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OPTIMUM OPTION

Traditional plan. Unlimited cover in any private hospital. Extensive day to day benefits paid from the insured benefits. Cover for additional non PMB conditions, full cover for chronic medicines at any pharmacy as per formulary for all chronic conditions on the disease list (CDL). Free preventative screening benefits and ER made EASY via Health Maximiser. Unlimited cover for oncology, dialysis, pathology and radiology.

MONTHLY CONTRIBUTION

MEMBERADULTCHILD
R6 204R5 280R1 551

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

Not sure what we mean? Refer to glossary.

ANY PROVIDER
Day-to-day limit M0 – R25 220
M1 – R35 130
M2 – R40 660
M3+ – R47 740
General practitioners (GPs) and specialists Subject to day-to-day limit
Medicines
Acute
M0 – R10 370
M1 – R12 370
M2 – R14 500
M3 – R15 790
M4+ – R16 850
Over the counter (OTC) R190 per event per day
Optometry Per beneficiary = 1 examination
Per beneficiary = a frame of up to R1 230 and 2 lenses every 24 months
OR
Contact lenses of up to R2 280 instead of glasses per year
Dentistry:
Basic
Single member = R2 230
Family = R4 480
Specialised Single member = R12 960
Family = R19 330
Auxiliary services

Sub-limits

At a preferred provider, subject to auxiliary sub-limit and day-to-day limits
Single member = R4 890
Family = R14 610
ADDITIONAL BENEFITS (paid from risk benefits)
Chronic medicine
Non-CDL chronic medicine limit 26 conditions – unlimited (page 12) – plus 28 conditions, subject to
sub-limits:
M0 – R6 000
M1 – R12 000
M2 – R13 000
M3 – R15 000
M4 – R16 500
M5+ – R17 500
Co-payment for non-formulary medicine 20%
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
Sub-limits to Appliance Benefit General per family = R9 500
Glucometer per beneficiary every 2 years R750
Nebuliser per family every 3 years R750
Hearing aids
Per beneficiary every 3 years Unilateral = R11085
Bilateral = R22 170
Hearing aid maintenance R1 000 per family per annum
External Prosthesis Per family per annum = R26 332
Health Maximiser™ Refer to page 7 of member guide
Patient care programmes (Diabetes, HIV, oncology) Subject to registration and managed care protocols

IN-HOSPITAL BENEFITS

ANY HOSPITAL
Subject to pre-authorisation and managed care protocols
Public and private hospital Unlimited
GPs and specialists Unlimited
Specialist – 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 = R39 498
Refractive eye surgery Per eye = R5 300; maximum of R10 600 for both eyes once per lifetime
Reconstructive surgery Per family = R61 520
MRI, CT, PET and radio isotope scans Per beneficiary per annum = 2 scans from risk thereafter from the annual day-today limit
Alternate care instead of hospitalisation Per family = 30 days to a maximum of R37 470
Mental health (in- and out-of-hospital) 100% of Scheme rate – Subject to clinical 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 clinical protocols
Dialysis Unlimited and subject to use of preferred provider
Oncology Unlimited
Pathology and radiology Unlimited
General dentistry Subject to day-to-day limit and sublimits
Ambulance transport Emergency – road and air