BENEFITS BROCHURE 2016 - CAMAFBENEFITS BROCHURE 2016 Nurture your health ABOUT US The Chartered...
Transcript of BENEFITS BROCHURE 2016 - CAMAFBENEFITS BROCHURE 2016 Nurture your health ABOUT US The Chartered...
BENEFITS BROCHURE2016
Nurture your health
ABOUT USThe Chartered Accountants Medical Aid Fund (CAMAF), which was established in 1951, was originally designed for accounting professionals and offers superior benefits to qualifying members. As the fund focuses on a niche market, it is able to provide a range of benefits that significantly surpass those offered by most open schemes. Always ahead of the curve, CAMAF strongly values innovation, and covers many procedures performed with the very latest technology. It also has a distinctly holistic focus, combining excellent healthcare benefits with an actively managed wellness programme. This is complemented by its loyalty programme, Multiply, which offers a range of attractive rewards for doing the everyday things that ensure a healthy and happy life. CAMAF is a trusted medical aid that gives its members peace of mind when it comes to the management of the scheme, as its Board of Trustees is made up of professionals who have a high regard for good corporate governance. They ensure that the delivery of excellent products and services is suitably balanced with sound reserves. While CAMAF provides cover mainly for companies, it also accepts individual members subject to certain approved qualifications (see Criteria for Individual Membership).
CAMAF BENEFIT OPTION SUMMARY - STAR RATINGVITAL ESSENTIAL PLUS NETWORK CHOICE FIRST CHOICE DOUBLE PLUS ALLIANCE
Hospital and Chronic
Day to Day - -
Preventative Wellness Benefits
- -
MSA(savings) - - -
MONTHlY CONTRIBUTION RATES
BENEFIT OPTION CHANGE 2016
CONTACT US
CAMAF BENEFIT OPTIONS - QUICK SUMMARY
VITAL ESSENTIAL PLUS NETWORK CHOICE FIRST CHOICE DOUBLE PLUS ALLIANCE
Hospital Facility Fees Any private hospital Any private hospital Netcare hospitals only Any private hospital Any private hospital Any private hospital. Private wards
Attending Doctor's and Specialists in Hospital Up to 300% CBt Up to 200% CBt Up to 100% CBt Up to 100% CBt Up to 300% CBt Up to 300% CBt
Chronic condition cover: medicines and consults 63 Conditions 27 Conditions 27 Conditions 27 Conditions 63 Conditions 64 Conditions
Radiology and Pathology Unlimited In or Out of Hospital
Unlimited In Hospital. Out of Hospital from MSa
Limits apply In and Outof hospital
Limits apply In and Outof hospital
Unlimited In or Outof Hospital
Unlimited In or Out of Hospital
Preventative Wellness Benefits 14 extra benefits 4 extra benefits 10 extra benefits 10 extra benefits 14 extra benefits 14 extra benefits
Day to Day Overall Limit (Principal Member) - -
R2 600 for Medicines. R8 010 for Specialists.
R2 600 for Other.From DSP only
R2 600 for Medicines. R8 010 for Specialists.
R2 600 for Other.Paid at 80%
R10 090 R25 780
Medical Savings Account (Principal Member) - R5 280 - - R4 056 R6 204
VItal
BENEFIT OPTION QUICK SUMMARY - VITAl
aNy PrIVate hoSPItal: No limits
atteNDING DoCtorS aND SPeCIalIStS: Up to 300% of CBt
63 ChroNIC CoNDItIoNS: Medication and consultations. Covers the medication and necessary consultations and procedures. Includes unlimited appropriate biological drugs and specialised technology as well as door to door medication delivery
uNlIMIteD X-rayS aND BlooD teStS IN and OUT of hospital including MRI’s and CT’s
SCreeNING BeNeFItS
3 MoNth post hospitalisation benefit
eXterNal aPPlIaNCeS: Wheelchair, hearing aid, breast pump, baby sleep monitor
CheCK-uPS aND VaCCINeS: GP, Specialist, Dental, Optometry, ECG
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% of Negotiated Rate in general ward and specialised units
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 300% CBT 100% of Scheme Rate
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT
PATHOLOGYIN HOSPITAL 100% Negotiated Rate
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% Negotiated Rate
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP 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 topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATION AND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - SEP plus dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
VItalAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY 100% CBT per beneficiary
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
100% CBT per beneficiary
PSYCHOTHERAPY 100% CBT limited to R9 450 per beneficiaryONE DIETICIAN CONSULTATION 100% CBT per beneficiary
ONE DENTISTRY CONSULTATIONGENERAL CHECK UP ONLY - excludes consumables 100% CBT per beneficiary
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
100% CBT per adult beneficiary
ONE OPTOMETRIST CONSULTATION 100% Optical Assistant RatesMETABOLIC SCREENING FOR NEW BORN BABIES 100% Negotiated Rate per new born baby
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY SEP plus a dispensing fee, limited to R 1 360 per beneficiary
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST 100% cost per beneficiaryMELANOMA SCREENING TEST 100% CBT per adult beneficiary
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
VItalAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON
REFERRAL FROM MEDICAL PRACTITIONER ONLY. ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-AUTHORISATION
100% CBT
PATHOLOGYOUT OF HOSPITAL
PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER
100% Negotiated Rate or CBT
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS
300% CBT for attending practitioners100% CBT for auxiliary services
MEDICATION 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
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
100% of cost subject to the overall limit of R 31 370 per beneficiary and subject to the following sub-limits:
Hearing Aids: R 27 170Wheelchairs for Quadriplegics: R 27 170Standard Wheelchairs: R 19 130Insulin Pumps: R 31 370Other external appliances: R 6 830• Baby Apnoea monitors: R 2 100• Breast pumps: R 3 500
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
VItalAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
TOTAL MONTHLY CONTRIBUTIONAdult R 1 718Child R 898
MONTHlY CONTRIBUTION RATES - VITAl
eSSeNtIal PluS
BENEFIT OPTION QUICK SUMMARY - ESSENTIAl PlUS
aNy PrIVate hoSPItal: No limits
atteNDING Dr’s aND SPeCIalIStS: Up to 200% CBt
27 ChroNIC CoNDItIoNS medication and consultations
uNlIMIteD X-rayS aND BlooD teStS IN hospital including MRI and CT scans
SCreeNING BeNeFIt
PSyChotheraPy aND IMMuNISatIoN BeNeFItS
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% of Negotiated Rate in general ward and specialised units
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 200% CBT 100% of Scheme Rate
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT
PATHOLOGYIN HOSPITAL 100% Negotiated Rate
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% Negotiated Rate
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP 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 topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATIONAND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - SEP plus dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
eSSeNtIal PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY Subject to Medical Savings Account
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
Subject to Medical Savings Account
PSYCHOTHERAPY 100% CBT limited to R 9 450 per beneficiaryONE DIETICIAN CONSULTATION Subject to Medical Savings Account
