Issue link: https://www.hub.camaf.co.za/i/1512931
2024 FIRST CHOICE 11 Am I covered for a Mammogram? Yes - this is covered under your preventive wellness benefit for all females from 25 years of age. What happens if the specialist refers me for tests e.g., pathology? Basic Pathology tests requested by the specialist are covered at 100% CBT but the costs are subject to the Pathology benefit of R8 460. Optical benefits This is a 24 month benefit cycle through PPN, the Network provider. Where can I find a Network optometrist? A detailed list of the PPN providers is available on the CAMAF website under the Products menu > Network Options. Who do I contact for any queries relating to my optical claim or benefits available? You can view your PPN claims and available benefits on the mobile app or webiste, Member Login under the Claims and Benefits menu. Alternatively, contact the PPN call centre on 0861 103 529 / 0861 101 477. Supplementary health What happens if I need a Physiotherapist, Occupational therapist or any other supplementary/auxiliary health practitioner? The benefit for this type of treatment is R3 300 per beneficiary per annum, paid at 80% CBT. External appliances External appliances are medical appliances that are used to assist with the recovery of an injury or condition e.g., crutches, splints and wheelchairs. These are covered at 100% of cost with a benefit of R8 093 per beneficiary per annum. The appliance must be obtained from a registered Orthotist, Prosthetist or Pharmacy in order to qualify for payment. Do I need to have my medical or surgical appliance prescribed by a medical practitioner or can I just purchase it? You may not just purchase the appliance - it must be prescribed by a medical practitioner, whether you purchase the appliance from a pharmacy, Orthotist or Prosthetist. For details of monetary limits consult the Benefit Brochure or the website www.camaf.co.za What happens to unused benefits at year end - other than MSA? Benefits run from January to December of each year. Any unused "risk" benefits are forfeited at year end and new benefits are allocated on 1st January each year. If I have not incurred any claims is there the possibility of a "No Claims Bonus" or any kind of refund? No - unlike the short term insurance industry, where this practice is common, medical schemes are governed by the Medical Schemes Act which does not allow this practice. As all medical schemes are "not for profit" organisations, all money in excess of the annual budget remains in the reserves of the scheme and is used for the benefits of members in paying claims. BACK TO CONTENTS PAGE