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SAVINGS

A simple cover solution with a savings account. Get limited in-hospital cover, basic chronic, wellness, supplementary and day-to-day benefits, with the added benefit of a personal medical savings account.

DAY-TO-DAY BENEFITS

  • Limited to Personal Medical Savings Account only, no PCB limits
  • At 100% of cost from PMSA and then from accumulated savings, subject to available funds
  • The following services are covered at cost from your PMSA or accumulated savings, subject to available funds:
    • GP and specialist consultations
    • Pathology
    • Radiology
    • Acute medicine paid at 100% of cost or Medicine Price, whichever is the lesser
    • Dentistry
    • Optometry
    • Psychology and psychiatry
    • Physiotherapy
    • Auxiliary services
    • 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

Annual Limit (OAL): R750 000 per beneficiary per benefit year

  • R1 500 000 per family per benefit year for hospital benefits (HB), subject to certain sub-limits
  • Unlimited Prescribed Minimum Benefits (PMB) is obtained from a Designated Service Provider (DSP)
  • Oncology covered within ICON Enhanced Protocols

Sub-limits apply:

  • Basic pathology: R18 000 per family per benefit year
  • Basic radiology: R24 250 per family per benefit year
  • Physiotherapy: R5 300 per family per benefit year

SUPPLEMENTARY BENEFITS

  • Paid at 1 x MSR
  • Ultrasound scans in and out of hospital
  • Specialised Radiology in and out of hospital
  • Maternity benefit

CHRONIC BENEFITS

Non-PMB conditions: A limit of R5 030 per family

  • Chronic Hepatitis, Depression, Macular Degeneration and Oedema, Anxiety and Post-Traumatic Stress Disorder only
  • Subject to Maximum Medical Aid Price (MMAP) or the Medicine Price
  • For other conditions, subject to available PMSA or, thereafter, accumulated savings

PMB Conditions:

  • Unlimited, subject to the Universal restrictive formulary and approval.

MATERNITY BENEFITS

  • All pregnant beneficiaries have to register on the Mother and Baby Care Programme
  • Antenatal classes: R1 280 per family per benefit year
  • Antenatal visits: R3 020 per pregnancy
  • Ultrasound scans (pregnancy): Two 2-D scans per beneficiary
  • Out-of-hospital pathology tests (pregnancy): R2 490 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

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 (available from Clicks, Dis-Chem and Pick n Pay Pharmacy clinics)
  • Contraceptive benefit: R2 990 per beneficiary per benefit year. R1 880 sub-limit for oral contraceptives
  • Non-pharmacy based benefits:
    • One pap smear and mammogram per female beneficiary per benefit year
    • One prostate 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
  • 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

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 Benef

WANT TO KNOW MORE?

Click here for the full membership guide.

Home | PLANS | SAVINGS

SAVINGS

A simple cover solution with a savings account. Get limited in-hospital cover, basic chronic, wellness, supplementary and day-to-day benefits, with the added benefit of a personal medical savings account.

DAY-TO-DAY BENEFITS

  • Limited to Personal Medical Savings Account only, no PCB limits
  • At 100% of cost from PMSA and then from accumulated savings, subject to available funds
  • The following services are covered at cost from your PMSA or accumulated savings, subject to available funds:
    • GP and specialist consultations
    • Pathology
    • Radiology
    • Acute medicine paid at 100% of cost or Medicine Price, whichever is the lesser
    • Dentistry
    • Optometry
    • Psychology and psychiatry
    • Physiotherapy
    • Auxiliary services
    • 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

Annual Limit (OAL): R750 000 per beneficiary per benefit year

  • R1 500 000 per family per benefit year for hospital benefits (HB), subject to certain sub-limits
  • Unlimited Prescribed Minimum Benefits (PMB) is obtained from a Designated Service Provider (DSP)
  • Oncology covered within ICON Enhanced Protocols

Sub-limits apply:

  • Basic pathology: R18 000 per family per benefit year
  • Basic radiology: R24 250 per family per benefit year
  • Physiotherapy: R5 300 per family per benefit year

SUPPLEMENTARY BENEFITS

  • Paid at 1 x MSR
  • Ultrasound scans in and out of hospital
  • Specialised Radiology in and out of hospital
  • Maternity benefits

CHRONIC BENEFITS

Non-PMB conditions: A limit of R5 030 per family

  • Chronic Hepatitis, Depression, Macular Degeneration and Oedema, Anxiety and Post-Traumatic Stress Disorder only
  • Subject to Maximum Medical Aid Price (MMAP) or the Medicine Price
  • For other conditions, subject to available PMSA or, thereafter, accumulated savings

PMB Conditions:

  • Unlimited, subject to the Universal restrictive formulary and approval.

MATERNITY BENEFITS

  • All pregnant beneficiaries have to register on the Mother and Baby Care Programme
  • Antenatal classes: R1 280 per family per benefit year
  • Antenatal visits: R3 020 per pregnancy
  • Ultrasound scans (pregnancy): Two 2-D scans per beneficiary
  • Out-of-hospital pathology tests (pregnancy): R2 490 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.

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 (available from Clicks, Dis-Chem and Pick n Pay Pharmacy clinics)
  • Contraceptive benefit: R2 990 per beneficiary per benefit year. R1 880 sub-limit for oral contraceptives
  • Non-pharmacy based benefits:
    • One pap smear and mammogram per female beneficiary per benefit year
    • One prostate 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
  • 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

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 Benef

WANT TO KNOW MORE?

Click here for the full membership guide.