ONE DENTISTRY CONSULTATIONGENERAL CHECK UP ONLY - excludes consumables Subject to Medical Savings Account
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
Subject to Medical Savings Account
ONE OPTOMETRIST CONSULTATION Subject to Medical Savings AccountMETABOLIC SCREENING FOR NEW BORN BABIES Subject to Medical Savings Account
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY) SEP plus a dispensing fee, limited to R 1 360 per beneficiary
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST Subject to Medical Savings AccountMELANOMA SCREENING TEST Subject to Medical Savings Account
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
eSSeNtIal PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON
REFERRAL FROM MEDICAL PRACTITIONER ONLY.ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-
AUTHORISATION
Subject to Medical Savings Account
PATHOLOGYOUT OF HOSPITAL
PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER
Subject to Medical Savings Account
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS Subject to Medical Savings Account
MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS(SUBJECT TO PRE-AUTHORISATION) REFER TO
ADDITIONAL CHRONIC CONDITIONS LISTSubject to Medical Savings Account except for Depression
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
Subject to Medical Savings Account
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
eSSeNtIal PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMITDAY TO DAY BENEFITS
BENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT Limited to funds available in the beneficiary’s Medical Savings Account
GP’S, SPECIALISTS AND DENTISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERS; BASIC DENTISTRYSubject to Medical Savings Account
SPECIALISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERSSubject to Medical Savings Account
ACUTE MEDICATIONINCLUDING INJECTIONS AND MATERIALS Subject to Medical Savings Account
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION
BENEFITSubject to Medical Savings Account
NURSE VISITS Subject to Medical Savings AccountSUPPLEMENTARY HEALTH
AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS,
PODIATRY AND SPEECH THERAPY
Subject to Medical Savings Account
ADVANCED DENTISTRYCROWNS, BRIDGES, ORTHODONTICS, DENTURES Subject to Medical Savings Account
OVER THE COUNTER MEDICATION Subject to Medical Savings AccountLASER K
NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS
IF THE LASER K BENEFIT IS UTILISED, NO SPECTACLE AND CONTACT LENSE BENEFIT ALLOWED FOR 2 YEARS
Subject to Medical Savings Account
ANTE-NATAL FOETAL SCANSPER PREGNANCY Subject to Medical Savings Account
ANTE-NATAL CLASSES Subject to Medical Savings AccountSPECTACLES AND LENSES
FROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE STATED
Subject to Medical Savings Account
eSSeNtIal PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
MONTHLY RISK CONTRIBUTIONPrincipal R 1 328Adult R 1 056Child R 618
MONTHLY MSA CONTRIBUTIONPrincipal R 440Adult R 351Child R 206
TOTAL MONTHLY CONTRIBUTIONPrincipal R 1 768Adult R 1 407Child R 824
MONTHlY CONTRIBUTION RATES - ESSENTIAl PlUS
NetWorK ChoICe
BENEFIT OPTION QUICK SUMMARY - NETWORK CHOICE
NetWorK hoSPItal: No limits (DSP hospital group is Netcare)
atteNDING Dr’s aND SPeCIalIStS: Up to 100% CBt only at DSP
27 ChroNIC CoNDItIoNS medication and consultations. Includes unlimited appropriate biological drugs and specialised technology and door to door medication delivery
X-rayS aND BlooD teStS Advanced scans limited to R30,000 per family
SCreeNING BeNeFIt
VaCCINeS
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% DSP tariff as per protocols. The DSP hospital group is Netcare.
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 100% CBT 100% CBT
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT limited to R30 000 per family
PATHOLOGYIN HOSPITAL 100% CBT
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost limited to R30 000 per family
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT (in lieu of hospitalisation only)
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% DSP Tariff
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP 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 topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATIONAND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to MMAP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - 100% SEP plus a dispensing fee, subject to MMAP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to MMAP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to MMAP and DSP. Consultations and procedures - at cost
NetWorK ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY 100% CBT per beneficiary (Network Doctor only)
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
100% CBT per beneficiary
PSYCHOTHERAPY 100% CBT limited to R9 450 per beneficiaryONE DENTISTRY CONSULTATION
GENERAL CHECK UP ONLY - excludes consumables 100% CBT per beneficiary (Network Dentist only)
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
100% CBT per adult beneficiary
ONE OPTOMETRIST CONSULTATION Refer to spectacle and lenses benefitsMETABOLIC SCREENING FOR NEW BORN BABIES 100% Negotiated Rate per new born baby
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY) SEP plus a dispensing fee, subject to MMAP, limited to R 1 360 per beneficiary
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST 100% CBT per beneficiary
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
NetWorK ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST 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 R3 500 per beneficiaryAdvanced scans: 100% CBT limited to R30 000 per family (referral by DSP or specialist)
PATHOLOGYOUT OF HOSPITAL
PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER
Referred by DSP or specialist, 100% CBT, limited to R5 600 per beneficiary
MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS(SUBJECT TO PRE-AUTHORISATION) REFER TO
ADDITIONAL CHRONIC CONDITIONS LISTNo Benefit except for Depression
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
100% of cost limited of R5 400 per beneficiary and subject to DSP referral and subject to the following sub-limits:
• Baby Apnoea monitors: R 1 870 • Breast pumps: R 3 150
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
NetWorK ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
NetWorK ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.OTHER BENEFITS (per Benef ic iary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMIT
DAY TO DAY BENEFITSBENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT
Annual overall limit: Beneficiary specific limits:(a) Medicines R 2 600(b) Advanced Dentistry R 5 440(c) Other R 2 600(d) Specialists R 8 010
GP’S, SPECIALISTS AND DENTISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE
PRACTITIONERS; BASIC DENTISTRY100% negotiated rate at a network provider only subject to sublimit (c)
SPECIALISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERS
100% CBTSubject to limit (d)
ACUTE MEDICATIONINCLUDING INJECTIONS AND MATERIALS
100% SEP plus a dispensing fee for basic formulary and 80% SEP plus dispensing fee for extended formulary, both subject to MMAP. Subject to limit (a)
NON-DSP VISITSTO DOCTORS’ ROOMS
One non-network visit per beneficiary or two per family, 20% co-paymentANDOne casualty visit per family (facility fee, consumed meds and materials).Limited to R 1 310Associated claims such as radiology and pathology are not covered unless it is a PMB or DTP.
