• MEDICAL EXPENSE SHORTFALL COVER

Increases the Medical Aid rate up to 500% (e.g. Specialists, GPs, Anaesthetists, Radiology, Pathology, Consumables, etc.). Subject to the Overall Annual Limit.

• CO-PAYMENT COVERS

Subject to the Overall Annual Limit.

• NON-DSP HOSPITAL PENALTY COVER

R12 500 per admission. Limited to 1 claim per family per annum. Subject to the Overall Annual Limit.

• SUB-LIMIT COVER

R31 000 per admission per insured. Limited to R70 000 per family per annum. Subject to the Overall Annual Limit.

• CO-PAYMENTS FOR MRI, CT AND PET SCANS

Subject to the Overall Annual Limit

• CO-PAYMENTS FOR SCOPES

R5 000 per event. Limited to 2 claims per insured per annum. Subject to the Overall Annual Limit

• SUB-LIMIT COVER FOR MRI, CT AND PET SCANS

R31 000 per event per insured. Limited to R70 000 per family per annum. Subject to the Overall Annual Limit.

• CASUALTY BENEFIT FOR ACCIDENTS

R11 000 per event per insured. Subject to the Overall Annual Limit

• CASUALTY BENEFIT FOR ILLNESS

R4 000 per event. Limited to 2 claims per family per annum. Subject to the Overall Annual Limit. Treatment is restricted to between the hours of 6pm – 6am Mondays – Fridays, Saturdays, Sundays and Public Holidays.

• MEDICAL EXPENSE SHORTFALL COVER

Increases the medical aid rate up to 500% for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the Overall Annual Limit.

• SUB-LIMIT COVER

R22 000 per admission and R50 000 per family per annum for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the Overall Annual Limit.

• CO-PAYMENT COVER

Subject to the Overall Annual Limit

• SUB-LIMIT AND CO-PAYMENT COVER FOR DENTAL IMPLANTS

Covers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Limited to R22 000 per admission and R50 000 per family per annum. Subject to the Overall Annual Limit.

• BASIC DENTAL MEDICAL EXPENSE SHORTFALL COVER FOR CHILDREN

Increases the Medical Aid rate up to 500% for basic dentistry for children up to and including 12 years old. Limited to R3 500 per family per annum. Subject to the Overall Annual Limit.

• TRADITIONAL CANCER COVER

Co-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the Overall Annual Limit.

• BIOLOGICAL CANCER DRUG COVER

Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to the formulary (see pg 15) and the Overall Annual Limit.

• INNOVATIVE CANCER DRUG COVER

Provides cover for new innovative cancer drugs. Limited to R11 000 per claim. Subject to the Overall Annual Limit.

• MRI AND CT SCAN COVER

Covers the cost of MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R6 000 per event and 2 claims per family per annum. Subject to the Overall Annual Limit.

• INVESTIGATIVE TREATMENT

Scopes for Screening purposes will be limited to 1 every 5 years, per insured person and R6 000. Subject to the Overall Annual Limit.

• TRAUMA CARE COVER

Covers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, has been a victim of a violent crime or experienced the death of an immediate family member. Limited to R2 500 per consultation and R7 000 per family per annum. Subject to the Overall Annual Limit.

• BREAST CANCER PREVENTION COVER

Increases the Medical Aid rate up to 500% for a Prophylactic Mastectomy. Subject to clinical entry criteria and the Overall Annual Limit.

• BREAST CANCER RECONSTRUCTION COVER

Increases the Medical Aid rate up to 500% for a breast reconstruction post mastectomy due to cancer for the affected breast. Reconstruction of the unaffected breast for the purposes of symmetry, when there is no benefit on the Insured person’s Medical Scheme is limited to R20 000 per insured person, per lifetime. Subject to the Overall Annual Limit.

• MEDICAL SCHEME CONTRIBUTION WAIVER

Up to R6 600 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the Medical Scheme Contribution Payer.

• GAP PREMIUM WAIVER

Pays the premium of your Optimal Policy for 12 months in the event of death or permanent and total disability as a result of an accident of the Contribution Payer.

• PERSONAL ACCIDENT BENEFIT

R18 000 per insured on the Policy in the event of accidental death or permanent and total disability.

• CRITICAL ILLNESS BENEFIT

R8 500 per insured on the Policy in the event of death due to a critical illness (excludes cancer)

• INTERNATIONAL TRAVEL COVER

R5 million per insured (notification of travel required 48 hrs prior to departure)