Complete cover
Get fully comprehensive, unlimited in-hospital cover, comprehensive chronic and supplementary benefits, enhanced wellness benefits and comprehensive day-to-day benefits.
Day-to-day Benefits
- PMSA is used to pay for day-to-day medical services such as GPs, dentistry, acute medicine etc.
- Paid from Personal Medical Savings Account at cost; then from PCB at 1 x MSR.
- Unused PMSA carries over to the new benefit year and becomes accumulated savings.
- Primary Care Benefit (PCB) is used similar to the PMSA when you’ve run out of PMSA.
- Any unused PCB does not carry over.
- PMSA can be used to purchase vitamins.
- Accumulated Savings can be used for frail care from registered frail care facilities.
Managed Care Benefits
Members have access to treatment plans and chronic medication for the medical management of their PMB conditions.
-
- Chronic Medicine Benefits.
- Mental Health Programme.
- Back and Neck Rehabilitation Programme.
- Oncology Programme.
- HIV/AIDS Management Programme.
- Active Disease Risk Management Programme.
- Mother and Baby Care Programme.
Hospital Benefits
Unlimited overall annual limit (subject to certain sub-limits)
- Basic pathology: Subject to the Overall Annual Limit and Managed Care protocols.
- Basic radiology: Subject to the Overall Annual Limit and Managed Care protocols.
- Physiotherapy: Subject to the Overall Annual Limit and Managed Care protocols.
- 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 from Risk and not from your Day-to-Day Benefits.)
- Medical Appliance Sub-limit of R13 200 per family. (Comprehensive, paid at 1 x MSR).
- Foot Orthotics R5 970 per family (subject to overall limit).
- Hearing Aids R15 000 per ear per beneficiary, subject to a co-payment of 10% Benefit is available every 3 years for those under the age of 7 and those over 85 years and every 5 years for beneficiaries between the ages of 7 and 84 years.
- Specialised Radiology R23 900 per family, with a co-payment of R1 500 per authorisation (non-PMBs).
- In-hospital Ultrasound benefit (non-pregnancy) R9 780 per family.
- Out-of-Hospital Ultrasound benefit (non-pregnancy): Subject to available day-to-day benefits.
- Refractive Procedures MSR or cost, whichever is the lesser, up to a sub-limit of R21 000 per beneficiary.
- Maternity Benefits refer to member guide for full benefit structure.
- Dental implants R19 900 per family. Subject to a 20% Co-payment.
- A R1 500 co-payment will apply for all Fund-approved dental admissions to hospital.
Maternity Benefits
- All pregnant beneficiaries have to register on the Mother and Baby Care Programme.
- Antenatal classes: R2 750 per family per benefit year.
- Antenatal visits: 12 visits per pregnancy, paid at MSR.
- Ultrasound scans: Two 2-D scans per beneficiary.
- Out-of-hospital pathology tests (pregnancy): R4 260 per family per benefit year: Refer to the Maternity Booklet on the website www.omsmaf.co.za for list of specific pregnancy related blood tests.
- Antenatal vitamins: 100% of MMAP or Medicine Price, subject to prescription from an approved list and included in the Hospital Benefit. Please refer to the Maternity Booklet on the website www.omsmaf.co.za for list of vitamins.
- A Doula (birthing coach): as part of the in-hospital maternity benefit, subject to a limit of R3 270 per pregnancy for delivery only.
- 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
Additional non-PMB Chronic limit.
- R16 800 per family. MMAP and out-of-formulary co-payments will still apply to medicine that is pre-approved.
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?
Traditional and Traditional SELECT Plan
Offers Comprehensive Benefits for a variety of Healthcare Services including Hospital Benefits, Day-to-day, a wide-range of Chronic conditions, an extensive Supplementary Benefit and Wellness Screenings.
Complete cover at a lower cost
Get all the cover of the Traditional Plan 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.