Issue link: https://www.hub.camaf.co.za/i/1512931
2024 FIRST CHOICE 10 OUT OF HOSPITAL Benefit and Extent of Cover Choice Total freedom of choice of service providers Preventative Wellness Cover Preventative programme accessible to all beneficiaries. One consultation per beneficiary per annum with a GP, specified specialists, dentist - for a general checkup only and optometrist for an eye test, once per 24 month period - paid at 80% CBT rate. Additionally, screening benefits (PSA, pap smear, mammogram) and certain vaccines are covered under this benefit. Other Benefits Not subject to an annual overall benefit limit - paid at CBT* rate. Generous external appliance benefits with specific sub-limits. Day-to-day Benefits Day-to-day benefits limited to an overall collective limit - paid at 80% CBT rate. *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. Day-to-day cover Do I have any benefit for immunisations under this option? Yes. Immunisations are covered at 100% of the SEP plus a dispensing fee, subject to MMAP and the benefit of R2 213 per beneficiary per annum. The Human Papilloma Virus (HPV) vaccine (cost of vaccine only) for female beneficiaries aged between 9 and 45 and male beneficiaries between 9 and 26 years of age is also paid from the above limit. Dentistry What is Basic Dentistry? The term Basic Dentistry means conservative and preventive dentistry, including consultations and examinations (general and specific), preventive treatment, cleaning and fluoride treatments, pain and sepsis treatment, infection control, permanent fillings and extractions, emergency treatment and basic x rays. Do I have an Advanced Dentistry benefit? The Advanced Dentistry benefit is R8 220 per beneficiary per annum, payable at 50% CBT; this includes Orthodontics. Specialists How much cover do I have for specialists consultations? These consultations are covered at 80% of CBT and the benefit is R12 070 per family per annum. Radiology and Pathology What is the difference between basic and advanced radiology? BASIC RADIOLOGY - black and white x-rays and soft tissue ultrasound. The out of hospital benefit is limited to R5 500 per beneficiary. ADVANCED RADIOLOGY - CT, MRI and PET Scans. The benefit for such radiology is R45 320 per family in or out of hospital. Such claims require authorisation and are paid at 100% CBT. Contact 0860 100 544 for authorisation. You are entitled to have 3 ante-natal scans (out of hospital) per pregnancy per annum and these scans are paid at 80% CBT and are subject to the advanced Radiology benefit of R45 320 (limit per family combined for in and out of hospital). 10 BACK TO CONTENTS PAGE