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CLASSIC OPTION

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
ClassicR7 500R6 360R1 860

MONTHLY CONTRIBUTION

OPTIONMEMBERADULTCHILD
ClassicR3 685R3 130R920

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 on pg 63 of 2020 Member Guide.

CLASSIC
General practitioners (GPs) and specialists Subject to ASL
Medicines
Acute
Over the counter (OTC)
Preventative medicines
Subject to ASL
R200 per event per day
Paid from ASL – refer to page 15 of 2020 Member Guide
Optometry
Subject to ASL
Per beneficiary: 1 composite eye examination, a frame of up to R820 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
Chronic medicines
Non-CDL chronic medicine

26 conditions – unlimited (refer to page 48 of 2020 Member Guide) – plus 10 conditions, subject to sub-limits:

M0 – R4 500
M1 – R8 900
M2 – R11 100
M3 – R12 100
M4 – R13 700
M5+ – R15 800

Network provider Scheme network 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
Free Hello Doctor consults Telephonic consults via HELLO DOCTOR.
Talk or text a doctor on your phone,
anytime, anywhere, in any language –
for free. Refer to page 6 for detailed
information
Medical and surgical appliances
General appliances per family per annum

R13 300

Sub-limits to Appliance Benefit:
Glucometer per beneficiary every 2 years
R790
Nebuliser per family every 3 years R790
External Prosthesis per family per annum R23 500
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 060 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
IMPORTANT: Treatment performed in-hospital or falls within the Major Medical Benefits needs to be pre-authorised prior to commencement of treatment. Conditions such as cancer will require you to register onto the Patient Care Programme to access benefits. MHC will pay benefits in accordance with the Scheme Rules and clinical protocols per condition. The sub-limits specified below apply per year. If you join the Scheme after January your limits will be pro-rated.
In-hospital limits Any hospital
State and private hospital Unlimited
CO-PAYMENT FOR SPECIALIZED PROCEDURES/TREATMENT
(This co-payment is only applicable to benefit below and not the entire benefit)
Procedure/treatment
Gastroscopy, colonoscopy,
sigmoidoscopy, arthroscopy, joint
replacements, diagnostic laparoscopy,
urological scopes and facet joint
injections
If performed in hospital
A co-payment of R1200 will apply per
admission which needs to be paid
directly by the member to the treating
practioner
If performed out of hospital
Procedure will be paid at scheme rate
subject to pre-authorisation and clinical
protocols.
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 = R65 000 (limit includes harvesting and transportation costs)
National donor only
Internal Prostheses Per family per annum = R35 400
Refractive eye surgery Per beneficiary per eye = R5 590; maximum of R11 180 for both eyes once Per lifetime
Reconstructive surgery (as part of PMBs) Per family = R64 900
MRI, CT, PET and radio isotope scans Per family = 2 scans paid from risk thereafter from ASL subject to motivation
Alternate care instead of hospitalisation Per family = 30 days to a maximum of R35 000
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

EXCLUSIONS

General exclusions as set out in the Annexure D of the Rules

Dental exclusions as set out in Annexure F of the Rules