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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 900 per family per benefit year
  • Basic radiology: R25 400 per family per benefit year
  • Physiotherapy: R5 550 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 270 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 340 per family per benefit year
  • Antenatal visits: R3 160 per pregnancy
  • Ultrasound scans (pregnancy): Two 2-D scans per beneficiary
  • Out-of-hospital pathology tests (pregnancy): R2 610 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: R3 130 per beneficiary per benefit year. R1 970 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
    • 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 to 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

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 Benefits

WANT TO KNOW MORE?

Click here for the full membership guide.

  1. Home
  2.  | 
  3. PLANS
  4.  | 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

Unlimited overall annual limit (subject to certain sub-limits)

    • Unlimited Prescribed Minimum Benefits (PMB) is obtained from a Designated Service Provider (DSP)
    • Oncology covered within ICON Enhanced Protocols
    • 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: R5790 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.

    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 500 per family

    • Chronic Hepatitis, Depression, Macular Degeneration and Oedema, Anxiety and Post-Traumatic Stress Disorder, Acne, Allergic Rhinitis, Cardiac Arrhythmia, Gout, Female Hormone Replacement Therapy, Migraine and Oestoarthritis.
    • 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 400 per family per benefit year
    • Antenatal visits: R3 300 per pregnancy
    • Ultrasound scans (pregnancy): Two 2-D scans per beneficiary
    • Out-of-hospital pathology tests (pregnancy): R2 720 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
      • Contraceptive benefit: R3 260 per beneficiary per benefit year. R2 050 sub-limit for oral contraceptives
      • Non-pharmacy based benefits:
      • One pap smear and mammogram per female beneficiary per benefit year
      • 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.
      • COVID-19 Vaccine: 1 vaccination per eligible adult beneficiary.
      • Fitness Assessment and Exercise Prescription benefit: Only available on the Traditional and Traditional Plus Plans, members will have access to the Universal Healthcare network of Biokineticists, who will assess the members’ needs and prescribe a relevant exercise plan that can be filled at a contracted fitness facility. This benefit will be paid from the Wellness Benefit. It is subject to registration on the program and Universal Healthcare protocols.

      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

      WANT TO KNOW MORE?

      Click here for the full membership guide.

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