All quoted amounts are in Emalangeni
INPATIENT BENEFITS | COMPREHENSIVE | FLEXIBLE PLAN |
---|---|---|
Overall Annual Limit (OAL) | 2 500 000 per beneficiary per annum | 750 000 per beneficiary per annum |
Travelling Expenses | 1 200 per family per annum | 900 per annum |
Accommodation expenses | 500 per night, limited to 2 nights per family per annum |
375 per night, limited to 2 nights per family per annum |
Blood and blood products | 100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
Consultations and Visits – (General Practitioners, Specialist and Nurse Practitioners) |
100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
Maxillofacial Surgeon | 100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
Hospitalisation In-Patient (Accommodation – General ward, Theatre fees, medicines, Material and Equipment) |
100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
TTO's | 7 days | 7 days |
Alternative to Hospitalisation (Step Down nursing facilities, Private nursing, Frail care, Hospice and Physical Rehabilitation |
17 480 per family | 17 480 per family |
Mental Health (in and out of Hospital) | 15 170 per family | 9 290 per family |
Non-Surgical Procedures | 100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
Organ Transplant (for pathology and Radiology the separate benefit limits apply) |
186 000 per family | 152 000 per family |
Oncology Radiotherapy & Chemotherapy (including medicine, radiology, and pathology) |
278 000 per family | 207 000 per family |
Brachytherapy (within oncology limit above) |
44 600 per family | 44 600 per family |
Pathology & Medical Technology | 41 600 per family | 20 700 per family |
Physiotherapy and Biokinetics | 2 310 M0 4 560 M1 6 820 M2+ |
780 M0 1 520 M1 2 410 M2+ |
Pregnancy/Confinement | ||
Hospitalisation (Accommodation, theatre fees, Labour ward fees, drugs, dressings, medicines, and materials) Physio will only apply to post caesarean cases during hospital stay. Abnormal Vaginal delivery will be considered for physiotherapy on application & authorisation |
33 100 per family | 31 300 per family |
Global fee for delivery within Maternity limit above |
6 450 per family | 6 140 per family |
Prosthesis Internal External |
57 200 per family 37 000 per family |
26 800 per family No Benefit |
Renal Dialysis Acute & Chronic – pathology and Radiology the separate benefit limits apply |
101 000 per family | 69 000 per family |
Radiology & Radiography In Hospital (general & specialised – including CT scans, MRI Scans etc) |
24 500 per family | 16 200 per family |
PET Scan and PET-CT scan Bone densitometry within Radiology limit |
1 per family per annum | 1 per family per annum |
Surgical Procedures | 100% of ORHE tariff and Subject to Overall IP Limit |
100% of ORHE tariff and Subject to Overall IP Limit |
Emergency Room Benefit | 3 000 per beneficiary per Annum | 2 000 per beneficiary per Annum |
Ambulance Service (Emergency only) | 15 170 per family | 12 120 per family |
Appliances – Medical and Surgical | 12 230 per family | 5 000 per beneficiary per annum |
INPATIENT BENEFITS | COMPREHENSIVE | FLEXIBLE PLAN |
---|---|---|
Alcoholism and drug dependency | 1940 per family | Subject to available Savings |
Alternative health care Practitioners & Paramedical Services (audiology, biokinetics, chiropractors (including X-Rays), dieticians, Genetic Counselling, hearing aid acousticians, homeopathy, naturopathy (including medicines), occupational therapy, Orthoptic, physiotherapy, podiatry & speech therapy) |
5460 per family | Subject to available Savings |
Consultations – (General Practitioners, Specialist and Nurse Practitioners) |
6 350 M0 7 240 M1 8 450 M2+ |
Subject to available Savings |
Advanced Dentistry/Oral Surgery (Inlays, crowns, Bridges, Study models, Metal base, Oral medicines by: Orthodontists, Periodontists, Prosthodontists, and dental technicians) |
