Simple cover with benefits
Get essential in-hospital cover, basic chronic, wellness and supplementary benefits, as well as basic day-to-day benefits.
Day-to-day Benefits
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Primary healthcare benefits via Universal Healthcare Network Provider.
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Annual Flexi Benefit (AFB), subject to R8 080 per beneficiary per benefit year and R13 500 per family per benefit year.
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Annual Flexi Benefit (AFB) for pathology, radiology, optometry, psychology and auxiliary services.
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GP consultations.
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Basic dentistry.
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Prescribed (acute) Medicines.
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Specialists consultations.
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Specified procedures in doctors rooms.
Managed Care Benefits
The Old Mutual Staff Medical Aid Fund aims to identify and manage beneficiaries’ disease risks. The Fund has a number of programmes that form part of the Managed Care approach.
- Back and Neck Rehabilitation Programme.
- Oncology Benefit Management Programme.
- HIV and AIDS Management Programme.
- Mental Health Programme.
- Active Disease Risk Management Programme.
- Mother and Baby Care Programme.
Hospital Benefits
Unlimited Overall Annual Limit (subject to certain sub-limits).
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- UNLIMITED Prescribed Minimum Benefits (PMB).
- Certain elective procedures, including hip, knee, shoulder and elbow replacements, are not covered, other than in accordance with Prescribed Minimum Benefits.
- Quro Medical – Hospital at Home.
Supplementary Benefits
- Specialised Radiology R18 700 per family, with a co-payment of R1 500 per authorisation for non-PMB’s).
- Utrasound scans (non-pregnancy) R6 350 per family.
Maternity Benefits
- All pregnant beneficiaries have to register on the Mother and Baby Care Programme.
- Antenatal classes: R1 690 per family per benefit year.
- Antenatal visits: 8 visits per pregnancy, paid at MSR.
- Ultrasound scans (pregnancy): Two 2-D scans per beneficiary.
- Out-of-hospital pathology tests (pregnancy): Refer to the Maternity Booklet on the website www.omsmaf.co.za for list of specific pregnancy related blood tests. R3 290 per family.
- Antenatal vitamins: MMAP or medicine price, subject to prescription from an approved list and Formulary and included in the Overall Annual Limit. Please refer to the Maternity Booklet on the website www.omsmaf.co.za for list of vitamins.
- A Doula (birthing coach): Benefit limited to R3 160 per pregnancy, specifically for the confinement (delivery). No post-natal/ out-of-hospital follow-ups.
- Lactation Nurse Consultation : Out-of-Hospital Benefit to access a lactation nurse for a maximum of 8 sessions within 2 weeks of discharge from hospital, paid at MSR to help establish breast feeding.
Chronic Benefits
(Medicine formularly applies.)
- Registration and approval required and medicine subject to the Universal Healthcare Network Formulary.
Wellness Benefits
- 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 950 per beneficiary. R2 470 sub-limit for oral contraceptives. HPV vaccine has been extended to all females up to the age of 26 years.
- Non-pharmacy based benefits: 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 consultation will be funded.
- 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 performed by a Radiology laboratory, similar to a Mammogram, no additional GP or Specialist consultations will be covered other than one GP or Specialist Wellness Consultation per beneficiary, per annum.
- *NEW! Wellness Maximiser Benefit – 2 virtual GP consultations (incl. the cost of acute medicine) per family and unlimited nurse advice online chats via the Universal.one App. Only available once all adult beneficiaries have completed all their Pharmacy-based Wellness Screening tests and available Day-to-Day benefits being depleted.
What are my monthly contributions?
Network and Network SELECT Plan
A value-for-money Plan that offers Hospital benefits, Primary Care Benefits at a Network Provider, Wellness Screenings, and an enhanced benefit to manage chronic conditions, among others, all at an affordable rate for those in lower income groups. The non-PMB chronic conditions were reduced and are now aligned to the Hospital Plan. Only mental-health related conditions are covered.
Simple cover with benefits at a lower cost
Get all the cover of Network for a more cost-effective monthly contribution, based on a restriction to select hospital providers.
Ready to make a decision?
Download and email your completed form to
membership@omsmaf.co.za or call 0860 100 076 for assistance.