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DOUBLE NETWORK

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

300% 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

PATHOLOGY IN HOSPITAL

100% Negotiated Rate

INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION

100% of cost

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

100% CBT

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

100% Negotiated Rate

MEDICATION IN HOSPITAL

100% SEP plus dispensing fee

TTO MEDICATION UP TO ONE WEEK’S SUPPLY

100% SEP plus dispensing fee

INFERTILITY TREATMENT

Treatment limited to R71 065 per family

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 (on referral from a nominated network GP)

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 (on referral from a nominated network GP)

ONCOLOGY SUBJECT TO PRE-AUTHORISATION AND ICON PROTOCOLS

Medication – 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures – at 300% CBT, The DSP is the ICON network. The ICON Core protocols apply.

CAMAF PREVENTIVE WELLNESS PROGRAMME PER ADULT BENEFICIARY

INCLUDES: Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy and free Online Wellness Club

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

100% CBT per beneficiary (Nominated Network GP)

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 R14 930 per beneficiary

ONE DIETICIAN CONSULTATION

100% CBT 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

100% CBT per adult beneficiary

ONE OPTOMETRIST CONSULTATION

PPN Rates

IMMUNISATION AND VACCINES (COST OF IMMUNISATION AND VACCINE ONLY)

SEP plus a dispensing fee, limited to: Adults R3 138 – Child R5 151

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

Females between 9 and 45 years of age (SEP plus dispensing fee)

HUMAN PAPILLOMA VIRUS (HPV) VACCINE (COST OF VACCINE ONLY)

Females between 9 and 45 years of age., Males between 9 and 26 years of age., Includes initial vaccination and two follow-up booster vaccinations, where applicable., (SEP plus dispensing fee)

PSA SCREENING

Males older than 40 years of age (100% Negotiated Rate or CBT)

PAP SMEAR SCREENING

Females between 21 and 65 years of age (100% Negotiated Rate or 100% CBT)

MAMMOGRAM

Females from 25 years of age (100% CBT)

ONE HIV VCT TEST

100% CBT per beneficiary

ONE MELANOMA SCREENING

100% CBT per adult 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: R3 125, Breast pumps: R5 205

METABOLIC SCREENING FOR NEW BORN BABIES

100% Negotiated Rate per new born baby

ANTE-NATAL FOETAL SCANS PER PREGNANCY

4 scans at 80% CBT, Subject to Annual Overall Day-to-Day Limit

ANTE-NATAL CLASSES

80% CBT limited to R2 232 per pregnancy, Subject to Annual Overall Day-to-Day 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

100% CBT (on referral from a nominated network GP or a specialist)

PATHOLOGY OUT OF HOSPITAL PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER

100% Negotiated Rate or CBT (on referral from a nominated network GP or a specialist)

POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS

300% CBT for attending practitioners, 100% CBT for supplementary services

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

100% SEP plus a dispensing fee, subject to RP and DSP, Consultations 100% CBT, (on referral from a nominated network GP; medication claims will not be paid if non-nominated network GP is used)

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

(on referral from a nominated network GP or a specialist), 100% NAPPI price or 100% of cost, subject to the overall limit of R81 324 per beneficiary and subject to the following sub-limits:, Hearing Aids: R81 324, Insulin Pumps: R53 110, Other external appliances: R17 440, Standard Wheelchairs: R51 870, Wheelchairs for Quadriplegics: R81 324

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.

R5 million per beneficiary per journey for emergency unforeseen and unexpected medical costs while you travel outside of South Africa, and have a policy in place before departing., This cover is for a maximum period of 90 days from your departure from South Africa and ceases upon your return to South Africa., The cover is available to beneficiaries who are not older than 80 years of age., Cover for pre-existing conditions is only available for members who have not yet turned 70 years of age and is limited to R250 000 in-hospital cover, unless additional cover is arranged., Refer to Travel Policy Wording.

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 Limits, Adult R15 390, Child R10 680

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

80% CBT Nominated Network GP

SPECIALISTS CONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE PRACTITIONERS

80% CBT (on referral from a nominated network GP)

ACUTE MEDICATION INCLUDING INJECTIONS AND MATERIALS

80% SEP plus dispensing fee, subject to MMAP, co-payment from MSA (on referral from a nominated network GP)

NON-DSP VISITS TO DOCTOR’S ROOMS

One visit per beneficiary 80% CBT for non-network or non-nominated GP

CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL

80% CBT

NURSE VISITS

80% CBT up to 21 days

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

80% CBT (on referral from a nominated network GP or from a specialist)

ADVANCED DENTISTRY CROWNS, BRIDGES, ORTHODONTICS, DENTURES

80% CBT limited to:, M0 R15 000, M1 R21 600, M2+ R29 090

OVER THE COUNTER MEDICATION

80% SEP plus a dispensing fee, subject to MMAP, co-payment from MSA, limited to R2 205 per beneficiary

LASER K/EXCIMER LASER NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS

80% CBT limited to R5 630 per beneficiary per eye

SPECTACLES & LENSES FROM OPTOMETRIST ONLY; ANNUAL BENEFIT, UNLESS OTHERWISE STATED; WHERE PPN IS INDICATED AS THE DSP, PPN RATES & TARIFFS WILL APPLY. FOR ALL OTHER OPTIONS, OPTICAL ASSISTANT RATES

Consultation: See Preventive Wellness Benefit, Add ons R1 300, Single vision R1 300 OR, Bifocal R3 470 OR, Varifocal R5 320 AND, Frames R4 780 OR, Contact lenses R4 640, Lenses, frames etc 80% PPN Rates

RATES

Adult R365, Adult R4 225, Adult R4 590, Child R2 422, Child R2 656, Child R234, Monthly MSA Contribution, Monthly Risk Contribution, Total Monthly Contribution