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT
NURSE VISITS 100% CBT subject to limit (c)SUPPLEMENTARY HEALTH
AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS,
PODIATRY AND SPEECH THERAPY
100% CBT limited to R2 180 per beneficiary on referral from DSP only.Subject to limit (c)
BENEFIT SPECIFIC LIMITSADVANCED DENTISTRY
CROWNS, BRIDGES, ORTHODONTICS, DENTURES100% of CBT at network provider only.Subject to limit (b) excluding dental implants
OVER THE COUNTER MEDICATION 80% SEP plus a dispensing fee, subject to MMAP, limited to R1 340 per beneficiary. Subject to limit (a)ANTE-NATAL FOETAL SCANS
PER PREGNANCY 3 scans at 80% CBT. Subject to limit (c)
ANTE-NATAL CLASSES 80% CBT subject to sub-limit R830 Subject to limit (c)
SPECTACLES AND LENSESFROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE
STATED
The benefit PER BENEFICIARY at a PPN provider would be as follows: 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 R550 off any alternative frame and/or lens enhancements and one pair of lenses: either One pair of Clear Aquity Single Vision; Clear Aquity Bifocal lenses or Clear Aquity Multifocal lenses OR CONTACT LENSES - Contact lenses to the value of R750.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 R635 AND EITHER SPECTACLES - A frame benefit of R550 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 R150 per lens or one pair of clear flat top bifocal spectacle lenses limited to R325 per lens or one pair of clear flat top Multifocal lenses limited to R570 per lens OR CONTACT LENSES - Contact Lenses to the value of R750.
R 0 - R 14 910
Principal R 1 146Adult R 9621st Child(rest are free) R 500
R 14 911 - R 20 000
Principal R 1 361Adult R 1 0871st Child(rest are free) R 615
R 20 001 - R 30 000Principal R 1 624Adult R 1 264Child R 815Principal R 2 158
R 30 001 + Adult R 1 751Child R 1 065
MONTHlY CONTRIBUTION RATES - NETWORK CHOICE
FIrSt ChoICe
BENEFIT OPTION QUICK SUMMARY - FIRST CHOICE
aNy PrIVate hoSPItal: No limits
atteNDING Dr’s aND SPeCIalIStS: Up to 100% CBt
27 ChroNIC CoNDItIoNS medication and consultations. Includes unlimited appropriate biological drugs and specialised technology and door to door medication delivery
X-rayS aND BlooD teStS Advanced scans limited to R30,000 per family
SCreeNING BeNeFIt
80% oF GP, Specialists, Dental, Optometry, Check-ups, ECG, Vaccines
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% of Negotiated Rate in general ward and specialised units
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 100% CBT 100% CBT
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT limited to R30 000 per family
PATHOLOGYIN HOSPITAL 100% CBT
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost limited to R30 000 per family
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT (in lieu of hospitalisation only)
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% Negotiated Rate
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP 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 topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATIONAND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
FIrSt ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY 100% CBT per beneficiary
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
100% CBT per beneficiary
PSYCHOTHERAPY 100% CBT limited to R9 450 per beneficiaryONE DENTISTRY CONSULTATION
GENERAL CHECK UP ONLY - excludes consumables 100% CBT per beneficiary
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
100% CBT per adult beneficiary
ONE OPTOMETRIST CONSULTATION Refer to spectacle and lenses benefitsMETABOLIC SCREENING FOR NEW BORN BABIES 100% Negotiated Rate per new born baby
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY) SEP plus a dispensing fee, subject to MMAP, limited to R 1 360 per beneficiary
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST 100% CBT per beneficiary
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
FIrSt ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
FIrSt ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON
REFERRAL FROM MEDICAL PRACTITIONER ONLY.ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-
AUTHORISATION
Basic Radiology: 100% CBT limited to R3 500 per beneficiaryAdvanced scans: 100% CBT limited to R30 000 per family
PATHOLOGYOUT OF HOSPITAL
PERFORMED BY A REGISTERED PATHOLOGIST AND REFERRED BY A MEDICAL PRACTITIONER
100% CBT limited to R5 600 per beneficiary
MEDICATION FOR ADDITIONAL CHRONIC CONDITIONS(SUBJECT TO PRE-AUTHORISATION) REFER TO
ADDITIONAL CHRONIC CONDITIONS LISTNo Benefit except for Depression
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
100% of cost in hospital and 80% of cost out of hospital with an overall limit of R5 400 per beneficiary and subject to the following sub-limits:
• Baby Apnoea monitors: R 1 870 • Breast pumps: R 3 150
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
OTHER BENEFITS (per Benef ic iary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMIT
DAY TO DAY BENEFITSBENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT
Annual overall limit: Beneficiary specific limits:(a) Medicines R 2 600(b) Advanced Dentistry R 5 440(c) Other R 2 600(d) Specialists R 8 010
GP’S, SPECIALISTS AND DENTISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE
PRACTITIONERS; BASIC DENTISTRY
80% CBTSubject to limit (c)
SPECIALISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERS
80% CBTSubject to limit (d)
ACUTE MEDICATIONINCLUDING INJECTIONS AND MATERIALS 80% SEP plus a dispensing fee, subject to MMAP. Subject to limit (a)
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT
Medication: 80% SEP plus a dispensing fee subject to limit (a)Treatment: 80% CBT subject to limit (c)
NURSE VISITS 80% CBT subject to limit (c)SUPPLEMENTARY HEALTH
AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS,
PODIATRY AND SPEECH THERAPY
80% CBT subject to sub-limit R2 180Subject to limit (c)
BENEFIT SPECIFIC LIMITSADVANCED DENTISTRY
CROWNS, BRIDGES, ORTHODONTICS, DENTURES50% CBTSubject to limit (b) excluding dental implants
OVER THE COUNTER MEDICATION 80% SEP plus a dispensing fee, subject to MMAP, limited to R 1 340 per beneficiary. Subject to limit (a)ANTE-NATAL FOETAL SCANS
PER PREGNANCY 3 scans at 80% CBT. Subject to limit(c)
ANTE-NATAL CLASSESSUBJECT TO ENROLMENT ON THE MOTHER-TO-BE PROGRAMME
80% CBT subject to sub-limit R830Subject to limit (c)
SPECTACLES AND LENSESFROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE
STATED
The benefit PER BENEFICIARY at a PPN provider would be as follows: 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 R550 off any alternative frame and/or lens enhancements and one pair of lenses: either One pair of Clear Aquity Single Vision; Clear Aquity Bifocal lenses or Clear Aquity Multifocal lenses OR CONTACT LENSES - Contact lenses to the value of R750.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 R635 AND EITHER SPECTACLES - A frame benefit of R550 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 R150 per lens or one pair of clear flat top bifocal spectacle lenses limited to R325 per lens or one pair of clear flat top Multifocal lenses limited to R570 per lens OR CONTACT LENSES - Contact Lenses to the value of R750.
