This is a plan designed to cater for middle level employees offering affordable medical aid benefits with private hospital access up to Grade A Hospitals.
Where usage is considered excessive the Society reserves the right to restrict usage or recommend cost effective treatment options.
The following benefits are paid at to tariff.
- Access to Private healthcare facilities.
- In-hospital drugs.
- General practitioners.
- Specialist Treatment is covered upon referral by a primary care service provider.
- Pathology and Radiology Services at Private and Government facilities.
- Blood Transfusion Services (BTS).
- Prescription drugs paid at the Cimas tariff up to an annual family limit.
- Optical benefit up to package sublimit once every two (2) year period.
- Maternity cover includes consultation, delivery as well as ante and post natal visits.
- Awards are paid at 100% up to sub limit.
- There are also 2 antenatal scans allowed per pregnancy.
This caters for general and preventive dentistry including inlays, root-treatment, fillings, crowns and bridges, implants and orthodontic work.
- Claims are paid at Healthguard tariff up to sub limit.
- Prior authorization is required for crowns, bridges, dentures and orthodontic treatment.
Emergency Evacuation Services
Covered for life threatening situations only
- Road Ambulance service is paid to tariff.
- Air evacuation is paid to tariff.
The following benefit waiting periods apply to those joining the Society for the first time or where there has been a lapse in the membership. The Society reserves the right to waive waiting periods for members transferring from AHFoZ affiliated medical aid societies. These waiting periods include:
Four months for:-
- A mandatory four (4) months waiting period will apply to all new members
Six months for:
- Specialist treatment
- MRI, CT scans and Nuclear medicine
- Admission or treatment at a hospital
- Dental treatment
Nine months for:
One (1) year for:
- Spectacles/Contact lenses
- Foreign treatment
Two (2) years for:
- All internal and external prosthetic devices
- Oncology benefit
- Pre-existing conditions
Four (4) years for:
- Orthodontic Treatment
- For orthodontic work, members seek prior-authorisation from the Society before accessing treatment.
- The age limit for the benefit is 18 years
- To access treatment for chronic conditions members need to register with the Society’s Managed Care department. The Society does not guarantee full cover where a member/service provider does not seek pre-authorisation before accessing services.