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Additional Information
ATTENDING DOCTORS AND SPECIALISTS CONSULTATIONS, MEDICAL AND SURGICAL PROCEDURES INCLUDING CHILDBIRTH CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION

Up to 100% CBT, 100% CBT

SUPPLEMENTARY HEALTHCARE IN HOSPITAL (EG. PHYSIOTHERAPY AND PSYCHOTHERAPY)

100% CBT

BLOOD TRANSFUSIONS (IN AND OUT OF HOSPITAL)

100% of cost

RADIOLOGY IN HOSPITAL

100% CBT

ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION

100% CBT limited to R38 000 per family

PATHOLOGY IN HOSPITAL

100% CBT

INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION

100% of cost limited to R38 000 per family, Exclusions: cochlear implants

HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION (PROFESSIONAL NURSES ONLY; FRAIL CARE EXCLUDED)

100% CBT (in lieu of hospitalisation only)

STEP-DOWN/PHYSICAL REHABILITATION APPROVED FACILITIES ONLY, UP TO 90 DAYS (SUBJECT TO PRE-AUTHORISATION)

100% DSP Tariff

MEDICATION IN HOSPITAL

100% SEP plus dispensing fee

TTO MEDICATION UP TO ONE WEEK’S SUPPLY

100% SEP plus dispensing fee

SUBSTANCE ABUSE

PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject to pre-authorisation and limited to 21 days

CHRONIC PMB CDL MEDICATION AND TREATMENT - SUBJECT TO PRE-AUTHORISATION, PROTOCOLS AND FORMULARIES REFER TO CHRONIC DISEASE LIST

100% SEP plus a dispensing fee, subject to RP and DSP, Consultations and procedures – as per PMB regulations

PMB DTP TREATMENT OUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF CONDITION AND PRE-AUTHORISATION

Medication – 100% SEP plus a dispensing fee, subject to MMAP and DSP, Consultations and procedures – as per PMB regulations

ONCOLOGY SUBJECT TO PRE-AUTHORISATION AND ICON PROTOCOLS

Medication – 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures – 100% DSP Tariff, The DSP is the ICON network., The ICON Essential benefits apply.

CAMAF PREVENTIVE WELLNESS PROGRAMME PER ADULT BENEFICIARY

INCLUDES: Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy

ONE GP CONSULTATION ONLY *ICD 10 CODE SPECIFIC TO GENERAL CHECKUP ONLY

100% CBT per beneficiary (Network Doctor only)

ONE SPECIALIST CONSULTATION *ICD 10 CODE SPECIFIC TO GENERAL CHECKUP ONLY. GYNAECOLOGISTS, UROLOGISTS, OR SPECIALIST PHYSICIANS FOR BENEFICIARIES OVER 18. PAEDIATRICIANS FOR UNDER 18's

100% CBT per beneficiary

PSYCHOTHERAPY

100% CBT limited to R13 040 per beneficiary

ONE DENTISTRY CONSULTATION GENERAL CHECKUP ONLY - excludes consumables

100% CBT per beneficiary

ONE ECG (PERFORMED BY GP OR SPECIALIST PHYSICIAN) *ICD 10 CODE SPECIFIC TO GENERAL CHECKUP ONLY
ONE OPTOMETRIST CONSULTATION

Refer to spectacle and lenses benefits

IMMUNISATION AND VACCINES (COST OF IMMUNISATION AND VACCINE ONLY)

SEP plus a dispensing fee, subject to MMAP, limited to R1 852 per beneficiary

CERVICAL CANCER VACCINE (HPV) (COST OF VACCINE ONLY)

Females between 9 and 16 years of age (SEP plus dispensing fee)

ONE HIV VCT TEST

100% CBT per beneficiary

HOSPITAL ACCOMMODATION (IN HOSPITAL) INCLUDING CHILDBIRTH CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION

See In Hospital and Prescribed Minimum Benefits above

EXTERNAL APPLIANCES SUBJECT TO OVERALL EXTERNAL APPLIANCES LIMIT: BREAST PUMPS & APNOEA MONITORS – 3 MONTHS PRIOR TO EXPECTED DUE DATE & WITHIN 6 MONTHS AFTER BIRTH OF BABY. SUBJECT TO REGISTRATION

Baby Apnoea Monitors: R2 265, Breast pumps: R3 900

METABOLIC SCREENING FOR NEW BORN BABIES

100% Negotiated Rate per new born baby

ANTE-NATAL FOETAL SCANS PER PREGNANCY

3 scans at 80% CBT., Subject to limit (c) of Annual Overall Day-to-Day Benefit Limit

ANTE-NATAL CLASSES

80% CBT subjects to sub-limit R1 050 per pregnancy., Subject to limit (c) of Annual Overall Day-to-Day Benefit Limit

UMBLICAL STEM CELL HARVESTING

Negotiated discount with Cryo-Save., Note: Please note that CAMAF does not cover expenses related to cord blood stem cell harvesting, testing and storage as this is not treatment for a specific medical condition., The cash discount that is offered is passed directly on to you and is not paid from your health plan benefits.