FIrSt ChoICeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in the Regulations listed in the Medical Schemes Act.
Income Category Total Monthly Contribution
R 0 - R 7 720Adult R 763Child R 462
R 7 721 - R 14 910Adult R 1 211Child R 716
R 14 911 - R 20 000Adult R 1 811Child R 1 056
R 20 001 - R 30 000Adult R 2 250Child R 1 475
R 30 001 +Adult R 2 455Child R 1 600
MONTHlY CONTRIBUTION RATES - FIRST CHOICE
DouBle PluS
BENEFIT OPTION QUICK SUMMARY - DOUBlE PlUS
aNy PrIVate hoSPItal: No limits
atteNDING Dr’s aND SPeCIalIStS: Up to 300% CBt
63 ChroNIC CoNDItIoNS medication and consultations. Includes unlimited appropriate biological drugs and specialised technology
uNlIMIteD X-rayS aND BlooD teStS IN and OUT of hospital including MRI and CT scans
SCreeNING BeNeFIt
3 MoNth post hospitalisation benefit
eXterNal aPPlIaNCeS: Wheelchair, hearing aid, breast pump, baby sleep monitor
CheCK-uPS aND VaCCINeS: GP, Specialist, Dental, Optometry, ECG
INFertIlIty R47 700 per family
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% of Negotiated Rate in general ward and specialised units
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 300% CBT 100% of Scheme Rate
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT
PATHOLOGYIN HOSPITAL 100% Negotiated Rate
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% Negotiated Rate
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP TO ONE WEEK’S SUPPLY 100% SEP plus dispensing fee
INFERTILITY TREATMENT Treatment limited to R47 700 per family
SUBSTANCE ABUSE PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATIONAND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - SEP plus dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
DouBle PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY 100% CBT per beneficiary
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
100% CBT per beneficiary
PSYCHOTHERAPY 100% CBT limited to R9 450 per beneficiaryONE DIETICIAN CONSULTATION 100% CBT per beneficiary
ONE DENTISTRY CONSULTATIONGENERAL CHECK UP ONLY - excludes consumables 100% CBT per beneficiary
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
100% CBT per adult beneficiary
ONE OPTOMETRIST CONSULTATION 100% Optical Assistant RatesMETABOLIC SCREENING FOR NEW BORN BABIES 100% Negotiated Rate per new born baby
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY) SEP plus a dispensing fee, limited to: Adults R2 040 - Child R3 400
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST 100% CBT per beneficiaryMELANOMA SCREENING TEST 100% CBT per adult beneficiary
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
DouBle PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON
REFERRAL FROM MEDICAL PRACTITIONER ONLY.ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-
AUTHORISATION
100% CBT
PATHOLOGYOUT OF HOSPITAL - PERFORMED BY A REGISTERED PATHOLOGIST AND
REFERRED BY A MEDICAL PRACTITIONER100% Negotiated Rate or CBT
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS
300% CBT for attending practitioners100% CBT for auxiliary services
MEDICATION 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
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
100% of cost subject to the overall limit of R 54 480 per beneficiary and subject to the following sub-limits:Hearing Aids: R 54 480Wheelchairs for Quadriplegics: R 54 480Standard Wheelchairs: R 34 750Insulin Pumps: R 35 460Other external appliances: R 11 610 • Baby Apnoea monitors: R 2 100 • Breast pumps: R 3 500
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
DouBle PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMIT
DAY TO DAY BENEFITSBENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT
Annual Overall LimitsAdult R 10 090Child R 7 050
GP’S, SPECIALISTS AND DENTISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE
PRACTITIONERS; BASIC DENTISTRY80% CBT
SPECIALISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERS80% CBT
ACUTE MEDICATIONINCLUDING INJECTIONS AND MATERIALS 80% SEP plus a dispensing fee
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT 80% CBT
NURSE VISITS 80% CBT up to 21 daysSUPPLEMENTARY HEALTH
AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS,
PODIATRY AND SPEECH THERAPY
80% CBT
ADVANCED DENTISTRYCROWNS, BRIDGES, ORTHODONTICS, DENTURES
80% CBT limited to:Mo R 10 090M1 R 14 450M2+ R 19 530
OVER THE COUNTER MEDICATION 80% SEP plus a dispensing fee, limited to R 1 500 per beneficiaryLASER K
NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS
IF THE LASER K BENEFIT IS UTILISED, NO SPECTACLE AND CONTACT LENSE BENEFIT ALLOWED FOR 2 YEARS
80% CBT limited to R3 790 per eye
ANTE-NATAL FOETAL SCANSPER PREGNANCY 4 Scans at 80% CBT
ANTE-NATAL CLASSES 80% CBT limited to R1 500 per pregnancy
