Moto Health Care Icon

HOSPICARE NETWORK

Targeted at members requiring hospital cover primarily. The extensive in and out of hospital benefits are for PMB conditions/treatment only with some value-added benefits and 26 Chronic conditions. Members on the Hospicare Network option can enjoy significant savings on their monthly contributions and still enjoy comprehensive benefits.

MONTHLY CONTRIBUTION

OPTION MEMBER ADULT CHILD
Hospicare NetworkR2 381R2 018R595

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.

medipost

Tel: 012 426 4000
Email: info@medipost.co.za

View the list of Network Hospitals

Look up your Medication Formulary

View the Chronic Conditions covered by Hospicare Network

OUT-OF-HOSPITAL BENEFITS

Not sure what we mean? Refer to glossary on pg 58 of 2021 Member Guide.

HOSPICARE
Day-to-day As part of an approved treatment plan
General practitioners (GPs) and specialists 271 DTPs; PMB treatment only
Specialists subject to preferred provider rates
Medicines
Acute
Chronic
Network provider
Co-payment for non-formulary medicine
Co-payment for non-network provider

271 DTPs; PMB treatment only
26 conditions (see page 51 of Member Guide)
Medipost Pharmacy
20%
30%

Non-CDL chronic medicine limit 271 DTPs; PMB treatment only
Optometry 271 DTPs; PMB treatment only
Dentistry Basic and specialised 271 DTPs; PMB treatment only
Auxiliary services 271 DTPs; PMB treatment only

ADDITIONAL BENEFITS

ADDITIONAL BENEFITS HOSPICARE
Free Hello Doctor consults

Telephonic consults via HELLO DOCTOR. Talk or text a doctor on your phone, anytime, anywhere, in any official language – for free Refer to page 10 for detailed information

Maternity

12 antenatal visits
Two 2D scans per pregnancy
3D and 4D scans are paid up to the rate of 2D scans
Two paediatric visits
Pregnancy related vitamins

Medical and surgical appliances 271 DTPs; PMB treatment only
Hearing aids 271 DTPs; PMB treatment only
Mental health 271 DTPs; PMB treatment only
Child immunisations Up to the age of 6 years, as per Department of Health protocols
Patient care programmes (Diabetes, HIV, oncology) Subject to registration and managed care protocols

IN-HOSPITAL BENEFITS

HOSPICARE NETWORK
IMPORTANT: Treatment performed in-hospital 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.
All services are subject to preauthorisation and managed care protocols Network hospital: Life Healthcare PMBs only
Public and private hospital Unlimited – PMBs only
30% co-payment for use of non-network provider
GPs and specialists 271 DTPs; PMB treatment only
To-take-out medicine Up to 7 days
Organ transplant* Unlimited – PMBs only
Prostheses Unlimited – PMBs only
Reconstructive surgery Unlimited – PMBs only
MRI, CT, PET and radio isotope scans Unlimited – PMBs only
Alternate care instead of hospitalisation Unlimited – PMBs only Subject to clinical protocols and pre-authorization
Mental health 100% of Scheme rate subject to managed care 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 managed care protocols
Dialysis Unlimited – PMBs only
Oncology Treatment covered at DSP rates if a network provider is used Unlimited – PMBs only
Pathology and radiology Unlimited – PMBs only
Ambulance transport  Road and air transportation
PMB Only
Subject to use of preferred provider,
clinical protocols and pre-authorization
ADDITIONAL BENEFITS
Only the 7 non-PMB procedures
listed are covered in hospital at a network provider and is paid at the Scheme rate
Tonsillectomy
Adenoidectomy
Basic dentistry – up to the age of 8
Grommets
Carpal tunnel
Varicose veins
Bunionectomy

*Organ transplant benefit includes:

  • Heart, liver and kidney transplants, including harvesting and transportation costs
  • Corneal transplant, including harvesting and transportation costs

All requests will be subject to clinical protocols and use of a national donor only.

EXCLUSIONS

Unless stated Non-PMB procedures in hospital

All non-PMB general exclusions as set out in the Annexure D of the Rules

All non-PMB dental exclusions as set out in Annexure F of the Rules