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IN-HOSPITAL - Pre-authorisation required |
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General ward and theatre fees |
Subject to Annual Limit |
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Specialist treatment |
Subject to Annual Limit |
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EMERGENCY TRANSPORT - Pre-authorisation required |
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Road |
Subject to Annual Limit |
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Air |
Subject to Annual Limit |
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MATERNITY - Subject to registration on the maternity programme |
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Confinement |
Subject to Annual Limit |
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Home birth |
Subject to Annual Limit |
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MEDICATION - Formulary and fund protocols apply. Designated Service Provider (DSP) |
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Chronic:
- Chronic Disease List (CDL) conditions |
Unlimited from DSP only |
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Acute / Prescribed |
Unlimited from Network Provider |
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OTC |
Subject to Annual Limit |
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DAY TO DAY BENEFIT |
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General Practitioners (GP) |
Unlimited from Network Provider |
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Radiology |
|
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Pathology |
|
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Specialists |
Subject to Annual Limit |
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Optometry |
Limited from Network Provider |
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Basic Dentistry |
Limited from Network Provider |
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Advanced Dentistry |
Limited from Network Provider |
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CO-PAYMENTS |
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Not applicable at Network Provider.
May be applicable when using a service provider outside the network. |
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PENALTIES |
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A penalty will be imposed where the Fund is not pre-notified of a hospital admission. |