BASIC AND ADVANCED RADIOLOGY OUT OF HOSPITAL MUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON REFERRAL FROM MEDICAL PRACTITIONER ONLY. ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION

Basic Radiology: Referrals by DSP or specialist, 100% CBT limited to R4 440 per beneficiary, Advanced scans: 100% CBT limited to R38 000 per family (on referral by DSP or specialist)

PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER, PRE-AUTHORISATION REQUIRED FOR ADVANCED PATHOLOGY

Referred by DSP or specialist, 100% Negotiated Rate, limited to R7 090 per beneficiary

MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS (SUBJECT TO PRE-AUTHORISATION) REFER TO ADDITIONAL CHRONIC CONDITIONS LIST

Depression only. 100% SEP plus a dispensing fee subject to RP and DSP Consultations 100% CBT

EXTERNAL APPLIANCES (subject to referral);rnIN & OUT OF HOSPITAL PURCHASE, HIRE AND MAINTENANCE; CPAP (subject to pre-authorisation) - 3 YEAR CYCLE; HEARING AIDS (subject to pre-authorisation) - 1 CLA

100% NAPPI price or 100% of cost, limited to R6 790 per beneficiary and subject to DSP or Specialist referral

INTERNATIONAL TRAVEL COVER PROVIDED BY TRAVEL INSURANCE CONSULTANTS (TIC) AND SUBJECT TO THEIR POLICY REQUIREMENTS. ARRANGE COVER PRIOR TO YOUR TRAVEL. VISIT OUR WEBSITE FOR FULL DETAILS.

R10 million per beneficiary per journey for emergency medical costs while you travel outside South Africa., This cover is for a period of 90 days from your departure from South Africa. Cover for pre-existing conditions is limited to R150,000 unless additional cover is arranged., The cover is available to members who are not older than 80 years of age.

NETCARE 911 EMERGENCY SERVICES

Unlimited, Subject to Netcare 911 authorisation

DAY TO DAY BENEFITS: BENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT

Annual overall limit: Beneficiary specific limits:, (a) Medicines R3 290, (b) Advanced Dentistry R6 890, (c) Other R3 290, (d) Specialists R10 120

GPs AND DENTISTS DENTAL X-RAYS PERFORMED BY DENTISTS, CONSULTATIONS AND PROCEDURES PERFORMED BY THESE PRACTITIONERS; BASIC DENTISTRY

100% negotiated rate, subject to sublimit (c) – Network GP only

SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS

100% CBT, Subject to limit (d) (on referral from a network GP only)

ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS

100% SEP plus a dispensing fee, subject to MMAP., Subject to limit (a) (on referral from a network GP only)

NON-DSP VISITS TO DOCTOR’S ROOMS

One non-network or non-nominated visit per beneficiary or two per family, 20% co-payment

CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATION WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT

One casualty visit per family (facility fee, consumed meds and materials). Limited to R 1 580

NURSE VISITS

100% CBT subject to limit (c)

SUPPLEMENTARY HEALTH AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS, PODIATRY AND SPEECH THERAPY

100% CBT limited to R2 760 per beneficiary on referral from DSP or from a Specialist., Subject to limit (c)

ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES

100% of CBT, Subject to limit (b) dental implants excluded

OVER THE COUNTER MEDICATION

50% SEP plus a dispensing fee, subject to MMAP, limited to R1 690 per beneficiary., Subject to limit (a)

SPECTACLES AND LENSES FROM OPTOMETRIST ONLY; ANNUAL BENEFIT, UNLESS OTHERWISE STATED

For the benefit cycle of 24 months from date of claiming, each beneficiary is entitled to:, One Composite Consultation inclusive of a Refraction, Tonometry and Visual Field screening AND, EITHER SPECTACLES – A PPN Frame to the value of R150 or R750 off any alternative frame and/or lens enhancements and, one pair of lenses: either One pair of Clear A quity Single Vision; Clear Aquity Bifocal lenses or Clear Aquity Multifocal lenses OR, CONTACT LENSES – Contact lenses to the value of R840., The benefit PER BENEFICIARY at a NON PPN provider would be as follows:, One consultation per Beneficiary during the Benefit Cycle, limited to a maximum cost of R300 AND, EITHER SPECTACLES – A frame benefit of R600 towards the cost of a frame and/or lens enhancements and, one pair of lenses: either one pair of clear single vision spectacle lenses limited to R175 per lens or, one pair of clear flat top bifocal spectacle lenses limited to R410 per lens or, one pair of clear flat top Multifocal lenses limited to R710 per lens, OR CONTACT LENSES – Contact Lenses to the value of R840., The benefit PER BENEFICIARY at a PPN provider would be as follows:

RATES

1st Child (rest are free) R725, 1st Child (rest are free) R891, Adult R1 394, Adult R1 582, Adult R1 837, Adult R2 544, Child R1 182, Child R1 548, Income Category R0 – R18 960, Income Category R18 961 – R25 420, Income Category R25 421 – R38 140, Income Category R38 141+, Principal R1 667, Principal R1 982, Principal R2 372, Principal R3 153, Monthly income based on Total Cost to Company of Principal Member