

Simple, cost-effective cover
A cost-effective solution with essential in-hospital cover and basic chronic, wellness and supplementary benefits.

Day-to-day Benefits
- No Primary Care Benefits.
- No Personal Medical Savings Account.
Managed Care Benefits
- Chronic Medicine Benefits.
- Mental Health Programme.
- Back and Neck Rehabilitation Programme.
- Oncology Programme.
- HIV/AIDS Management Programme.
- Active Disease Risk Management Programme.
- Mother and Baby Care Programme
Hospital Benefits
- Sub-limits apply:
- Basic pathology: Subject to the Overall Annual Limit and Managed Care protocols.
- Basic radiology: Unlimited Subject to the Overall Annual Limit and Managed Care protocols.
- Physiotherapy: R6 710 per family per benefit year.
- Quro (home-based monitoring service) Medical benefit. This benefit allows you to return home from hospital sooner. Member can recover in their own home while still being closely monitored 24 hours-a-day by a team of medical professionals.
NOTE: Under the Hospital, Network and Network SELECT Plans, certain elective procedures, including hip, knee, shoulder and elbow replacements, are not covered, other than in accordance with Prescribed Minimum Benefits.
Supplementary Benefits
- Specialised Radiology R17 900 pfpa (co-payment of R1 500 per scan for non-PMBs).
- Ultrasound scans (non-pregnancy): R6 080 per family.
Maternity Benefits
- If you are on the Hospital Plan, you will not have out-of-hospital maternity benefits, but you will receive educational support and relevant contact information.
- Delivery in-hospital will be subject to pre-authorisation and managed care protocols.
- A Doula (birthing coach): as part of the in-hospital maternity benefit, subject to a limit of R3 030 per pregnancy, specifically for the confinement (delivery). No post-natal/out-of-hospital follow-ups.
Chronic Benefits
- Specialised Radiology R17 900 pfpa (co-payment of R1 500 per scan for non-PMBs).
- Ultrasound scans (non-pregnancy): R6 080 per family.
Wellness Benefits
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- Pharmacy-based health-screening tests: Blood pressure, blood glucose, cholesterol, HIV/AIDS, BMI. One of each screening test per beneficiary per benefit year.
- Pharmacy-based vaccines: One flu vaccine per beneficiary per benefit year, one pneumococcal vaccine per lifetime.
- Contraceptive benefit: R3 780 per beneficiary per benefit year. R2 370 sub-limit for oral contraceptives.
- Non-pharmacy based benefits:
*NEW! One consultation per beneficiary per benefit year with a GP paid at 100% of MSR or a Gynaecologist or a Urologist or a Dermatologist paid at 200% of MSR from the Wellness benefit for any of the following non-pharmacy screenings benefits: - One Pap smear, Mammogram, Syphilis and Chlamydia infection screening, limited to 1 test per female beneficiary, including consultation with a Gynaecologist or General Practitioner. (Please note for the Pap smear, Mammogram and Syphilis and Chlamydia screening, only one Gynaecologist.
- Colorectal screening, limited to one test per beneficiary per benefit year.
- One health risk assessment per beneficiary per benefit year for services rendered by a registered healthcare practitioner (such as a General Practitioner). It is very important that your service provider uses the correct ICD-10 code to claim for these benefits.
- Nutritional assessment and healthy eating plan – Access to Universal network of dieticians for annual assessment, healthy eating plan prescription and regular monitoring.
- Childhood immunisations – Applicable for children up to the age of 12 years, as per recommendation of the Department of Health.
- Pre-school eye and hearing screening – For children aged 5 and 6.
- Hearing screening for newborns up to six weeks.
- PAED-IQ’s Babyline: A 24/7, paediatric telephone service, whereby parents or caregivers of children from birth to three years of age registered on the Fund can phone in and get up-to-date child healthcare advice and reassurance.
- COVID-19 Benefit Package: Any beneficiary who tested positive for COVID-19 will be able to access the following: Pulse oximeter, Nebuliser, Oxygenator, Thermometer, 2 GP consultations and Chest physiotherapy. Pre-authorisation and managed care protocols apply.
- Dental caries (prevention and oral fluoride supplementation): limited to beneficiaries up to age 6 years, subject to Managed Care Protocols, including oral-hygienist consultation.
- COVID-19 Vaccine: Vaccinations for all eligible beneficiaries in accordance with the Department of Health recommendation.
- Dermatologist Consultation – limited to 1 consultation for cancer screening per beneficiary every 2 years, for beneficiaries 35-years and older.
- Bone Density Scan – limited to 1 bone density scan per beneficiary, per annum.
- *NEW! HPV vaccine has been extended to all females up to the age of 26 years.
What are my monthly contributions?
An entry-level Plan that offers Hospital benefits, Basic Chronic Benefits and Wellness Screenings.
Ready to make a decision?
Download and email your completed form to
membership@omsmaf.co.za or call 0860 100 076 for assistance.