CBT Rates 2022

Consultation Rates For GP & Specialists 2022

Practice Type	CONSULTATION TARIFF CODES 0190/0191/0192 – Out of Hospital	Alliance Plus, Alliance Network, Double Plus, Double Network & First Choice	Alliance Plus, Alliance Network, Double Plus, Double Network & First Choice	Network Choice
Discipline	Practice description	CAMAF BASE TARIFF	80% CAMAF BASE TARIFF	100% CAMAF BASE TARIFF
12	DERMATOLOGIST	R 444.30	R 355.44	**R 444.30
14	GENERAL PRACTITIONER	R 426.86	R 341.90	* R 494.80
16	GYNAECOLOGIST	R 470.47	R 376.40	**R 470.47
17	PULMONOLOGIST	R 679.56	R 543.68	**R 679.56
18	SPECIALIST PHYSICIAN	R 679.56	R 543.68	**R 679.56
19	GASTROENTEROLOGIST	R 679.56	R 543.68	**R 679.56
20	NEUROLOGIST	R 679.56	R 543.68	**R 679.56
21	CARDIOLOGIST	R 679.56	R 543.68	**R 679.56
23	MEDICAL ONCOLOGIST	R 679.56	R 543.68	**R 679.56
24	NEUROSURGERY	R 679.56	R 543.68	**R 679.56
26	OPTHALMOLOGIST	R 444.30	R 355.44	**R 444.30
27	HAEMATOLOGIST	R 679.56	R 543.68	**R 679.56
28	ORTHOPAEDICS	R 444.30	R 355.44	**R 444.30
30	E N T (OTORHINOLARYNGOLOGIST)	R 444.30	R 355.44	**R 444.30
31	RHEUMATOLOGIST	R 679.56	R 543.68	**R 679.56
32	PAEDIATRICIAN	R 679.56	R 543.68	**R 679.56
34	PHYSICAL MEDICINE	R 679.56	R 543.68	**R 679.56
36	PLASTIC SURGERY	R 444.30	R 355.44	**R 444.30
40	RADIATION ONCOLOGIST	R 444.30	R 355.44	**R 444.30
42	SURGEON	R 444.30	R 355.44	**R 444.30
44	CARDIO THORACIC	R 679.56	R 543.68	**R 679.56
46	UROLOGY	R 444.30	R 355.44	**R 444.30
52	PATHOLOGY CLINICAL	R 444.30	R 355.44	**R 444.30
53	PATHOLOGY ANATOMICAL	R 444.30	R 355.44	**R 444.30

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.

*	100% CAMAF agreed rates
*	Refer to CAMAF website for list of approved Network GPs
**	Consultations requires a Nominated Network GP referral

Dental Consultation Rates Alliance Plus, Alliance Network, Double Plus, Double Network, Vital Plus, Vital Network, Network Choice & First Choice 2022

Practice Type: Dentist (Pr 54)	CONSULTATION TARIFF CODES 8101/8104 – Out of Hospital	Alliance Plus, Alliance Network, Double Plus, Double Network, Vital Plus, Vital Network, First Choice & Network Choice	Alliance Plus, Alliance Network, Double Plus, Double Network
Tariff code	Practice description	CAMAF BASE TARIFF	80% CAMAF BASE TARIFF
8101 or	DENTAL EXAMINATION	R 274.60	R 219.68
8104	LIMITED ORAL EXAMINATION	R 133.20	R 106.56

CAMAF Optical Rates 2022

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

Pr Type	Tariff	Alliance Plus, Double Plus, Vital Plus and Essential Plus	Alliance Network and Double Network	First Choice & Network Choice
70	11001 or	R 650.00	R 600.00	REFER TO PPN
70	11081 or	R 685.00	R 600.00	REFER TO PPN
	70001 or		R 600.00
	70002 or		R 500.00
	70003 or		R 550.00
	70004		R 460.00

	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

CBT Rates 2022

Consultation Rates For GP & Specialists 2022

Dental Consultation Rates Alliance Plus, Alliance Network, Double Plus, Double Network, Vital Plus, Vital Network, Network Choice & First Choice 2022

CAMAF Optical Rates 2022

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NETWORK CHOICE

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FIRST CHOICE

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ESSENTIAL PLUS & ESSENTIAL NETWORK

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VITAL PLUS & VITAL NETWORK

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DOUBLE PLUS & DOUBLE NETWORK

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ALLIANCE PLUS & ALLIANCE NETWORK

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NETWORK CHOICE

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FIRST CHOICE

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ESSENTIAL PLUS & ESSENTIAL NETWORK

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VITAL PLUS & VITAL NETWORK

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DOUBLE PLUS & DOUBLE NETWORK

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ALLIANCE PLUS & ALLIANCE NETWORK

	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