinical protocols

IN-HOSPITAL BENEFITS

Public hospital Unlimited treatment in accordance with Scheme protocols
Private hospital Resuscitation and stabilisation only
Subject to pre-authorisation within 48 hours of admission and managed care protocols
GPs and specialists Unlimited treatment in a state facility in accordance with Scheme protocols
To-take-out medicine Up to 7 days
Internal Prostheses Per family = R8 590 where approved during hospital admission
Oncology Where approved during hospital admission Subject to state and managed care protocols
Pathology Where approved during hospital admission Subject to state and managed care protocols
Radiology Where approved during hospital admission Subject to state and managed care protocols
Maternity Treatment in accordance with Scheme and state protocols
Antenatal care available from a primary care network provider for the first 20 weeks. Patient will be referred to a State Facility for Specialist care and the confinement.
Ambulance Emergency road transport only

This option is exempt from PMBs. Terms and conditions apply including specific exclusions.