SPECTACLES AND LENSESFROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE
STATED
Consultation: See Preventative WellnessAdd ons R 890Single vision R 890 - ORBifocal R 2 400 - ORVarifocal R 3 680 - ANDFrames R 2 460 - ORContact lenses R 3 400 Lenses & Add ons 80% Optical Assistant Rates and Frame 80% of Cost
DouBle PluSAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
MONTHLY RISK CONTRIBUTIONAdult R 2 659Child R 1 528
MONTHLY MSA CONTRIBUTIONAdult R 338Child R 214
TOTAL MONTHLY CONTRIBUTIONAdult R 2 997Child R 1 742
MONTHlY CONTRIBUTION RATES - DOUBlE PlUS
allIaNCe
BENEFIT OPTION QUICK SUMMARY - AllIANCE
aNy PrIVate hoSPItal: No limits, private wards
atteNDING Dr’s aND SPeCIalIStS: Up to 300% CBt
64 ChroNIC CoNDItIoNS medication and consultations. Includes unlimited appropriate biological drugs and specialised technology
uNlIMIteD X-rayS aND BlooD teStS IN and OUT of hospital including MRI and CT scans
SCreeNING BeNeFIt
3 MoNth post hospitalisation benefit
eXterNal aPPlIaNCeS: Wheelchair, hearing aid, breast pump, baby sleep monitor
CheCK-uPS aND VaCCINeS: GP, Specialist, Dental, Optometry, Dermatologist, ECG, Dietician
INFertIlIty R68 120 per family
IN HOSPITAL AND PRESCRIBED MINIMUM BENEFITSHOSPITAL ACCOMMODATION
INCLUDING CONFINEMENTS, SUBJECT TO PRE-AUTHORISATION 100% of Negotiated Rate in general ward and specialised units. Private ward for confinements (subject to availability)
ATTENDING DOCTORS AND SPECIALISTSCONSULTATIONS MEDICAL AND SURGICAL PROCEDURES
INCLUDING CONFINEMENTS
Up to 300% CBT 100% of Scheme Rate
AUXILIARY HEALTHCARE IN HOSPITAL(EG. PHYSIOTHERAPY AND PSYCHOTHERAPY) 100% CBT
BLOOD TRANSFUSIONS(IN AND OUT OF HOSPITAL) 100% of cost
RADIOLOGY IN HOSPITALADVANCED SCANS (MRI/CT/PET)
SUBJECT TO PRE-AUTHORISATION
100% CBT100% CBT
PATHOLOGYIN HOSPITAL 100% Negotiated Rate
INTERNAL PROSTHESIS SUBJECT TO PRE-AUTHORISATION 100% of cost
HOME NURSING UP TO 21 DAYS, SUBJECT TO PRE-AUTHORISATION 100% CBT
STEP DOWN APPROVED FACILITIES (ONLY, UP TO 90 DAYS) SUBJECT TO PRE-AUTHORISATION 100% Negotiated Rate
MEDICATIONIN HOSPITAL 100% SEP plus dispensing fee
TTO MEDICATIONUP TO ONE WEEK’S SUPPLY 100% SEP plus dispensing fee
INFERTILITY TREATMENT Treatment limited to R68 120 per family
SUBSTANCE ABUSE PMB applied to hospital based treatment and limited to one rehabilitation treatment per beneficiary per year, subject topre-authorisation and limited to 21 days
CHRONIC PMB CDL MEDICATIONAND TREATMENT - SUBJECT TO PRE-AUTHORISATION AND PROTOCOLS
REFER TO CHRONIC DISEASE LIST100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
PMB DTP TREATMENTOUT OF HOSPITAL TREATMENT SUBJECT TO REGISTRATION OF
CONDITION AND PRE-AUTHORISATIONMedication - SEP plus dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
ONCOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
SPECIALISED MEDICINE AND TECHNOLOGY SUBJECT TO PREAUTHORISATION AND PROTOCOLS Medication - 100% SEP plus a dispensing fee, subject to RP and DSP. Consultations and procedures - at cost
allIaNCeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
PREVENTATIVE WELLNESS COVER
CAMAF LIFESTYLE PROGRAMMEPER ADULT BENEFICIARY
INCLUDES: • Free health risk assessment at Clicks, Dischem or Pick n Pay pharmacy • Access to e|Care portal with online wellness solutions to monitor your health and promote balanced, healthy living • Comprehensive wellness report plus personalised health articles in weekly emails when you complete your wellness assessment online.
ONE GP CONSULTATION ONLYICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY 100% CBT per beneficiary
ONE SPECIALIST CONSULTATION ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY. GYNAECOLOGISTS,
UROLOGISTS, OR SPECIALIST PHYSICIANS**FOR BENEFICIARIES OVER 16 YEARS. PAEDIATRICIANS FOR
BENEFICIARIES UNDER 16 YEARS
100% CBT per beneficiary
PSYCHOTHERAPY 100% CBT limited to R9 450 per beneficiaryONE DIETICIAN CONSULTATION 100% CBT per beneficiary
ONE DENTISTRY CONSULTATIONGENERAL CHECK UP ONLY - excludes consumables 100% CBT per beneficiary
ECG(PERFORMED BY GP OR SPECIALIST PHYSICIAN**)
ICD 10 CODE SPECIFIC TO GENERAL CHECK UP ONLY - excludes consumables
100% CBT per adult beneficiary
ONE OPTOMETRIST CONSULTATION 100% Optical Assistant RatesMETABOLIC SCREENING FOR NEW BORN BABIES 100% Negotiated Rate per new born baby
IMMUNISATION(COST OF IMMUNISATION AND VACCINE ONLY) SEP plus a dispensing fee, limited to R4 100 per beneficiary
CERVICAL CANCER VACCINE(COST OF VACCINE ONLY)
Females between 9 and 16 years of age(SEP plus dispensing fee)
ONE HIV VCT TEST 100% CBT per beneficiaryMELANOMA SCREENING TEST 100% CBT per adult beneficiary
UMBILICAL STEM CELL HARVESTINGNegotiated 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.
allIaNCeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) NOT SUBJECT TO THE ANNUAL OVERALL BENEFIT LIMITBASIC AND ADVANCED RADIOLOGY
OUT OF HOSPITALMUST BE PERFORMED BY A REGISTERED RADIOLOGIST, ON
REFERRAL FROM MEDICAL PRACTITIONER ONLY.ADVANCED SCANS (MRI/CT/PET) SUBJECT TO PRE-
AUTHORISATION
100% CBT
PATHOLOGYOUT OF HOSPITAL - PERFORMED BY A REGISTERED PATHOLOGIST AND
REFERRED BY A MEDICAL PRACTITIONER100% Negotiated Rate or CBT
POST-HOSPITALISATION CONSULTATIONS AND TREATMENT UP TO 90 DAYS
300% CBT for attending practitioners100% CBT for auxiliary services
MEDICATION 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
EXTERNAL APPLIANCES IN AND OUT OF HOSPITAL - PURCHASE, HIRE AND MAINTENANCE
HEARING AIDS - 1 CLAIM PER 3 YEARCYCLE FOR OVER 16 YEARS OF AGE, YOUNGER THAN 16 YEARS
OF AGE - 18 MONTH CYCLEWHEELCHAIRS - 3 YEAR CYCLE
INSULIN PUMPS, SUBJECT TOPRE-AUTHORISATION - 4 YEAR CYCLE
BREAST PUMPS AND APNOEA MONITORS - THREE MONTHS PRIOR TO EXPECTED DUE DATE AND WITHIN SIX MONTHS AFTER THE
BIRTH OF THE BABY. SUBJECT TO REGISTRATION ON THE MOTHER TO BE PROGRAMME
100% of cost subject to the overall limit of R 68 120 per beneficiary and subject to the following sub-limits:Hearing Aids: R 68 120Wheelchairs for Quadriplegics: R 68 120Standard Wheelchairs: R 40 820Insulin Pumps: R 40 820Other external appliances: R 13 650 • Baby Apnoea monitors: R 2 100 • Breast pumps: R 3 500
INTERNATIONAL TRAVEL COVER 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. Pre-existing conditions are excluded.
NETCARE 911 EMERGENCY SERVICES Unlimited - Subject to Netcare 911 authorisation
allIaNCeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
OTHER BENEFITS (per Benef ic iary) SUBJECT TO THE ANNUAL OVERALL DAY-TO-DAY BENEFIT LIMIT
DAY TO DAY BENEFITSBENEFITS BELOW ARE SUBJECT TO THE OVERALL ANNUAL LIMIT
Annual Overall LimitsAdult R 25 780Child R 16 200
GP’S, SPECIALISTS AND DENTISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY THESE
PRACTITIONERS; BASIC DENTISTRY80% CBT
SPECIALISTSCONSULTATIONS, PROCEDURES AND RADIOLOGY PERFORMED BY
THESE PRACTITIONERS80% CBT
ACUTE MEDICATIONINCLUDING INJECTIONS AND MATERIALS 80% SEP plus a dispensing fee
CASUALTY AND OUT PATIENT TREATMENT AT A HOSPITAL ALL MEDICATIONS WILL BE PAID OUT OF ACUTE MEDICATION BENEFIT 80% CBT
NURSE VISITS 80% CBT up to 21 daysSUPPLEMENTARY HEALTH
AUDIOLOGY, CHIROPRACTORS, DIETICIANS, HOMOEOPATHS, OCCUPATIONAL THERAPY, PHYSIOTHERAPISTS, BIOKINETICISTS,
PODIATRY AND SPEECH THERAPY
80% CBT
ADVANCED DENTISTRYCROWNS, BRIDGES, ORTHODONTICS, DENTURES
80% CBT limited to:Mo R 13 520M1 R 20 230M2+ R 24 270
OVER THE COUNTER MEDICATION 80% SEP plus a dispensing fee, limited to R 3 400 per beneficiaryLASER K
NO APPROVAL FOR SURGERY WHERE SPECTACLES OBTAINED IN PREVIOUS 12 MONTHS
IF THE LASER K BENEFIT IS UTILISED, NO SPECTACLE AND CONTACT LENSE BENEFIT ALLOWED FOR 2 YEARS
80% CBT limited to R10 205 per eye
ANTE-NATAL FOETAL SCANSPER PREGNANCY 6 Scans at 80% CBT
ANTE-NATAL CLASSES 80% CBT limited to R2 040 per pregnancy
SPECTACLES AND LENSESFROM OPTOMETRIST ONLY ANNUAL BENEFIT, UNLESS OTHERWISE
STATED
Consultation: See Preventative WellnessAdd ons R 1 080Single vision R 1 360 - ORBifocal R 2 730 - ORVarifocal R 4 100 - ANDFrames R 5 420 - ORContact lenses R 6 830Lenses & Add ons 80% Optical Assistant Rates and Frame 80% of Cost
allIaNCeAll benefits listed below are annual, unless otherwise stated. Where a condition qualifies as a PMB and is registered with the Scheme, payment will be governed by the legislation set out in
the Regulations listed in the Medical Schemes Act.
