CLASSIC OPTION
This new generation plan provides members with the flexibility and independence to manage their own day to day expenses via generous
savings and a rich hospital cover. Members on the Classic Network option can enjoy significant savings on their monthly contributions and
still enjoy comprehensive benefits.
ANNUAL SAVINGS LIMIT (ASL)
This is the portion of your monthly contribution that is allocated to a savings account that is held in the principal member’s name. The money in this account is used to pay for out-of-hospital medical expenses
| OPTION | MEMBER | ADULT | CHILD |
|---|---|---|---|
| Classic | R8 700 | R7 380 | R2 172 |
MONTHLY CONTRIBUTION
| OPTION | MEMBER | ADULT | CHILD |
|---|---|---|---|
| Classic | R4 304 | R3 653 | R1 078 |
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 62 of the Member Guide.
| CLASSIC NETWORK | |
| General practitioners (GPs) and specialists | Subject to ASL |
| Telehealth | Subject to ASL Scheme rates and managed care protocols apply Please call 0861 000 300 for more information |
| Medicines Acute Over the counter (OTC) Preventative medicines |
Subject to ASLR230 per event per day Paid from ASL – refer to page 11 of the Member Guide |
| Chronic benefit Benefits are subject to registration onto the chronic management programme |
Provider - Network pharmacy 26 conditions covered as per the chronic disease list and prescribed minimum benefits Refer to page 18 of the Member Guide for more information on co-payments |
| Optometry Subject to ASL |
Per beneficiary: 1 composite eye examination, a frame of up to R860 and 2 lenses every 24 months OR contact lenses of up to R1 530 instead of glasses per year
Members may utilise positive savings for claim values above the annual optometry limits. Please call 0861 000 300 for more info |
| 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 pre-authorised by emailing a detailed quotation and clear panoramic radiograph to the dental department. |
Subject to ASL |
| Auxiliary services | Subject to ASL |
ADDITIONAL BENEFITS (not paid from ASL)
| CLASSIC NETWORK | |
| Chronic medicines
Non-CDL chronic medicine |
26 conditions – unlimited (refer to page 60 of the Member Guide), M0 – R5 180 |
| Network provider | Medipost Pharmacy |
| Co-payment for non-formulary medicine | 20% |
| Co-payment for use of non-network provider | 30% |
| Free Hello Doctor consults | Telephonic consults via HELLO DOCTOR. Talk or text a doctor on your phone, anytime, anywhere, official language – for free. Refer to page 10 for detailed information |
| Medical and surgical appliances | |
| General appliances per family per annum | R14 690 |
| Sub-limits to Appliance Benefit: Glucometer per beneficiary every 2 years |
R865 |
| Nebuliser per family every 3 years | R865 |
| External Prosthesis per family per annum | R25 900 |
| MRI, CT, PET and radio isotope scans | R15 000 per scan Per family = 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 every 3 years |
| Hearing aid maintenance | R1 160 per beneficiary per annum |
| Mental health | Subject to ASL |
| 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 NETWORK |
| 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 | Network hospital - Life Healthcare |
| State and private hospital | Unlimited 30% co-payment for using non-network provider |
| 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 = R71 770 (limit includes harvesting and transportation costs) National donor only |
| Internal Prostheses | Per family per annum = R40 800 |
| Refractive eye surgery |
Per beneficiary per eye = R6 170; maximum of R12 340 for both eyes once per lifetime |
| Reconstructive surgery (as part of PMBs) | Per family = R71 660 |
| MRI, CT, PET and radio isotope scans | R15 000 per scan Per family = 2 scans paid from risk thereafter from ASL subject to motivation Subject to clinical protocols and pre-authorisation |
| Alternate care instead of hospitalisation | Per family = 30 days to a maximum of R38 580 per event subject to clinical protocols and pre-authorisation |
| Mental health (in- and out-of-hospital) | 100% of Scheme rate subject to clinical protocols and pre-authorisation |
| Alcohol and drug rehabilitation | 100% of negotiated rate, at a South African National Council on Alcoholism and Drug Dependence (SANCA)- approved facility |
| Dialysis | Subject to use of preferred provider, clinical protocols and pre-authorization |
| Oncology in and out of hospital Non-PMB cases PMB cases |
Per family = R500 000 per annum 20% co-payment after limit has been reached Subject to clinical protocols and preauthorisationUnlimited |
| Pathology and basic radiology | At Scheme rate |
| General dentistry | Subject to ASL and dental protocols |
| Ambulance transport | Emergency – road and air Subject to use of the designated service provider, clinical protocols and preauthorization |
EXCLUSIONS
General exclusions as set out in the Annexure D of the Rules
Dental exclusions as set out in Annexure F of the Rules