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
- Primary healthcare benefits via Universal Healthcare Network Provider.
- Annual Flexi Benefit (AFB), subject to R8 370 per beneficiary per benefit year and R14 000 per family per benefit year.
- Annual Flexi Benefit (AFB) for pathology, radiology, optometry, psychology and auxiliary services.
- GP consultations.
- Basic dentistry.
- Prescribed (acute) Medicines.
- Specialists consultations.
- 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).
- 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 R19 400 per family, with a co-payment of R1 500 per authorisation for non-PMB’s).
- In-hospital Ultrasound benefit (non-pregnancy) R6 580 per family.
- Out-of-Hospital Ultrasound benefit (non-pregnancy): requested by Universal Healthcare Network GP and subject to Universal Healthcare Protocols and limited to available AFB.
Maternity Benefits
- All pregnant beneficiaries have to register on the Mother and Baby Care Programme.
- Antenatal classes: R1 750 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 410 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 270 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:
- Flu vaccine – Limited to 1 vaccination per beneficiary.
- Pneumococcal vaccine – Limited to 2 vaccinations per beneficiary per lifetime and where clinically appropriate.
- HPV vaccine has been extended to all females up to the age of 26 years.
- Contraceptive benefit: R4 090 per beneficiary. R2 560 sub-limit for oral contraceptives.
- 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:
- Pap Smear and HPV PCR tests: limited to 1 pap smear and 1 HPV PCR test every 3 years per female beneficiary.
- Mammogram – limited to 1 test per female beneficiary.
- Syphilis and Chlamydia infection screening – limited to 1 test per female beneficiary.
- Please note for the Pap smear, HPV PCR test, Mammogram and Chlamydia screening, only one Gynaecologist consultation per benefit year will be funded from the Screening Benefit.
- Prostate Specific Antigen – limited to 1 test per male beneficiary, including consultation with General Practitioner or Urologist.
- Colorectal screening – limited to one fecal sample pathology test per beneficiary.
- Health Risk Assessment – limited to 1 test per beneficiary.
- Audiology screening – limited to 1 test per beneficiary up to the age of 6 weeks.
- OMSMAF Nurture – a structured, proactive and personalised mother and baby programme, powered by Baby Yum Yum, providing support during pregnancy and early parenting.
- Nutritional assessment and healthy eating plan – Access to Universal Network of Dieticians – subject to pre-authorisation and registration – for annual assessment, healthy eating plan prescription and regular monitoring.
- Pre-School readiness – Eye and hearing screening for children aged 5 and 6.
- Dental caries (prevention and oral fluoride supplementation) – limited to beneficiaries up to age 6 years, subject to Managed Care Protocols, by oral hygienist consultation.
- Childhood immunisations – Children up to the age of 12 years, as per recommendation by the Department of Health.
- Dermatologist Consultation – limited to 1 consultation for cancer screening per beneficiary every year, 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.
- 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 test 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.