MONTHLY RISK CONTRIBUTIONAdult R 4 015Child R 2 189
MONTHLY MSA CONTRIBUTIONAdult R 517Child R 240
TOTAL MONTHLY CONTRIBUTIONAdult R 4 532Child R 2 429
MONTHlY CONTRIBUTION RATES - AllIANCE
DOUBLE PLUSVITAL FIRST CHOICE
Totalmonthly contribution
Total Monthly Contribution
Adult R 1 718Child R 898
Monthly Risk Contribution
Principal R 1 328Adult R 1 056Child R 618
Monthly MSA Contribution
Principal R 440Adult R 351Child R 206
Total Monthly Contribution
Principal R 1 768Adult R 1 407Child R 824
Income Category
R 0 - R 14 910Principal R 1 146Adult R 9621st Child R 500(rest are free)
R 14 911 - R 20 000Principal R 1 361Adult R 1 0871st Child R 615(rest are free)
R 20 001 - R 30 000Principal R 1 624Adult R 1 264Child R 815
R 30 001 +Principal R 2 158Adult R 1 751Child R 1 065
Income Category
R 0 - R 7 720Adult R 763Child R 462
R 7 721 - R 14 910Adult R 1 211Child R 716
R 14 911 - R 20 000Adult R 1 811Child R 1 056
R 20 001 - R 30 000Adult R 2 250Child R 1 475
R 30 001 +Adult R 2 455Child R 1 600
Monthly Risk Contribution
Adult R 2 659Child R 1 528
Monthly MSA Contribution
Adult R 338Child R 214
Total Monthly Contribution
Adult R 2 997Child R 1 742
Monthly Risk Contribution
Adult R 4 015Child R 2 189
Monthly MSA Contribution
Adult R 517Child R 240
Total Monthly Contribution
Adult R 4 532Child R 2 429
ESSENTIAL PLUS NETWORK CHOICE ALLIANCE
http://www.camaf.co.za/products/products_calculator.htmlclick here
to link to our online calculator
MONTHlY CONTRIBUTION RATES
CHRONIC DISEASE lIST - PMB CDl Conditions - All OptionsCoNDItIoN CoNSultatIoNS leVel oF CoNSultatIoN CoVer
ADDISON’S DISEASE General Practitioner (GP), Physician, Paediatrician, Endocrinologist 100% COST
ASTHMA* GP, Physician, Pulmonologist, Paediatrician, Physiotherapist 100% COST
BIPOlAR MOOD DISORDER* Psychiatrist, Clinical Psychologist, Social Worker 100% COST
BRONCHIECTASIS* GP, Physician, Pulmonologist, Physiotherapist 100% COST
CARDIAC FAIlURE GP, Physician, Cardiologist, Dietician 100% COST
CARDIOMYOPATHY GP, Physician, Cardiologist, Dietician 100% COST
CHRONIC OBSTRUCTIVE PUlMONARY DISORDER (COPD)* GP, Physician, Pulmonologist, Physiotherapist 100% COST
CHRONIC RENAl DISEASE GP, Physician, Urologist, Dietician 100% COST
CORONARY ARTERY DISEASE GP, Physician, Cardiologist, Dietician 100% COST
CROHN’S DISEASE GP, Gastroenterologist, Dietician, Physician 100% COST
DIABETES INSIPIDUS GP, Physician, Urologist, Paediatrician, Endocrinologist 100% COST
DIABETES MEllITUS (TYPE 1 AND TYPE 2)*** GP, Physician, Paediatrician, Ophthalmologist, Dietician, Podiatrist, Endocrinologist 100% COST
DYSRHYTHMIA GP, Physician, Cardiologist, Paediatrician 100% COST
EPIlEPSY GP, Physician, Neurologist, Occupational Therapist, Speech Therapist, Physiotherapist, Paediatrician 100% COST
GlAUCOMA GP, Physician, Ophthalmologist 100% COST
HAEMOPHIlIA A & B GP, Physician, Paediatrician, Haematologist 100% COST
HIV/AIDS** GP, Physician, Paediatrician 100% COST
HYPERlIPIDAEMIA* GP, Physician, Cardiologist, Paediatrician, Dietician 100% COST
HYPERTENSION* GP, Physician, Cardiologist, Dietician 100% COST
HYPOTHYROIDISM GP, Physician, Paediatrician 100% COST
MUlTIPlE SClEROSIS GP, Physician, Neurologist, Ophthalmologist, Urologist, Occupational Therapist, Physiotherapist 100% COST
PARKINSON’S DISEASE GP, Physician, Neurologist 100% COST
RHEUMATOID ARTHRITIS GP, Physician, Ophthalmologist, Orthopaedics, Rheumatologist, Paediatrician 100% COST
SCHIZOPHRENIA* Psychiatrist, Clinical Psychologist, Social Worker, Occupational Therapist 100% COST
SYSTEMIC lUPUS ERYTHEMATOSIS GP, Physician, Dermatologist, Paediatrician, Rheumotologist 100% COST
UlCERATIVE COlITIS Gastroenterologist, Dietician, GP, Physician, Rheumotologist 100% COST
In terms of the Medical Schemes Act Regulations that came into effect on 1 January 2004, Medical Schemes are required to fund the cost of the diagnosis, medical management (consultations and procedures) and medication of the specified list of chronic conditions. All of these conditions are covered by CAMAF
CHRONIC DISEASE lIST - Additional Chronic Conditions- Alliance, Double Plus and Vital options
CoNDItIoN CoNSultatIoNS leVel oF CoNSultatIoN CoVerADHD (Alliance only) Paediatrician, Neurologist, Psychiatrist 100% CBTAGRANUlOCYTOSIS Physician 100% CBTAllERGIC RHINITIS GP, Ear Nose and Throat Specialist (ENT), Paediatrician 100% CBTAlZHEIMER’S DISEASE Neurologist, Psychiatrist 100% CBTANAEMIAS: APlASTIC, HAEMOlYTIC, SICKlE CEll Physician 100% CBTANKYlOSING SPONDYlITIS Physician, Rheumatologist 100% CBTBENIGN PROSTATIC HYPERTROPHY Urologist 100% CBTCHRONIC GRANUlOMATOUS DISEASE Physician 100% CBTCOAGUlATION DISORDERS Cardiologist, Physician, Clinical Haemotologist 100% CBTCONGENITAl HEART MAlFORMATIONS Physician, Cardiologist, Paediatrician 100% CBTCYSTIC FIBROSIS Physician, Physiotherapist, Pulmonologist, Paediatrician, GP 100% CBTDEEP VEIN THROMBOSIS Physician 100% CBTDEPRESSION (includes First Choice and Essential Plus) GP, Psychiatrist, Clinical Psychologist, Social Worker 100% CBTECZEMA Dermatologist, GP 100% CBTENDOMETRIOSIS Gynaecologist 100% CBTGASTRO-OESOPHAGEAl REFlUX DISEASE (GORD) GP, Gastroenterologist, Physician, Paediatrician 100% CBTGAUCHERS DISEASE Physician, Paediatrician 100% CBTGOUT PROPHYlAXIS GP 100% CBTHORMONE REPlACEMENT GP 100% CBTHYPERPARATHYROIDISM Physician 100% CBTHYPERTHYROIDISM GP, Paediatrician 100% CBTMENIERE’S DISEASE GP, Ear Nose and Throat Specialist (ENT) 100% CBTMIGRAINE PROPHYlAXIS GP, Neurologist 100% CBTMUSCUlAR DYSTROPHY Neurologist, Physician, Paediatrician 100% CBTMYASTHENIA GRAVIS Physician 100% CBTNARCOlEPSY Neurologist 100% CBTORGAN TRANSPlANT Appropriate multi disciplinary team 100% CBTOSTEOARTHRITIS Physician, Rheumatologist, GP 100% CBTOSTEOPOROSIS Physician, Gynaecologist, GP 100% CBTPlEGIA; HEMI, PARA & QUAD Physician, Orthopaedic Surgeon, Physiotherapist, Urologist, Neurologist, Occupational Therapist, Paediatrician, Speech Therapist, GP 100% CBTPOlYCYSTIC OVARIAN SYNDROME Gynaecologist 100% CBTPSORIASIS Dermatologist 100% CBTRESTRICTIVE lUNG DISEASE Pulmonologist, Physician 100% CBTTHAlASSAEMIA Physician 100% CBTTRANSIENT ISCHAEMIC ATTACK / STROKE Physician, Neurologist 100% CBTTUBERCUlOSIS GP 100% CBTVAlVUlAR HEART DISEASE Physician, Cardiologist, Paediatrician 100% CBT
BENEFIT OPTION CHANGE 2016
What makes CAMAF truly unique is the combinationof excellent cover, unmatched service and support and our real
commitment to ensuring that in both good times and bad,we’re here for our members.
