 |
IN-HOSPITAL - Pre-authorisation required |
 |
General ward and theatre fees |
Unlimited |
|
Specialist treatment |
Unlimited |
 |
EMERGENCY TRANSPORT - Pre-authorisation required |
|
Road |
Unlimited |
|
Air |
Unlimited |
 |
MATERNITY - Subject to registration on the maternity programme |
|
Confinement |
Unlimited |
|
Home birth |
Unlimited |
|
MEDICATION - Formulary and fund protocols apply. Designated Service Provider (DSP) |
 |
Chronic:
- Chronic Disease List (CDL) conditions
- Non CDL conditions |
Unlimited from DSP
Subject to Annual Limit |
 |
Acute / Prescribed |
Subject to Annual Savings Limit |
 |
OTC |
Subject to Annual Savings Limit |
|
DAY TO DAY BENEFIT - Subject to Annual Savings Limit (ASL) |
 |
General Practitioners (GP) |
Subject to Annual Savings Limit |
|
Radiology |
Subject to Annual Savings Limit |
|
Pathology |
Subject to Annual Savings Limit |
|
Specialists |
Subject to Annual Savings Limit |
 |
Optometry |
Subject to Annual Savings Limit |
 |
Basic Dentistry |
Subject to Annual Savings Limit |
 |
Advanced Dentistry |
Subject to Annual Savings Limit |
|
SUPPLEMENTARY BENEFITS |
|
Prosthesis and artificial limbs |
Subject to Annual Limit |
|
Appliances |
Subject to Annual Limit |
 |
Physiotherapy, dietician, psychologist etc |
Subject to Annual Savings Limit |
|
CO-PAYMENTS |
|
Applicable to procedures as defined in the benefits schedule. |
|
PENALTIES |
|
A penalty will be imposed where the Fund is not pre-notified of a hospital admission. |
