Issue link: https://www.hub.camaf.co.za/i/1512927
2024 ALLIANCE PLUS & ALLIANCE NETWORK 10 2024 ALLIANCE PLUS & ALLIANCE NETWORK As a minimum requirement, all CAMAF members have, included in their benefits, all PMBs as well as other benefits - see below: PMBs Prescribed Minimum Benefits (PMB) as set down in the Medical Schemes Act, 1998. Medical schemes have to cover the costs related to the diagnosis, treatment and care of: • Any emergency condition. • A limited set of 271 medical conditions, as defined in the Diagnosis and Treatment Pairs (DTP*). • 27 chronic conditions, defined in the Chronic Disease List (CDL). DTP *DTP - the protocols for the treatment and care of PMB conditions should be based on healthcare that has proven to work best, taking affordability into consideration. The minimum standard is the practice and protocol applied in the public sector; however, schemes have the option of providing more extensive care. Such costs may not be paid from a member's savings benefit. Cost saving measures can be used by way of utilising DSPs (Designated Service Providers), Reference pricing and formularies and "evidence based" treatment protocols. Benefits In Hospital Benefit and Extent of Cover Hospital Unlimited, hospital benefits - paid at 100% negotiated rate for general and specialised wards - subject to pre-authorisation. Services in Hospital Service providers paid up to 300% of CBT* in a general ward unless a more specialised ward is medically indicated. Choice Freedom of choice for Alliance Plus; only Life Healthcare and Netcare hospital groups for Alliance Network (20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies). Childbirth Confinements Private ward - subject to availability Co-payments No scheme imposed co-payments on surgery or procedures. 20% co-payment applies for utilisation of non-DSP hospitals for non-emergencies. Infertility Treatment Generous Infertility treatment benefit of R106 811 per family Radiology and Pathology Unlimited Radiology (including MRI and CT scans) and Pathology - in or out of hospital. Emergency Evacuation Unlimited emergency evacuation – Netcare 911 Additional Chronic Conditions 38 *CBT (CAMAF Base tariff) - the maximum tariff paid to providers of health care services. For full details consult the Rules - Schedule 1. For details of monetary limits consult the Benefit Brochure. BACK TO CONTENTS PAGE