Nurture your health2016
BeNeFIt oPtIoN ChaNGe
What makes CAMAF truly unique is the combination
of excellent cover, unmatched service and support and our real
commitment to ensuring that in both good times and bad,
we’re here for our members.
Nurture your health2016BeNeFIt oPtIoN ChaNGe
click here
to change your Benefit Option for 2016
ICD10 CODES 2016BeNeFIt PraCtICe tyPe ICD 10 CODES ICD 10 DESCRIPTIONGP Consultation GP (14) Z00.0 General Medical Examination
Z00.1 Routine Child Health ExaminationZ00.8 Other General ExaminationsZ01.3 Examination Of Blood PressureZ01.4 Gynaecological Examination (General)(Routine)Z10.8 Routine General Health Check-Up Of Other Defined SubpopulationsZ12.4 Special Screening Examination For Neoplasm Of CervixZ12.5 Special Screening Examination For Neoplasm Of ProstateZ13.1 Special Screening Examination For Diabetes MellitusZ13.6 Special Screening Examination For Cardiovascular Disorders
Specialist Consultation Paediatrician (32) Z00.0 General Medical ExaminationZ00.1 Routine Child Health ExaminationZ00.8 Other General ExaminationsZ10.8 Routine General Health Check-Up Of Other Defined Subpopulations
Specialist Consultation Gynaecologist (16) Z00.0 General Medical ExaminationSpecialist Physician (18) Z00.8 Other General ExaminationsUrologist (46) Z01.3 Examination Of Blood Pressure
Z01.4 Gynaecological Examination (General)(Routine)Z10.8 Routine General Health Check-Up Of Other Defined SubpopulationsZ12.4 Special Screening Examination For Neoplasm Of CervixZ12.5 Special Screening Examination For Neoplasm Of ProstateZ13.1 Special Screening Examination For Diabetes MellitusZ13.6 Special Screening Examination For Cardiovascular Disorders
Melanoma Screening Dermatologist (12) Z12.8 Special Screening Examination for Neoplasm of other sitesZ12.9 Special Screening Examination for Neoplasm, unspecifiedD22.0 Melanocytic naevi of lipD22.1 Melanocytic naevi of eyelid, including canthusD22.2 Melanocytic naevi of ear and external auricular canalD22.3 Melanocytic naevi of other and unspecified parts of faceD22.4 Melanocytic naevi of scalp and neckD22.5 Melanocytic naevi of trunkD22.6 Melanocytic naevi of upper limb, including shoulderD22.7 Melanocytic naevi of lower limb, including hipD22.9 Melanocytic naevi, unspecified
CONTACT USLIFESENSE (HIV DISEASE MANAGEMENT PROGRAMME)24 Hour Call Centre 0860 506 080E-mail [email protected] PROGRAMMETelephone 0860 100 544E-mail [email protected] 911Emergency Number 082 911Telephone 011 254 1911Fax 011 254 1950Namibia 09264 61 230 612PMB DTP AUTHORISATIONFax 011 707 8866E-mail [email protected] PROGRAMMETelephone 0861 700 600 (Option 3)Fax 011 707 8622E-mail [email protected] 0861 700 600 (Option 4)Fax 011 707 8747E-mail [email protected] (LOYALTY PROGRAMME)General Enquires 0861 886 600E-mail [email protected] www.momentum.co.za/multiplyINTERNATIONAL TRAVEL INSURANCE DESKTelephone 0860 100 484 (RSA) or +27 (0)11 521 4000 (International)FOR FIRST CHOICE AND NETWORK CHOICE MEMBERS ONLYPPN CALL CENTRETelephone 0860 103 529Post Claims To PO Box 12450, Centrahil, 6006Website www.ppn.co.za
CAMAFClient Relations 0860 100 545E-mail [email protected] 0861 113 676Reception 0861 700 600Hospital Pre-authorisations 0860 100 544Hospital Pre-authorisations Fax 011 706 9946Hospital Pre-authorisations E-mail [email protected] Pre-authorisations Online www.camaf.co.zaWebsite www.camaf.co.zaMembership Fax 011 707 8735Post Claims to: PO Box 2964, Randburg, 2125CAMAF LIFESTYLE PROGRAMMETelephone 0860 200 911E-mail [email protected]/ONCOLOGY DISEASE MANAGEMENT PROGRAMMETelephone 011 707 8461Fax 011 707 8466E-mail [email protected] SUPPORT LINETelephone 0860 100 544CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) DISEASE MANAGEMENT PROGRAMMEEmergency Contact Number 082 456 7844General Enquires 011 712 6000Website www.cdecentre.co.zaCHRONIC CONDITION AUTHORISATIONTelephone for:Doctors and Pharmacists only 0800 200 300Members 0861 700 600 (Option 3)Fax 011 707 8622E-mail [email protected] WELLNESS PROGRAMMETelephone 0860 100 544Fax 011 707 8747E-mail [email protected] AND HYPERLIPIDEMIA PROGRAMMETelephone 0861 700 600 (Option 3)Fax 011 707 8622E-mail [email protected]