5 250 M0 8 970 M1 12 440 M2+ 5 250 per beneficiary |
Subject to available Savings |
Basic/ Ordinary & Restorative (Including Plastic Dentures, Dental Technicians & Dental Therapist) Joint limit with Advanced Dentistry |
2 150 M0 3 930 M1 5 560 M2+ 2 150 per beneficiary |
Subject to available Savings |
Osseo integrated Implants (Including hospitalisation, Dental practitioner, Anaesthetist) Joint limit with Advanced Dentistry |
subject to clinical protocols | No benefit |
Immune Deficiency (related to HIV/AIDS) | subject to clinical protocols | subject to clinical protocols |
Chronic Medication Only cover for: asthma, allergic rhinitis, epilepsy, GORD, Hypertension, Diabetes (Type 1 &2), hyperlipidaemia Subject to registration |
3 510 M0 6 510 M1 8 870 M2+ |
1 150 M0 2 360 M1 2 940 M2+ |
Acute Medication | 4 620 M0 9 030 M1 12 750 M2+ |
Subject to available Savings |
Pharmacy Advised Therapy (OTC) Within acute medicine limit Schedule 0,1,2 only |
1 150 M0 2 150 M1 3090 M2+ 220 per script |
Subject to available Savings 220 per script |
Contraceptives Within acute medication limit |
100 per script | Subject to available Savings 100 per script |
Optometry Frames, Lenses, Readers One in 24 months claiming period |
3 880 M0 5 580 M1 6 400 M2+ 3 880 per beneficiary |
Subject to available Savings |
Eye Examination | One per Beneficiary per year | Subject to available Savings |
Refractive Surgery (Radial Keratotomy/Excimer Laser) |
2 940 per family | No Benefit |
Pathology & Medical Technology | 6 140 per family | Subject to available Savings |
Pregnancy/Confinement Services (Consultants, Visits & Scans) Ante-natal consults are from the consultation benefit and scans are from the radiology benefit and scans are limited to two |
4 x post-natal midwife consultation per pregnancy |
4 x post-natal midwife consultation per pregnancy Subject to available Savings |
Radiology & Radiography Out of Hospital Within In-Hospital Radiology |
3 990 per family | Subject to available Savings |
All quoted amounts are in Emalangeni
SPECIAL BENEFITS | COMPREHENSIVE | FLEXIBLE PLAN |
---|---|---|
Wellness Program | Limited to 1 GP consultation per beneficiary per annum. 1 GP consultation per beneficiary per annum covering: GP consultation fee Health Assessment (Blood pressure, Cholesterol, Blood glucose, BMI) Pap smear for female beneficiaries Prostate test for male beneficiaries Bone Density Screen Mammogram for female beneficiaries Flu vaccine Pneumococcal vaccine |
COMPREHENSIVE | FLEXIBLE PLAN | |||||
---|---|---|---|---|---|---|
1-20 members | 21- 499 members |
1-20 members | 21- 499 members |
Additional Contributions for Savings for Flexible Plan |
||
M0 | 2 800 | 2 661 | 1 048 | 996 | Level 0 | 0 |
M1 | 3 943 | 3 747 | 1 475 | 1 401 | Level 1 | 236 |
M2 | 4 403 | 4 182 | 1 646 | 1 564 | Level 2 | 354 |
M3 | 4 628 | 4 398 | 1 731 | 1 644 | Level 3 | 472 |
M4 | 4 736 | 4 501 | 1 771 | 1 683 | Level 4 | 941 |
M5 | 5 043 | 4 791 | 1 886 | 1 792 | Level 5 | 1410 |
Parent | 1 432 | 1 360 | 1 048 | 996 |
COMPREHENSIVE | FLEXIBLE PLAN | |||
---|---|---|---|---|
Private Members |
<60 years | >=60 years | <60 years | >=60 years |
Principal Member |
2 862 | 8 584 | 1 139 | |
Adult Dependant |
1 432 | 4 293 | 570 | 1 708 |
Child Dependant |
717 | 2 147 | 285 | 855 |
Parent | 3 577 | 4 293 | 1 424 | 1 708 |
This Plan is subject to underwriting as per the Scheme Rules. Underwriting will be done at application stage. NPL: Medscheme Eswatini Price List NHRPL (SA): National Health Reference Price List (inside South Africa) SAOA: South African Optometrists Association
JOIN US TODAY
- Download the application form below.
- Complete both sides of this application form to avoid a delay in registration.
- Send the comleted form to the following email: membership@medscheme-eswatini.com/medscheme