Member Guide
CLASSIC NETWORK
CLASSIC NETWORK This new generation savings option provides members with the flexibility and independence to manage their own day- to-day expenses rich hospital cover; 26 CDL and 10 non-CDL conditions. Members on the Classic Network option can enjoy significant savings on their monthly contributions and still enjoy comprehensive benefits. Download 2026 Classic Network Benefits ANNUAL…
CLASSIC OPTION
CLASSIC OPTION This new generation savings option provides members with the flexibility and independence to manage their own day-to-day expenses with hospital cover; 26 CDL and 10 non-CDL conditions. Members on the Classic Network option can enjoy significant savings on their monthly contributions and still enjoy comprehensive benefits. Download 2026 Classic Benefits ANNUAL SAVINGS LIMIT…
CUSTOM OPTION
CUSTOM OPTION Targeted at young and healthy members. The Custom plan provides you and your dependants an opportunity to make health part of your journey with quality provider networks and a continuously enhanced benefit package. Download 2026 Custom Benefits MONTHLY CONTRIBUTION SALARY BAND MEMBER ADULT CHILD R0 – R4 047 R1 402 R1 122 R359…
ESSENTIAL OPTION
ESSENTIAL OPTION This entry level option is ideal for first time medical cover buyers – young and healthy individuals. It offers them peace of mind every stage of their health journey by using quality provider networks that offer simple day-to-day benefits and hospital cover. Download 2026 Essential Benefits MONTHLY CONTRIBUTION SALARY BAND MEMBER ADULT CHILD…
Fight Against Fraud backup 2019
FIGHT AGAINST FRAUD! Anonymous, 24-hour, toll free fraud line: 0800 00 04 36 Fraud is a serious issue that affects your medical scheme benefits. Fraud is an unlawful and intentional misrepresentation that results in actual or potential wrong-doing to the Scheme. The Scheme’s fraud line is managed by an independent team that ensures that members reporting…
Exclusions per Option
Exclusions per Option OPTIMUM OPTION HOSPICARE OPTION HOSPICARE NETWORK CLASSIC OPTION CLASSIC NETWORK CUSTOM OPTION ESSENTIAL OPTION ANNEXURE D: General exclusions ANNEXURE F: Dental Exclusions
ANNEXURE F: Dental Exclusions
ANNEXURE F: Dental Exclusions (with due regard to the Prescribed Minimum Benefits) The cost of general dentistry performed in hospital The cost of gold, metal or other inlays in a denture or crown Fee for after-hours visits that the Scheme considers as convenience visits Bleaching of vital teeth Unregistered items and items listed as ‘by…