CBT Rates 2020

Practice Type	CONSULTATION TARIFF CODES 0190/0191/0192 – Out of Hospital	Alliance, Double Plus & First Choice	Alliance, Double Plus & First Choice
Discipline	Practice description	CAMAF BASE TARIFF	80% CAMAF BASE TARIFF
12	DERMATOLOGIST	428.00	342.40
14	GENERAL PRACTITIONER	414.40	331.52
16	GYNAECOLOGIST	453.20	362.56
17	PULMONOLOGIST	654.70	523.76
18	SPECIALIST PHYSICIAN	654.70	523.76
19	GASTROENTEROLOGIST	654.70	523.76
20	NEUROLOGIST	654.70	523.76
21	CARDIOLOGIST	654.70	523.76
23	MEDICAL ONCOLOGIST	654.70	523.76
24	NEUROSURGERY	654.70	523.76
26	OPTHALMOLOGIST	428.00	342.40
27	HAEMATOLOGIST	654.70	523.76
28	ORTHOPAEDICS	428.00	342.40
30	E N T (OTORHINOLARYNGOLOGIST)	428.00	342.40
31	RHEUMATOLOGIST	654.70	523.76
32	PAEDIATRICIAN	654.70	523.76
34	PHYSICAL MEDICINE	654.70	523.76
36	PLASTIC SURGERY	428.00	342.40
40	RADIATION ONCOLOGIST	428.00	342.40
42	SURGEON	428.00	342.40
44	CARDIO THORACIC	654.70	523.76
46	UROLOGY	428.00	342.40
52	PATHOLOGY CLINICAL	428.00	342.40
53	PATHOLOGY ANATOMICAL	428.00	342.40

Preventative Wellness consultations are paid at 100% CBT, subject to the correct ICD10 code.

Day to day consultations are paid at 80% CBT, subject to funds available in the member’s Other benefit limit.

Practice Type: Dentist (Pr 54)	CONSULTATION TARIFF CODES 8101/8104 – Out of Hospital	Alliance, Double Plus, First Choice, Network Choice	Alliance, Double Plus
Tariff code	Practice description	CAMAF BASE TARIFF	80% CAMAF BASE TARIFF
8101 or	DENTAL EXAMINATION	R 253.90	R 203.12
8104	LIMITED ORAL EXAMINATION	R 123.10	R 98.48

Code 11001 or 11081 wellness and pays 100% optical assistant rates

Pr Type	Tariff	ALLIANCE, DOUBLE PLUS, VITAL, ESSENTIAL PLUS	FIRST CHOICE, NETWORK CHOICE
70	11001 or	611.40	REFER TO PPN
70	11081	714.00	REFER TO PPN

	Network Hospital: DSP hospital group is Netcare – No limits
	Attending Doctors: 100% CBT only at DSP
	27 Chronic Conditions: medication and consultations.
	Radiology Advanced scans limited to R49 965 per family (combined limit for in and out of hospital.) Limit before PMB/CDL applies. R5 845 per beneficiary for basic radiology (on referral by nominated GP or specialist for out of hospital)
	Screening Benefits: PSA, Pap Smear, Mammogram
	Vaccines

	Any Private Hospital – No limits
	Attending Doctors and Specialists: 100% CBT
	27 Chronic Conditions: medication and consultations.
	Radiology Advanced scans limited to R49 965 per family (combined limit for in and out of hospital.) Limit before PMB/CDL applies. R5 845 per beneficiary for basic radiology
	Screening Benefits: PSA, Pap Smear, Mammogram
	80% of GP, Specialists, Dental, Optometry, Checkups, ECG, Vaccines

	Essential Plus: Any Private Hospital – No limits Essential Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies.
	Attending Doctors and Specialists: 200% of CBT
	27 Chronic Conditions: Medication and consultations
	Unlimited X-Rays and Blood Tests IN hospital including MRI and CT scans
	Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram
	Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG

	Vital Plus: Any Private Hospital – No limits Vital Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies.
	Attending Doctors and Specialists: 300% of CBT
	60 Chronic Conditions: Medication and consultations. Covers the medication and necessary consultations and procedures
	Unlimited X-Rays and Blood Tests IN hospital, limits apply to advanced scans
	Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram
	3 Months post-hospitalisation benefit
	External Appliances: Wheelchair, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor, Insulin pump
	Checkups and Vaccines: GP, Specialist, Dental, Optometry, ECG

	Double Plus: Any Private Hospital – No limits Double Network: DSP hospitals are Life Healthcare and Netcare – No limits 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies.
	Attending Doctors and Specialists: 300% CBT
	64 Chronic Conditions Medication and Consultations. Biological medication for non-PMB conditions is available in exceptional cases on Alliance options, a 20% co-payment will apply (not on biologics approved for CDL conditions)
	Unlimited X-rays and Blood Tests In and Out of Hospital including MRI and CT Scans
	Screening Benefits Melanoma, PSA, Pap Smear, Mammogram
	3 Months post-hospitalisation benefit
	External Appliances: wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Double Network)
	Checkups and Vaccines: GP (nominated network GP referral applies for Double Network), Specialist, Dental, Optometry (PPN optometrist for Double Network), ECG
	Infertility R83 050 per family

Quick Option Overview

	Alliance Plus: Any Private Hospital – No limits. Private wards for childbirth confinements (subject to availability and pre-authorisation) Alliance Network: DSP hospitals are Life Healthcare and Netcare – No limits, private wards for childbirth confinements (subject to availability and pre-authorisation) (20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies)
	Attending Doctors and Specialists: 300% CBT
	65 Chronic Conditions medication and consultations. Biological medication for non-PMB conditions is available in exceptional cases on Alliance options, a 20% co-payment will apply (not on biologics approved for CDL conditions)
	Unlimited X-Rays and Blood Tests IN and OUT of hospital including MRI and CT scans
	Screening Benefits: Melanoma, PSA, Pap Smear, Mammogram
	3 Months post-hospitalisation benefit
	External Appliances: Wheelchair, Insulin pump, hearing aid (DSP is HearConnect), breast pump, baby sleep monitor (on referral from a nominated network GP or a specialist for Alliance Network)
	Checkups and Vaccines: GP (nominated network GP referral applies for Alliance Network), Specialist, Dental, Optometry (PPN optometrist for Alliance Network), Dermatologist, ECG, Dietician
	Infertility R117 760 per family