

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 R7 740 per beneficiary per benefit year and R12 900 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.
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- 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
Overall Annual Limit (OAL): R1 000 000 per beneficiary per benefit year (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 R17 900 pfpa (co-payment of R1 500 per scan for non-PMB’s).
- Utrasound scans (non-pregnancy) R6 080 pfpa.
- Antenatal visit: 8 visits per pregnancy, paid at MSR.
- Antenatal classes: R1 620 pfpa.
- Antenatal vitamins as per the approved list and prescription, subject to registration on the Mother and Baby Programme.
Maternity Benefits
- All pregnant beneficiaries have to register on the Mother and Baby Care Programme.
- Antenatal classes: R1 620 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): R3 150 per family per benefit year.
- Antenatal vitamins: 100% of MMAP or Medicine Price, whichever is the lesser, subject to the prescription from an approved list and included in the Hospital Benefit.
- 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).
Chronic Benefits
(Medicine formularly applies.)
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- 27 PMB chronic conditions PLUS 10 additional DTP chronic conditions.
- Additional 6 non-PMB chronic conditions managed by your network GP.
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 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 consultation per benefit year will be funded from the Screening Benefit.)
- One prostate specific antigen test per male beneficiary.
- 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.
- Over-the-Counter medication available at your Universal Healthcare Pharmacy Network, subject to Network formulary, MMAP and limited to R400 per family and R110 per event.
- *NEW! HPV vaccine has been extended to all females up to the age of 26 years.
- NOTE: Please ask the General Practitioner, Gynaecologist or Urologist (whichever is applicable) to submit the wellness consultation claim using the following primary ICD-10 code: Z00.0. If this code is not used, the benefit will be paid from your available Day-to-Day Benefit.
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.
Ready to make a decision?
Download and email your completed form to
membership@omsmaf.co.za or call 0860 100 076 for assistance.