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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 000R370R220R150
R3 001 – R6 500R390R230R150
R6 501 – R9 500R560R340R225
R9 501 +R645R390R260

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.

Find GP’s, Dentists and Pharmacies on CareCross lookup tool

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 on pg 63 of 2020 Member Guide.

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

Ten conditions covered (see page 35 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 R505
R195 towards a frame outside the standard range

Subject to use of primary care network service provider and 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 = 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
ADDITIONAL BENEFITS
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

Paedriatric visits

1 visit per family subject to the Specialist benefit limit

Wellness Benefit

Refer to page 9 for the detailed benefits on free early detection, preventative and ante-natal care.

IN-HOSPITAL BENEFITS

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
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 = 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.

EXCLUSIONS

  • General exclusions as set out in the Annexure D of the Rules
  • Dental exclusions as set out in Annexure F of the Rules
  • Alcoholism and drug dependency
  • Cochlear Implants
  • Corneal transplants
  • Dentistry in hospital
  • Infertility
  • Kidney dialysis
  • Refractive eye surgery