Benefit changes for 2018

1. Most benefit limits for 2018 will increase to accommodate yearly inflation and cost increases.

2. When you use casualty services, the Scheme must give authorisation to the hospital. If the treatment is authorised, you will have to pay the first R325 and the Scheme will pay the remaining portion of the claim. If authorisation is not given, the Scheme will not pay the claim.

   This does not apply when it is a medical emergency.

3. We are introducing home-based care services for wound care, end-of-life care, IV Infusions and postnatal care that will be paid for by the Scheme from your Risk Benefits. You must use the Scheme’s Designated Service Provider and get authorisation for these services.

4. When basic screening tests indicate the possibility of diabetes or high cholesterol, advanced testing must be done. The Scheme will pay for Hb1AC and LDL tests under the Screening benefit, subject to clinical criteria.