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HOSPICARE OPTION

Targeted at members requiring hospital cover primarily. The extensive in and out of hospital benefits are for PMB conditions only. Hospicare members have unlimited hospital cover at any provider. Hospicare Network members can benefit from discounted contributions but are required to utilise a designated service provider. 26 chronic conditions are covered in full if our pharmacy network provider is used.

MONTHLY CONTRIBUTION

OPTIONMEMBERADULTCHILD
HospicareR1 982R1 675R493

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

HOSPICARE
Day-to-day As part of an approved treatment plan
General practitioners (GPs) and specialists 270 DTPs; PMB treatment only
Specialists subject to preferred provider rates
Medicines
Acute
Chronic
Network provider
Co-payment for non-formulary medicine
Co-payment for non-network provider
270 DTPs; PMB treatment only
26 conditions (see page 12 of member guide)
Scheme’s pharmacy network
20%
30%
Non-CDL chronic medicine limit 270 DTPs; PMB treatment only
Optometry 270 DTPs; PMB treatment only
Dentistry Basic and specialised 270 DTPs; PMB treatment only
Auxiliary services 270 DTPs; PMB treatment only

ADDITIONAL BENEFITS

ADDITIONAL BENEFITS HOSPICARE
Maternity 12 antenatal visits
x2 2D scans per pregnancy
3D and 4D scans are paid up to the rate of 2D scans.
x2 paediatric visits
Pregnancy related vitamins
Medical and surgical appliances 270 DTPs; PMB treatment only
Hearing aids 270 DTPs; PMB treatment only
Mental health 270 DTPs; PMB treatment only
Child immunisations Up to the age of 6 years, as per Department of Health protocols
Patient care programmes (Diabetes, HIV, oncology) Subject to registration and managed care protocols

IN-HOSPITAL BENEFITS

HOSPICARE
All services are subject to preauthorisation and managed care protocols Any hospital – PMBs only
Public and private hospital Unlimited – PMBs only
GPs and specialists 270 DTPs; PMB treatment only
To-take-out medicine Up to 7 days
Organ transplant* Unlimited – PMBs only
Prostheses Unlimited – PMBs only
Reconstructive surgery Unlimited – PMBs only
MRI, CT, PET and radio isotope scans Unlimited – PMBs only
Alternate care instead of hospitalisation Unlimited – PMBs only
Mental health 100% of Scheme rate subject to managed care protocols
Alcohol and drug rehabilitation 100% of negotiated rate, at a South African National Council on Alcoholism and Drug Dependence (SANCA)-approved facility. Subject to managed care protocols
Dialysis Unlimited – PMBs only
Oncology Treatment covered at DSP rates if a network provider is used Unlimited – PMBs only
Pathology and radiology Unlimited – PMBs only
ADDITIONAL BENEFITS
Only the 7 non-PMB procedures listed are covered in hospital at a network provider and is paid at the Scheme rate Tonsillectomy
Adenoidectomy
Basic dentistry – up to the age of 8
Grommets
Carpal tunnel
Varicose veins
Bunionectomy

*Organ transplant benefit includes:

  • Heart, liver and kidney transplants, including harvesting and transportation costs
  • Corneal transplant, including harvesting and transportation costs

All requests will be subject to clinical protocols and use of a national donor only.