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.
|R0 – R3 000||R370||R220||R150|
|R3 001 – R6 500||R390||R230||R150|
|R6 501 – R9 500||R560||R340||R225|
|R9 501 +||R645||R390||R260|
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.
|PRIMARY CARE NETWORK ONLY|
|General practitioners (GPs)||Unlimited at the primary care network service provider|
|Acute||Unlimited at the primary care network service provider - subject to network formulary|
|Over the counter (OTC)||Single member = 3 prescriptions
Family = 5 prescriptions
Ten conditions covered (see page 35 of Member Guide)
Optical benefit available per beneficiary every 24 months
1 optical test per beneficiary per year
Subject to use of primary care network service provider and protocols
|Basic dentistry||Per beneficiary per annum:
• one dental examination
• eight primary extractions
• eight fillings
|External prostheses||Per family = R6 000|
|Medical and surgical appliances (in- and out-of-hospital)||The following appliances are subject to the annual limit of R2 620 per family|
|Glucometers||R790 per beneficiary every 2 years|
|Nebulisers||R790 per family every 3 years|
|Other Appliances – once every 4 years||Subject to clinical protocols|
|Out-of-Hospital Procedures subject to use of a network provider||11 new procedures covered out of hospital. Refer to list above for the detailed information|
|Free Hello Doctor consults||Telephonic consults via HELLO DOCTOR. Talk or text a doctor on your phone, anytime, anywhere, in any language – for free|
Out-of-area or emergency visits
Per family = three visits to a maximum of R1 000
1 visit per family subject to the Specialist benefit limit
Refer to page 9 for the detailed benefits on free early detection, preventative and ante-natal care.
|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.|
|Public hospital||Unlimited treatment in accordance with Scheme protocols|
Resuscitation and stabilisation only
|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 = R9 000 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.