Covers the difference between a specialist’s fee and what your medical scheme pays. Limited to an additional 600% of the medical scheme tariff.

Examples of procedures in hospital:

• Childbirth
• Basic dentistry
• Tonsil removal
• Broken bones

Examples of procedures covered out of hospital:

• Gastroscopy, cystoscopy or hysteroscopy
• Dialysis treatment
• Home births
• Circumcision
• Root canal

These are defined amounts that you need to pay upfront (as per your medical scheme) to the hospital, which you can claim back.

In-hospital examples include:

• Scopes
• Pacemakers
• Implants

Out-of-hospital examples include:

• MRI scans
• CT scans
• PET scans
• Scopes

Medical schemes often put limits on certain procedures. Get cover of up to R68,370 per event.

Examples of such procedures:

• Internal prosthetics
• Pacemakers
• Implants
• Joint replacements

• An agreed benefit payment for a first-time cancer diagnosis.
• Applies to medical equivalent of stage 2 or higher form of cancer.
• Excludes any form of cancer previously identified or that required treatment.
• Limited to R15,000 per insured party.
• One claim per insured party for the lifetime of the policy.

Cover for tariff shortfalls, sub-limits and co-payments related to approved cancer treatments.

Oncology tariff shortfalls

• Covers you for shortfalls in respect of cancer-related treatment approved by the medical scheme.
• Limited to an additional 500%.

Oncology sub-limits

• Cover for when the charges relating to the services supplied have exceeded the benefit sub-limit that applies to cancer treatment of the medical scheme plan type you are on.

Oncology co-payments

• Cover for the co-payment applied once your cancer-related costs have exceeded the specific threshold defined by your medical scheme.
• Limited to 20% of your co-payment amount.

Innovative Oncology Medicines

• Cover for defined innovative oncology medicines which have been approved by your medical scheme.
• Limited to the lesser of 25% of the total drug cost or R14,600.

• For dental reconstruction surgery that is required as a direct result of either accidental harm or oncology treatment.
• Covers the difference between what the specialist charges and the medical aid paid.
• Limited to 2 events per family annually and a maximum of R49,900.

• When your medical scheme doesn’t cover services provided in casualty for accidents, or illness for children under 12 years of age.
• If payment is made from your available medical savings account, or from your own pocket, we will reimburse that too.
• Examples of accidental harm are broken bones, falls and cuts.
• Cover is limited to R19,550 for accidental casualty and R3,200 for child casualty.
• Casualty Emergency – Covers Emergency illness-related outpatient services in a Hospital casualty ward, limited to one event per year and up to R2,500 per event.​

Agreed benefit payment
An agreed benefit payment in the case of accidental death or permanent disability due to an accident.  The following limits apply:

• Children up to 6 years:
R20,000
• All other insured parties: R30,000

Contribution Waiver
Your medical scheme contributions will be covered for 6 months up to a maximum of R35,500 where the policyholder is the principal member of the medical scheme.

An agreed benefit payment is payable when a premature birth occurs.

Agreed benefit payment for hospital admission related to an accident or premature birth:
Maximum 2 hospital episodes, R29,300 per family per year
Payments:

• R480 per day, from Day 1–13 (inclusive).
• R860 per day, from Day 14–20 (inclusive).
• R1 700 per day, from Day 21–30 (inclusive).